2 Minute Medicine Rewind November 27, 2023

Rapid Access Addiction Medicine Clinics for People With Problematic Opioid Use

1. Among individuals with opioid use disorder, receiving care at a rapid access addictions clinic was associated with reduced risk of emergency department visits, hospitalizations, and overall mortality. 

Evidence Rating Level: 2 (Good)

Individuals suffering from opioid use disorder (OUD) often present to emergency departments for care, largely related to barriers to accessing pharmacotherapy for OUD in other settings. Easy to access, rapid care models for the treatment of OUD are needed to address this issue. In this retrospective cohort study, data from four rapid access addiction medicine (RAAM) clinics in Ontario, Canada were used to examine the association between receiving care at a RAAM clinic and emergency department visits, hospitalizations, and mortality among those with OUD. 440 individuals with OUD who received care at a RAAM clinic were compared to 436 geographically matched control subjects with OUD who did not receive care at a RAAM clinic. Visits occurred over a two-year period, between October 2017 and October 2019. Researchers assessed the combined odds ratio for the 30-day composite outcome of all ED visits, hospitalizations, and mortality. Attending RAAM clinics was associated with a significantly reduced risk of these combined outcomes (OR, 0.68; 95% CI, 0.50-0.92). A limitation of this study is that individuals who received care from RAAM clinics may be more help-seeking and interested in harm reduction, which is an important confounding variable. Overall, this is the first multicentre study to show the measurable benefits of RAAM clinics in Canada. Future research may aim to replicate this finding among a larger cohort and with a prospective study design. 

Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older

1. In this cohort study, food insecurity was associated with dementia and poor memory function among older adults in the United States. 

Evidence Rating Level: 2 (Good)

Food insecurity is a common problem among older adults in the United States. No prior quantitative research has addressed whether food insecurity is related to dementia. In this cohort study, 7012 adults in the US aged 50 and older were determined to be in one of three groups: food-secure, low food secure, or very low food secure, based on the US Department of Agriculture 6-item Household Food Security Module. The mean (SD) age was 67.7 (10.0) years. The main outcome assessed was the probability of developing dementia. Researchers adjusted for preexposure cognition, childhood and adulthood socioeconomic status, and preexposure body mass index. Compared to those with food security, low food security was associated with a higher risk of dementia (OR, 1.28; 95% CI, 1.15-1.67). Similarly, experiencing very low food security was associated with greater dementia risk (odds ratio, 1.37; 95% CI, 1.11-1.59). Studies like these are very valuable for identifying modifiable risk factors that can reduce the risk of developing dementia. This research may be useful in future policy work to address food insecurity among older adults in the United States. A limitation of this study is that there are likely many confounding variables that were not adjusted for, which could impact the findings. Overall, this study demonstrates food insecurity is associated with dementia and poor memory function among older adults in the United States. 

Body mass index and cancer risk among adults with and without cardiometabolic diseases: evidence from the EPIC and UK Biobank prospective cohort studies

1. In this prospective cohort study, there was an increased risk of developing cancer associated with the combined effect of obesity and cardiovascular disease, which was greater than the sum of the independent associations of these two variables.

Evidence Rating Level: 1 (Excellent)

Both overweight and obesity are known to increase the risk of developing cardiometabolic diseases, such as type 2 diabetes and cardiovascular disease, as well as several types of cancer. Researchers aimed to assess the association between BMI and obesity-related cancers, as well as the interaction between BMI and cardiometabolic diseases and associated cancer risk. Using a large prospective cohort study design, data were collected from the UK Biobank (UKB) and the European Prospective Investigation into Cancer and Nutrition (EPIC). 577,343 individuals were included in the study. All participants were cancer-free and without cardiometabolic disease at the beginning of the study period. BMI was found to be positively associated with the risk of developing obesity-related cancers among participants with no cardiometabolic diseases (HR, 1.11; 95% CI 1.07-1.16), participants with type 2 diabetes, (HR: 1.11, 95% CI: 1.05-1.18), and participants with CVD (HR, 1.17; 95% CI, 1.11-1.24). An additive interaction was found between obesity and CVD and the risk of cancer, with a meta-analytical RERI of 0.28 (95% CI 0.09–0.47). There was no clear association between having both cardiovascular disease and type 2 diabetes and the risk of developing cancer (HR, 1.09; 95% CI, 0.94-1.25). An important limitation of this study is that participants’ weights were assessed at the time of recruitment and were not re-evaluated during the study period. As well, the UK Biobank is known to have a poor response rate to recruitment, with participants being of greater socioeconomic status on average compared to the general UK population. Overall, this study demonstrates that there is an increased risk of developing cancer associated with the combined effect of obesity and cardiovascular disease, which is greater than the sum of the separate associations of the two variables.

Attention-deficit/hyperactivity disorder symptoms and subsequent cardiometabolic disorders in adults: investigating underlying mechanisms using a longitudinal twin study

1. In this prospective study, ADHD symptoms were associated with an increased risk of cardiometabolic disorders, which may be related to reduced education attainment, lifestyle factors, and psychiatric comorbidities. 

Evidence Rating Level: 1 (Excellent)

Attention-deficit/ hyperactivity disorder (ADHD) is a condition that most often manifests in childhood and persists into adulthood. Little is known about whether physical health problems are associated with ADHD. Researchers aimed to assess the association between ADHD and the development of cardiometabolic disorders.10,394 adults from the Swedish Twin Registry were included in this prospective cohort study. Participants were born between 1958 and 1985 and had no previously diagnosed cardiometabolic disease. The subjects completed self-assessment questionnaires for assessment of ADHD symptoms between 2005 and 2006 and were then followed until the end of 2018. Every unit increase in the ADHD symptom score was associated with a 2% increased rate of cardiovascular disease (HR, 1.02; 95% CI, 1.01-1.03) and a 3% increase in the rate of metabolic disorders (HR, 1.03; 95% CI, 1.02-1.05). Interestingly, the associations were no longer significant after adjusting for educational attainment, lifestyle factors, and comorbid psychiatric disorders. A limitation of this study is that the researchers did not assess whether individuals were treated with medication for ADHD, which is a potentially confounding variable. Overall, this study demonstrates that ADHD symptoms are associated with an increased risk of cardiometabolic disorders, which may be in part due to reduced educational attainment, lifestyle factors, and psychiatric comorbidities. 

Association between patient-surgeon gender concordance and mortality after surgery in the United States: retrospective observational study

1. In this retrospective cohort study, postoperative mortality was similar regardless ofo gender concordance between patients and surgeons. 

Evidence Rating Level: 2 (Good)

Surgical outcomes are influenced by many factors, including patient comorbidities, disease characteristics, and the quality of perioperative care. Researchers aimed to determine whether there is an association between patient and surgeon gender concordance and mortality within 30 days of surgery. Patient, surgeon, and hospital characteristics were adjusted for as confounding variables. 2,902,756 patients aged 65 or older undergoing surgery were included in this study. 44.4% of participants had a surgeon of the same gender, 41.4% male patient and male surgeon, and 3.0% female patient and female surgeon. 55.6% had surgeons of different genders, 1.8% male patient and female surgeon, and 53.8% female patient and male surgeon. 30-day mortality was 2.0% for male patient and male surgeon pairs, 1.7% for male patient and female surgeon pairs, 1.5% for female patient and male surgeon pairs, and 1.3% for female patient and female surgeon pairs. Overall, gender concordance between patient and surgeon was associated with reduced mortality risk for females, (adjusted risk difference −0.2%; 95% CI −0.3 to −0.1; P<0.001) and increased mortality risk for males (0.3%; 95% CI, 0.2 to 0.5; P<0.001). A limitation of this study is that only the genders of patients and surgeons were considered, while potential associations between the genders of patients and nurses, anesthesiologists, and other members of the healthcare team were not assessed. As well, the study did not include individuals younger than 65, so the data may not be generalizable to younger populations. Overall, this large cohort study demonstrated that postoperative mortality was similar with and without gender concordance between physicians and surgeons.  

Image: PD

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