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Association of Economic Policies With Hypertension Management and Control: A Systematic Review

Zhang, Donglan; Lee, Jun Soo; Pollack, Lisa M; Dong, Xiaobei; Taliano, Joanna M; Rajan, Anand; Therrien, Nicole L; Jackson, Sandra L; Popoola, Adebola; Luo, Feijun
IMPORTANCE/UNASSIGNED:Economic policies have the potential to impact management and control of hypertension. OBJECTIVES/UNASSIGNED:To review the evidence on the association between economic policies and hypertension management and control among adults with hypertension in the US. EVIDENCE REVIEW/UNASSIGNED:A search was carried out of PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, CINAHL, EconLit, Sociological Abstracts, and Scopus from January 1, 2000, through November 1, 2023. Included were randomized clinical trials, difference-in-differences, and interrupted time series studies that evaluated the association of economic policies with hypertension management. Economic policies were grouped into 3 categories: insurance coverage expansion such as Medicaid expansion, cost sharing in health care such as increased drug copayments, and financial incentives for quality such as pay-for-performance. Antihypertensive treatment was measured as taking antihypertensive medications or medication adherence among those who have a hypertension diagnosis; and hypertension control, measured as blood pressure (BP) lower than  140/90 mm Hg or a reduction in BP. Evidence was extracted and synthesized through dual review of titles, abstracts, full-text articles, study quality, and policy effects. FINDINGS/UNASSIGNED:In total, 31 articles were included. None of the studies examined economic policies outside of the health care system. Of these, 16 (52%) assessed policies for insurance coverage expansion, 8 (26%) evaluated policies related to patient cost sharing for prescription drugs, and 7 (22%) evaluated financial incentive programs for improving health care quality. Of the 16 studies that evaluated coverage expansion policies, all but 1 found that policies such as Medicare Part D and Medicaid expansion were associated with significant improvement in antihypertensive treatment and BP control. Among the 8 studies that examined patient cost sharing, 4 found that measures such as prior authorization and increased copayments were associated with decreased adherence to antihypertensive medication. Finally, all 7 studies evaluating financial incentives aimed at improving quality found that they were associated with improved antihypertensive treatment and BP control. Overall, most studies had a moderate or low risk of bias in their policy evaluation. CONCLUSIONS AND RELEVANCE/UNASSIGNED:The findings of this systematic review suggest that economic policies aimed at expanding insurance coverage or improving health care quality successfully improved medication use and BP control among US adults with hypertension. Future research is needed to investigate the potential effects of non-health care economic policies on hypertension control.
PMCID:10858400
PMID: 38334993
ISSN: 2689-0186
CID: 5631992

Trends and disparities in prevalence of cardiometabolic diseases by food security status in the United States

Liu, Junxiu; Yi, Stella S; Russo, Rienna G; Horowitz, Carol R; Zhang, Donglan; Rajbhandari-Thapa, Janani; Su, Dejun; Shi, Lu; Li, Yan
BACKGROUND:Previous studies have demonstrated the association between food security and cardiometabolic diseases (CMDs), yet none have investigated trends in prevalence of CMDs by food security status in the United States (US). METHODS:Serial cross-sectional analysis of the US nationally representative data from National Health and Nutrition Examination Survey (1999-2018) was conducted among adults aged 20 years or older. Food security status was defined by the US Household Food Security Survey Module (full, marginal, low, and very low food security). We estimated the age-adjusted prevalence of CMDs including obesity, hypertension, diabetes, and coronary heart disease by food security status. Racial and ethnic disparities in age-adjusted prevalence of CMDs by food security status were also assessed. RESULTS:A total of 49,738 participants were included in this analysis (weighted mean age 47.3 years; 51.3% women). From 1999 to 2018, the age-adjusted prevalence of CMDs was lower in full food secure group as compared with other groups. For example, trends in hypertension decreased from 49.7% (47.5-51.8%) to 45.9% (43.8-48.0%) (P-trend = 0.002) among the full and from 54.2% (49.9-58.5%) to 49.7% (46.8-52.6%) (P-trend = 0.02) among the marginal but remained stable among the low at 49.7% (47.9-51.6%) and among the very low at 51.1% (48.9-53.3%) (P-interaction = 0.02). Prevalence of diabetes increased from 8.85% (8.15-9.60%) to 12.2% (11.1-13.5%) among the full (P-trend < 0.001), from 16.5% (13.2-20.4%) to 20.9% (18.6-23.5%) (P-trend = 0.045) among the marginal and from 14.6% (11.1-19.0%) to 20.9% (18.8-23.3%) (P-trend = 0.001) among the low but remained stable at 18.8% (17.0-20.9) among the very low (P-trend = 0.35) (P-interaction = 0.03). Racial and ethnic differences in prevalence of CMD by food security status were observed. For example, among individuals with full food secure status, the prevalence of diabetes was 9.08% (95% CI, 8.60-9.59%) for non-Hispanic whites, 17.3% (95% CI, 16.4-18.2%) for non-Hispanic blacks, 16.1% (95% CI, 15.0-17.4%) for Hispanics and 14.9% (95% CI, 13.3-16.7%) for others. CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Prevalence of CMDs was greatest among those experiencing food insecurity, and food insecurity disproportionately affected racial/ethnic minorities. Disparities in CMD prevalence by food security status persisted or worsened, especially among racial/ethnic minorities.
PMCID:10763098
PMID: 38172928
ISSN: 1475-2891
CID: 5626082

Mind Your Heart: A Mindful Eating and Diet Education eHealth Program

Reina, Anita M; Beer, Jenay M; Renzi-Hammond, Lisa M; Zhang, Donglan; Padilla, Heather M
OBJECTIVE:Examine user perceptions of the Mind Your Heart (MYH) program, a mindful eating and nutrition education program delivered via an eHealth system. METHODS:Sixteen participants (41.5 ± 13.1 years) completed sample MYH lessons over 3 weeks. We examined changes in mindfulness from the State Mindfulness Scale via text messages sent 3 times per week. We assessed MYH user perceptions in a semistructured interview after 3 weeks. Analyses included Spearman's correlation, repeated measures ANOVA, and thematic analysis. RESULTS:State Mindfulness Scale scores were significantly improved (F[1,15] = 5.35, P = 0.01) from week 1 (M = 2.28 ± 0.80) to week 3 (M = 2.75 ± 1.04). Four themes emerged: (1) MYH is supportive of health goals, (2) text messages act as an intervention, (3) facilitators or inhibitors of use, and (4) enhancing engagement. CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Based on participant feedback, the final version of MYH should include example-based learning to translate abstract concepts like mindful eating into action.
PMID: 38185491
ISSN: 1878-2620
CID: 5628532

Racial and ethnic disparities in the usage and outcomes of ischemic stroke treatment in the United States

Metcalf, Delaney; Zhang, Donglan
OBJECTIVES/OBJECTIVE:This study explores racial and ethnic differences in 1) receiving tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) as treatment for ischemic stroke and 2) outcomes and quality of care after use of tPA or EVT in the US. MATERIALS AND METHODS/METHODS:An observational analysis of 89,035 ischemic stroke patients from the 2019 National Inpatient Sample was conducted. We performed weighted logistic regressions between race and ethnicity and 1) tPA and EVT utilization and 2) in-hospital mortality. We also performed a weighted Poisson regression between race and ethnicity and length of stay (LOS) after tPA or EVT. RESULTS:Non-Hispanic (NH) Black patients had significantly lower odds of receiving tPA (Adjusted odds ratio [AOR] = 0.85, 95 % Confidence Internal [C.I.]: 0.80-0.91) and EVT (AOR = 0.75, 95 % CI: 0.70-0.82) than NH White patients. Minority populations (including but not limited to NH Black, Hispanic, Pacific Islander, Native American, and Asian) had significantly longer hospital LOS after treatment with tPA or EVT. We did not find a significant difference between race/ethnicity and in-hospital mortality post-tPA or EVT. CONCLUSIONS:While we failed to find a difference in in-hospital mortality, racial and ethnic disparities are still evident in the decreased usage of tPA and EVT and longer LOSs for racial and ethnic minority patients. This study calls for interventions to expand the utilization of tPA and EVT and advance quality of care post-tPA or EVT in order to improve stroke care for minority patients.
PMID: 37797411
ISSN: 1532-8511
CID: 5607912

The Health and Economic Impact of Expanding Home Blood Pressure Monitoring

Li, Yan; Zhang, Donglan; Li, Weixin; Chen, Zhuo; Thapa, Janani; Mu, Lan; Zhu, Haidong; Dong, Yanbin; Li, Lihua; Pagán, José A
INTRODUCTION/BACKGROUND:Home blood pressure monitoring is more convenient and effective than clinic-based monitoring in diagnosing and managing hypertension. Despite its effectiveness, there is limited evidence of the economic impact of home blood pressure monitoring. This study aims to fill this research gap by assessing the health and economic impact of adopting home blood pressure monitoring among adults with hypertension in the U.S. METHODS:A previously developed microsimulation model of cardiovascular disease was used to estimate the long-term impact of adopting home blood pressure monitoring versus usual care on myocardial infarction, stroke, and healthcare costs. Data from the 2019 Behavioral Risk Factor Surveillance System and the published literature were used to estimate model parameters. The averted cases of myocardial infarction and stroke and healthcare cost savings were estimated among the U.S. adult population with hypertension and in subpopulations defined by sex, race, ethnicity, and rural/urban area. The simulation analyses were conducted between February and August 2022. RESULTS:Compared with usual care, adopting home blood pressure monitoring was estimated to reduce myocardial infarction cases by 4.9% and stroke cases by 3.8% as well as saving an average of $7,794 in healthcare costs per person over 20 years. Non-Hispanic Blacks, women, and rural residents had more averted cardiovascular events and greater cost savings related to adopting home blood pressure monitoring compared with non-Hispanic Whites, men, and urban residents. CONCLUSIONS:Home blood pressure monitoring could substantially reduce the burden of cardiovascular disease and save healthcare costs in the long term, and the benefits could be more pronounced in racial and ethnic minority groups and those living in rural areas. These findings have important implications in expanding home blood pressure monitoring for improving population health and reducing health disparities.
PMID: 37187442
ISSN: 1873-2607
CID: 5544162

Trust in COVID-19 Information from Different Media Types and Its Association with Preventive Measures Adoption in the U.S

Li, Hongmei; Chen, Baojiang; Chen, Zhuo; Chen, Liwei; Zhang, Donglan; Wen, Ming; Li, Jian; Li, Yan; Han, Xusong; Su, Dejun
This study compares and contrasts how key factors influence Americans' trust in different types of media (broadcast, print, and social) as COVID-19 information sources and how people's media trust is associated with their adoption of preventive measures. Our results from a national survey (sample = 2571) showed that age, political party affiliation, and race and ethnicity and income level were significantly associated with people's trust in different media types as COVID information sources. Elder adults trusted print and broadcast media more, while younger adults trusted social media more. Democrats and Lean Democrats had more trust in all three forms of media than Republicans and Lean Republicans. Asians had the highest levels of trust in all three media types, while Whites had the lowest level of trust in broadcast and social media. Trust in broadcast media was found to be associated with facial mask wearing, but trust in social media, however, did not contribute to the adoption of any COVID-19 preventive measures. This study contributes to a general understanding of media trust and mediated health communication and provides nuanced understanding of how demographic factors shape media trust and the consequence of media trust during a historical pandemic.
PMID: 37665096
ISSN: 1087-0415
CID: 5605162

Cost-effectiveness of physical activity interventions for prevention and management of cognitive decline and dementia-a systematic review

Li, Weixin; Kim, Kun-Woo Rafael; Zhang, Donglan; Liu, Bian; Dengler-Crish, Christine M; Wen, Ming; Shi, Lu; Pan, Xi; Gu, Yian; Li, Yan
BACKGROUND:Although increasing physical activity (PA) has been suggested to prevent and manage cognitive decline and dementia, its economic impact on healthcare systems and society is largely unknown. This study aimed to summarize evidence on the cost-effectiveness of PA interventions to prevent and manage cognitive decline and dementia. METHODS:Electronic databases, including PubMed/MEDLINE, Embase, and ScienceDirect, were searched from January 2000 to July 2023. The search strategy was driven by a combination of subject-heading terms related to physical activity, cognitive function, dementia, and cost-effectiveness. Selected studies were included in narrative synthesis, and extracted data were presented in narrative and tabular forms. The risk of bias in each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list. RESULTS:Five of the 11 identified studies focused on individuals with existing dementia. Six of the 11 identified studies focused on individuals with no existing dementia, including 3 on those with mild cognitive impairment (MCI), and 3 on those with no existing MCI or dementia. PA interventions focused on individuals with no existing dementia were found to be cost-effective compared to the control group. Findings were mixed for PA interventions implemented in individuals with existing dementia. CONCLUSIONS:PA interventions implemented before or during the early stage of cognitive impairment may be cost-effective in reducing the burden of dementia. More research is needed to investigate the cost-effectiveness of PA interventions in managing dementia. Most existing studies used short-term outcomes in evaluating the cost-effectiveness of PA interventions in the prevention and management of dementia; future research should consider adding long-term outcomes to strengthen the study design.
PMCID:10519096
PMID: 37749587
ISSN: 1758-9193
CID: 5611512

Medical Expenditures Associated with Attention-Deficit/Hyperactivity Disorder Among Adults in the United States by Age, 2015-2019

Witrick, Brian; Zhang, Donglan; Su, Dejun; Li, Yan; McCall, William V; Hendricks, Brian; Shi, Lu
BACKGROUND:Attention-deficit hyperactivity disorder is a common disorder that affects both children and adults. However, for adults, little is known about ADHD-attributable medical expenditures. OBJECTIVE:To estimate the medical expenditures associated with ADHD, stratified by age, in the US adult population. DESIGN/METHODS:Using a two-part model, we analyzed data from Medical Expenditure Panel Survey for 2015 to 2019. The first part of the model predicts the probability that individuals incurred any medical costs during the calendar year using a logit model. The second part of the model estimates the medical expenditures for individuals who incurred any medical expenses in the calendar year using a generalized linear model. Covariates included age, sex, race/ethnicity, geographic region, Charlson comorbidity index, insurance, asthma, anxiety, and mood disorders. PARTICIPANTS/METHODS:Adults (18 +) who participated in the Medical Expenditure Panel Survey from 2015 to 2019 (N = 83,776). MAIN MEASURES/METHODS:Overall and service specific direct ADHD-attributable medical expenditures. KEY RESULTS/RESULTS:A total of 1206 participants (1.44%) were classified as having ADHD. The estimated incremental costs of ADHD in adults were $2591.06 per person, amounting to $8.29 billion nationally. Significant adjusted incremental costs were prescription medication ($1347.06; 95% CI: $990.69-$1625.93), which accounted for the largest portion of total costs, and office-based visits ($724.86; 95% CI: $177.75-$1528.62). The adjusted incremental costs for outpatient visits, inpatient visits, emergency room visits, and home health visits were not significantly different. Among older adults (31 +), the incremental cost of ADHD was $2623.48, while in young adults (18-30), the incremental cost was $1856.66. CONCLUSIONS:The average medical expenditures for adults with ADHD in the US were substantially higher than those without ADHD and the incremental costs were higher in older adults (31 +) than younger adults (18-30). Future research is needed to understand the increasing trend in ADHD attributable cost.
PMID: 36781580
ISSN: 1525-1497
CID: 5427062

Meditation and Cognitive Outcomes: A Longitudinal Analysis Using Data From the Health and Retirement Study 2000-2016

Lopes, Snehal; Shi, Lu; Pan, Xi; Gu, Yian; Dengler-Crish, Christine; Li, Yan; Tiwari, Biplav; Zhang, Donglan
OBJECTIVE/UNASSIGNED:We aimed to assess the association between meditation practice and cognitive function over time among middle-aged and older adults. METHOD/UNASSIGNED:= 1,160) and were followed up for outcomes over 2000-2016 period. We examined the association between meditation ≥ twice a week vs none/less frequent practice and changes in the outcomes of recall, global cognitive function, and quantitative reasoning using generalized linear regression models. Stratified analyses among persons with/without self-reported baseline depressive symptoms were conducted to assess the link between meditation and cognitive outcomes. RESULTS/UNASSIGNED: CONCLUSIONS/UNASSIGNED:Frequent meditation practice might have a protective effect on cognitive outcomes over time, but this protection could be limited to those without self-reported baseline depressive symptoms. Future studies could incorporate more precise meditation practice assessment, investigate the effect of meditation on cognitive outcomes over time, and include more rigorous study designs with randomized group assignment. PRE-REGISTRATION/UNASSIGNED:This study is not preregistered.
PMCID:10557979
PMID: 37808263
ISSN: 1868-8527
CID: 5605372

Racial Discrimination and Sleep Quality during the COVID-19 Pandemic: Findings from the Health, Ethnicity, and Pandemic (HEAP) Study

Niu, Li; Zhang, Donglan; Shi, Lu; Han, Xuesong; Chen, Zhuo; Chen, Liwei; Wen, Ming; Li, Hongmei; Chen, Baojiang; Li, Jian; Su, Dejun; Li, Yan
Previous research has documented the association between racial discrimination and poor sleep quality. However, few studies have examined this association during the COVID-19 pandemic when racial discrimination is on the rise due to structural injustice and racism against people of color. Using data from the Health, Ethnicity, and Pandemic (HEAP) Study, a nationally representative survey of US adults, we assessed the association between racial discrimination and sleep quality among overall adults and by race and ethnicity. We found that racial discrimination during the pandemic was significantly associated with higher risks of poor sleep quality among non-Hispanic Black (OR = 2.19, 95% CI: 1.13-4.25) and Asian (OR = 2.75, 95% CI: 1.53-4.94) participants, but not among the other groups. The results suggested that sleep quality among Black and Asian populations may have been disproportionately affected by racial discrimination during the pandemic. Further study is needed to assess the causal relationship between racial discrimination and sleep quality.
PMCID:10323061
PMID: 37382863
ISSN: 1468-2869
CID: 5536802