|Title||Longitudinal patient-oriented outcomes in neuropathy: Importance of early detection and falls.|
|Publication Type||Journal Article|
|Year of Publication||2015|
|Authors||Callaghan, BC, Kerber, K, Langa, KM, Banerjee, M, Rodgers, A, McCammon, RJ, Burke, JF, Feldman, EL|
|Date Published||2015 Jul 07|
|Keywords||Accidental Falls, Aged, Aged, 80 and over, Early Diagnosis, Female, Humans, International Classification of Diseases, Longitudinal Studies, Male, Medicare, Patient-Centered Care, Peripheral Nervous System Diseases, Treatment Outcome, United States|
OBJECTIVE: To evaluate longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis.
METHODS: The 1996-2007 Health and Retirement Study (HRS)-Medicare Claims linked database identified incident peripheral neuropathy cases (ICD-9 codes) in patients ≥65 years. Using detailed demographic information from the HRS and Medicare claims, a propensity score method identified a matched control group without neuropathy. Patient-oriented outcomes, with an emphasis on self-reported falls, pain, and self-rated health (HRS interview), were determined before and after neuropathy diagnosis. Generalized estimating equations were used to assess differences in longitudinal outcomes between cases and controls.
RESULTS: We identified 953 peripheral neuropathy cases and 953 propensity-matched controls. The mean (SD) age was 77.4 (6.7) years for cases, 76.9 (6.6) years for controls, and 42.1% had diabetes. Differences were detected in falls 3.0 years before neuropathy diagnosis (case vs control; 32% vs 25%, p = 0.008), 5.0 years for pain (36% vs 27%, p = 0.002), and 5.0 years for good to excellent self-rated health (61% vs 74%, p < 0.0001). Over time, the proportion of fallers increased more rapidly in neuropathy cases compared to controls (p = 0.002), but no differences in pain (p = 0.08) or self-rated health (p = 0.9) were observed.
CONCLUSIONS: In older persons, differences in falls, pain, and self-rated health can be detected 3-5 years prior to peripheral neuropathy diagnosis, but only falls deteriorates more rapidly over time in neuropathy cases compared to controls. Interventions to improve early peripheral neuropathy detection are needed, and future clinical trials should incorporate falls as a key patient-oriented outcome.
|User Guide Notes|
|Endnote Keywords|| |
Peripheral neuropathy/Peripheral neuropathy/Medicare/Propensity score
|Endnote ID|| |
|PubMed Central ID||PMC4501944|
|Grant List||R01 DC012760 / DC / NIDCD NIH HHS / United States |
U01 AG009740 / AG / NIA NIH HHS / United States
P30 AG024824 / AG / NIA NIH HHS / United States
R01 MD008879 / MD / NIMHD NIH HHS / United States
R01 AG030155 / AG / NIA NIH HHS / United States
R18HS022258 / HS / AHRQ HHS / United States
U01 AG09740 / AG / NIA NIH HHS / United States
K23 RR024009 / RR / NCRR NIH HHS / United States
R24 082841 / / PHS HHS / United States
NS079417 / NS / NINDS NIH HHS / United States
DP3DK094292 / DK / NIDDK NIH HHS / United States
P30 DK020572 / DK / NIDDK NIH HHS / United States
K08 NS082597 / NS / NINDS NIH HHS / United States
R18HS017690 / HS / AHRQ HHS / United States