Poster Day 2023: Abstracts: Population Health

We analyzed the impact of civil commitment laws for substance use disorder (SUD) on opioid overdose death rates (OODR) from 2010-21. 

CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset was used to extract death rates from 2010-21 focusing on opioid deaths using ICD-10 codes. T-tests were conducted using Excel. A two-way ANOVA was performed using GraphPad Prism 10.0. 

This study aimed to evaluate the nutrition literacy and perceived emotional burden of disease in young adult type-1 diabetics. All participants are members of the non-profit organization The Diabetes Link, a 501 c3 nonprofit organization working to connect and support young adult type-1 diabetics. Previously conducted research showed a significant uptick in HbA1c levels in type 1 diabetics between the ages of 18 and 24. Lack of nutritional knowledge is frequently highlighted as the cause.

Participants completed a 40-question survey via Google Forms containing questions about their treatment, dietary habits, confidence in healthcare professionals, and overall feelings towards their diagnosis. The survey also included 4 questions aimed at evaluating the participant’s carbohydrate counting knowledge. A binary logistic regression was performed using SPSS 27 to assess the influences of burden and carbohydrate counting knowledge on participants’ diabetes care and nutrition perception.

Data from this study shows that participants who scored high on the carbohydrate counting quiz were 2.389 times more likely to avoid eating because of an out-of-range blood sugar (P-value= 0.05), and participants who reported higher levels of burden were 9.325 times more likely to avoid a social gathering because of food (P-value= 0.002). 

Results from this study demonstrate that the emotional burden associated with eating contributes to HbA1c spikes, not necessarily nutritional literacy. Emotional aids should be an added component of care for this demographic to correct burnout. Future studies should be conducted to evaluate the type of support necessary to alleviate the reported symptoms.

Ryan Pearman, MS; Victoria Boyd, MS

The use of GLP-1 receptor agonists in the settings of obesity and type 2 diabetes mellitus has increased dramatically in recent years. Though this drug class has been shown to promote significant weight loss in patients, the high cost of these drugs and shifting insurance policies frequently forces patients to discontinue their medication. The purpose of this study is to assess the outcomes of patient weight following the discontinuation of GLP-1 agonists.

Data was retrieved from the Semaglutide Treatment Effect in People with Obesity (STEP) clinical trial program. We analyzed data following cessation of semaglutide therapy at 68 weeks and 120 weeks. Our outcome variable was percent increase in weight compared to the patient’s weight on the first day of semaglutide cessation.

We found that patients tend to experience rebound weight gain following cessation of GLP-1 agonists. At 68 weeks following medication cessation, patient weight increased by 6.9% on average. At 120 weeks, patient weight increased by 11.6% from baseline.

Though patients tend to lose clinically significant weight while using GLP-1 agonists, patients tend to gain weight following their cessation. We show that patients’ weight increased by an average of 6.9% at 68 weeks and 11.6% at 120 weeks, showing a steady rebound weight gain following GLP-1 discontinuation. Thus, continued weight loss interventions may be needed if a patient must discontinue their medication. Future research is needed to explore effective weight loss maintenance solutions in these patients.

Ashley James, OMS-III, Ryan Liengswangwong, OMS-III, Danielle Roehrs, OMS-III

In patients suffering traumatic injuries, every second between injury and initiation of care matters. In this study we investigate whether rural/urban classification reveals health disparities with respect to the course and outcome of trauma cases in Florida.

Ashley James, OMS-III, Allison Lewis, OMS-III, Soumya Sidana, OMS-III, Johnny Dang, OMS-III

In 2021, Alabama had the 3rd highest homicide rate in the US and the 4th highest death rate from firearms according to data from the CDC. That same year, firearms passed motor vehicle traffic to become the leading cause of death of minors between 1 and 17 in Alabama. These statistics beg the question of what factors contribute to the high rates of death attributable to gun violence in Alabama.

Justin Thorne, B.S.E., Patrick Ransbottom, M.S., Peyton McMahan M.S., Rahul Garg, Ph.D., MPharm

Background:

Chronic diseases are common among elderly individuals and a significant cost burden on the U.S. healthcare system. Additional multiple comorbidities add to this cost burden which varies by hospital type, region, and specific chronic condition, and are principally borne by Medicare. Alabama has among the highest incidence rates of multiple chronic conditions. It is imperative to investigate the burden of multiple comorbidities on the cost of care on Medicare in Alabama.

We analyzed Alabama 2021 Centers for Medicare and Medicaid Services (CMS) healthcare claims data for the most discharged Diagnosis Related Groups (DRGs). We compared cost burdens associated with DRG codes with Major Complication and Comorbidity (MCC) and without MCC by using t-tests. We excluded DRGs with non-major comorbidities and those reported by less than four hospitals, resulting in 6 top discharged DRGs.

We found that the top discharged health conditions with MCC cost an average of $4,703.98 more than those without MCC (p <.0001). Average additional costs due to MCC varied with specific conditions: Stroke ($7670.6), Sepsis ($5711.4), Myocardial infarction ($5420.6), Heart failure ($4389.6), Esophagitis ($3113.3), and Kidney infections ($1918.4). These substantial added expenses highlight inefficiencies in our medical payment system andcall for better prevention and treatment of comorbidities.

Utilization of Medicare and other insurance expenditures for preventive measures and improved management of chronic conditions may yield substantial long-term cost savings. Affordable generic drugs and routine screenings could prevent chronic conditions from worsening and lessen the burden on an already strained healthcare budget.

Alec Lippman, OMS-II, Cory Dixon, OMS-II, Francis Sto. Domingo, OMS-II, Sawyer Longley, OMS-II

Food deserts are characterized as an area of low-income and poor access to affordable healthy foods. Compared to their urban counterparts, food deserts are found in rural areas of the United States. Food deserts have been shown to have a higher prevalence of cardiovascular disease risk. This study focuses on food deserts and the prevalence of cardiovascular risk in the Black Belt region of Alabama. The Education Policy Center (EPC) of Alabama created the most comprehensive, current, and expansive definition, which defined it as totaling 24 counties.

Victoria Boyd MS OMS-III, Ryan Pearman MS OMS-III

Osteoarthritis is the most common arthritis worldwide, causing progressive loss of joint function and eventual joint failure. Several risk factors contribute to the disorder; however, a patient’s diet and BMI are the greatest modifiable risk factors. Lack of access to grocery stores may put patients at risk for a poor diet and obesity, and thus, increase their risk of osteoarthritis. The current study’s purpose is to determine a relationship between the prevalence of osteoarthritis and patient access to grocery stores.

A literature search was performed using Google Scholar, PubMed, and ClinicalKey using terms such as, “osteoarthritis and grocery access.” The literature search was not restricted by a time frame or geographic area. A similar search was performed on PolicyMap, using the most recent data available. Geographic data was unavailable for osteoarthritis specifically, and therefore arthritis, including OA and other arthritides, was substituted. The maps were used to analyze a geographic relationship between arthritis and grocery store locations in Alabama.

There were no articles that analyzed the relationship between osteoarthritis prevalence and patient access to grocery stores. A relationship was seen, however, when analyzing the data geographically. Areas of Alabama with a greater density of grocery store retail locations (Figure 1) show a decreased prevalence of patients diagnosed with arthritis (Figure 2).

Conclusions:

Geographic population data illustrates that limited access to grocery stores may be a risk factor for arthritis in Alabama. Further research is needed to identify the scale of the impact that grocery store access has on joint health.

Justin Moon, MEd, OMS-II, Swarna Sakshi, MS, OMS-II, Katherine Thornburgh, MPH, OMS-II

Mary Olivia Smith, OMS-II  Sarah Duffy, MMS, OMS-II Maya Kalaria, OMS-II  Caitlin Curran, OMS-II

This is a retrospective correlational study observing the impact of opioid prescription capping laws on opioid overdose mortality. Archival data was obtained via PolicyMap, Centers for Disease Control, Clinical Key, and Drug and Alcohol Dependence journal. The years 2014 and 2019 were examined in order to analyze outcomes before and after capping laws implementation.

Prescription opioid overdose deaths began declining in 2010 while other causes were rapidly increasing nationwide. The decline in prescription opioid overdoses was seen across the US in both states that did not have opioid capping laws and states that did have opioid prescription capping laws.

PubMed database was primarily utilized with keywords "peer-based," "school education," and "health outcomes" to narrow 900+ articles. Filters included text availability, type, and publication date, selecting five articles focused on peer-based school education's impact on health outcomes. Additional information was obtained from the CDC. The study strategy incorporated a global perspective, ultimately examining six sources total.

Kratom, a psychoactive derivative of Mitragyna Speciosa, originally prevalent in Southeast Asia, is increasingly becoming a concern in the United States. This herbal substance targets opioid receptors in the brain, akin to the potent opioid, fentanyl. In Southeast Asia, kratom is commonly consumed as a tea, serving as a cost-effective alternative for opioid addiction treatment, withdrawal management, and fatigue reduction. Conversely, in the United States, a significant portion of the population turns to kratom primarily to address chronic pain and alleviate opioid withdrawal symptoms.

As accessibility to kratom widens, it emerges in various forms, including powders, capsules, and extracts, often sold in gas stations, smoke shops, and lounges advertising euphoria and relaxation. Kratom has been referred to as “gas station heroin” due to its ease of access. Despite escalating apprehensions about its abuse potential, the Drug Enforcement Administration (DEA) lists kratom as a "drug of concern," remaining legal in most states except for a few. The lack of stringent regulation leads to concerns regarding the authenticity, potency, and quality of this substance, raising contamination-related issues.

While the long-term effects of kratom remain poorly studied, there is a growing body of evidence indicating kratom-related toxicities and numerous associated fatalities. This discussion underscores the clinically significant aspects of kratom use and abuse, emphasizing the need for further research, regulation, and public awareness regarding this evolving issue.

Food insecurity (FI) is a growing public health concern within the U.S.; Alabama falls within the top ten FI states. FI is associated with poorer health outcomes, but little is known about the impact of FI and surgical outcomes. This study seeks to identify a correlation between FI and surgical outcomes in Alabama and how FI interventions can affect these outcomes.

A literature search was conducted across PubMed, Policy Maps, Center for Medicare and Medicaid Services, American Hospital Association, U.S. Department of Agriculture, Center on Budget and Policy Priorities focusing on FI and surgical outcomes in the southern U.S. with emphasis on Alabama. Articles and data from the last decade addressing FI prevalence, perioperative complications and mortality, food assistance programs (FAP) benefits and limitations, and healthcare preventative efforts were included. A search of FI interventions within healthcare was completed focusing on the U.S.

The review highlights that FI elevates perioperative risks, readmission rates, and mortality. FI linked complications worsen outcomes in arthroplasty procedures. In Alabama, 8 hospitals with higher surgical complications than the national average are in counties with 11.82% FI (2019-2021). FI initiatives at health centers have shown a decrease in readmission rates. While FAP helps combat FI, Supplemental Nutrition Assistance Plan participants exhibit poorer Healthy Eating Index which could heighten perioperative risks.

This review emphasized the evidence linking FI and perioperative complications is limited. Additional research is needed to establish this connection and explore the advantages of implementing FI support interventions for surgical patients.

The study revealed a significant association between dietary factors and chronic diseases. Reduced fruit consumption emerged as a leading contributor to these diseases, resulting in nearly 4.9 million attributable deaths annually. High sodium intake and reduced consumption of nuts, seeds, vegetables, and whole grains were also identified as significant risk factors. SES impacted dietary habits, particularly in low-income populations, increasing vulnerability to chronic diseases.

A notable finding was the inverse relationship between areas of high obesity and areas of high income in the Southeastern US. Traditional dietary practices deeply rooted in Southern culture, characterized by calorie-dense and processed foods, were identified as potential contributors to the elevated prevalence of chronic diseases in the region. The increased proportion of fast-food restaurants in certain areas was correlated with lower SES and adverse health trends.

Access to nutrition is a critical social determinant of health in the United States. Many Americans live in food deserts or food swamps, which are areas with limited access to nutritious food. Obesity is closely associated with elevated risks of various cancers, amplified in regions with food deserts or swamps, which often coincide with low-income and underserved populations.

This paper explores the correlations between nutritious food availability and healthcare outcomes of communities that are affected by nutritious food insecurity. Current research suggests a potential correlation between food deserts and swamps, and increased obesity-related cancer mortality, even after adjusting for demographics. Variations exist in how different racial and ethnic groups perceive their environment, which may affect dietary habits.

A correlation between food insecurity and negative healthcare outcomes in regions labeled as food deserts and swamps exists. It is essential to mitigate obesity-related health disparities to improve healthcare outcomes in these vulnerable communities. However, addressing this complex issue requires a multifaceted approach encompassing access to nutritious foods and broader social determinants of health.

There is an overall correlation between the proliferation of fast-food and convenience markets and the exacerbation of obesity-related disease in regions where other nutritious food options are extremely limited. Further healthcare policy and efforts are needed to assist these communities which are in need of proper nutrition. The goal to ensure equitable access to nutritious foods and opportunities for physical activity, regardless of geographic location or socioeconomic status is possible with societal change.

Data came from peer-reviewed sources published on PubMed using “AND/OR” functions, as follows:

((((anxiety[Title]) OR (anxiety disorder [Title])) AND (low socioeconomic status [Title] OR (poverty[Title]))

We excluded articles that didn’t mention a relationship between the variables, and those whose primary studies were outside the United States.