@article {11815, title = {No association between rheumatoid arthritis and cognitive impairment in a cross-sectional national sample of older U.S. adults.}, journal = {BMC Rheumatology}, volume = {5}, year = {2021}, pages = {24}, abstract = {

BACKGROUND: Studies suggest an increased prevalence of cognitive impairment (CI) among people with rheumatoid arthritis (RA). However, most prior studies have used convenience samples which are subject to selection biases or have failed to adjust for key confounding variables. We thus examined the association between CI and RA in a large national probability sample of older US adults.

METHODS: Data were from interviews with 4462 participants in the 2016 wave of the nationally representative U.S. Health and Retirement Study with linked Medicare claims. RA diagnoses were identified via a minimum of two ICD-9CM or ICD-10 codes in Medicare billing records during the prior 2 years. The Langa-Weir Classification was used to classify cognitive status as normal, cognitively impaired non-dementia (CIND), or dementia based on a brief neuropsychological battery for self-respondents and informant reports for proxy respondents. We compared the odds of CI between older adults with and without RA using logistic regression, adjusted for age, education, gender, and race.

RESULTS: Medicare records identified a 3.36\% prevalence of RA (150/4462). While age, gender, education, and race independently predicted CI status, controlling for these covariates we found no difference in CI prevalence according to RA status (prevalent CI in 36.7\% of older adults with RA vs. 34.0\% without RA; adjusted OR = 1.08, 95\% CI 0.74-1.59, p~= .69).

CONCLUSION: There was no association between RA and CI in this national sample of older U.S. adults.

}, keywords = {cognitive impairment, Epidemiology, National health survey, rheumatoid arthritis}, issn = {2520-1026}, doi = {10.1186/s41927-021-00198-z}, author = {Booth, Michael J and Mary R Janevic and Lindsay C Kobayashi and Daniel Clauw and John D Piette} } @article {11993, title = {No increased risk of Alzheimer{\textquoteright}s disease among people with immune-mediated inflammatory diseases: findings from a longitudinal cohort study of U.S. older adults.}, journal = {BMC Rheumatology}, volume = {5}, year = {2021}, pages = {48}, abstract = {

OBJECTIVE: Immune-mediated inflammatory diseases (IMID) are characterized by systemic inflammation affecting the joints and bodily organs. Studies examining the association between individual IMIDs and the risk of Alzheimer{\textquoteright}s disease (AD) have yielded inconsistent findings. This study examines AD risk across a group of IMIDs in a large population-based sample of older adults.

METHODS: Data on a national sample of US adults over age 50 was drawn from the Health and Retirement Study (HRS) and linked Medicare claims from 2006 to 2014. IMIDs include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn{\textquoteright}s disease, ulcerative colitis, and related conditions. We identified IMIDs from 2006 to 2009 Medicare claims using International Classification of Diseases (ICD9-CM) codes. The date of incident AD was derived from Chronic Conditions Warehouse (CCW) identifiers. We examined the risk of AD from 2009 to 2014 using Cox proportional hazards models, both unadjusted and adjusted for age, gender, education, race, and the genetic risk factor APOE-e4.

RESULTS: One hundred seventy-one (6.02\%) of the 2842 total HRS respondents with Medicare coverage and genetic data were classified with IMIDs. Over the subsequent 6 years, 9.36\% of IMID patients developed AD compared to 8.57\% of controls (unadjusted hazard ratio (HR): 1.09, 95\% CI .66-1.81, p = 0.74). Adjusted HR 1.27 (95\% CI 0.76-2.12, p = 0.35). Age (HR for 10-year increment 3.56, p < .001), less than high school education (HR 1.70, p = .007), and APOE-e4 (HR 2.61, p < .001 for one or two copies), were also statistically significant predictors of AD.

CONCLUSION: HRS respondents with common IMIDs do not have increased risk of Alzheimer{\textquoteright}s disease over a 6-year period.

}, keywords = {Alzheimer, immune-mediated inflammatory disease, Medicare claims data}, issn = {2520-1026}, doi = {10.1186/s41927-021-00219-x}, author = {Booth, Michael J and Lindsay C Kobayashi and Mary R Janevic and Daniel Clauw and John D Piette} } @article {11466, title = {Validation of Self-Reported Rheumatoid Arthritis Using Medicare Claims: A Nationally Representative Longitudinal Study of Older Adults.}, journal = {ACR Open Rheumatology}, volume = {3}, year = {2021}, pages = {239-249}, abstract = {

OBJECTIVE: To determine the validity of self-reported physician diagnosis of rheumatoid arthritis (RA) using multiple gold-standard measures based on Medicare claims in a nationally representative sample of older adults and to verify whether additional questions about taking medication and having seen a physician in the past two years for arthritis can improve the positive predictive value (PPV) and other measures of the validity of self-reported RA.

METHODS: A total of 3768 Medicare-eligible respondents with and without incident self-reported RA were identified from the 2004, 2008, and 2012 waves of the United States Health and Retirement Study. Self-reported RA was validated using the following three claims-based algorithms: 1) a single International Classification of Diseases, ninth edition, Clinical Modification claim for RA, 2) two or more claims no greater than 2 years apart, and 3) two or more claims with at least one diagnosis by a rheumatologist. Additional self-report questions of medication use and having seen a doctor for arthritis in the past two years were validated against the same criteria.

RESULTS: A total of 345 respondents self-reported a physician diagnosis of RA. Across all three RA algorithms, the PPV of self-report ranged from 0.05 to 0.16., the sensitivity ranged from 0.23 to 0.55., and the κ statistic ranged from 0.07 to 0.15. Additional self-report data regarding arthritis care improved the PPV and other validity measures of self-report; however, the values remained low.

CONCLUSION: Most older adults who self-report RA do not have a Medicare claims history consistent with that diagnosis. Revisions to current self-reported RA questions may yield more valid identification of RA in national health surveys.

}, keywords = {Medicare claims, rheumatoid arthritis, self reported}, issn = {2578-5745}, doi = {10.1002/acr2.11229}, author = {Booth, Michael J and Daniel Clauw and Mary R Janevic and Lindsay C Kobayashi and John D Piette} } @article {9249, title = {Racial and socioeconomic disparities in disabling chronic pain: Findings from the Health and Retirement Study.}, journal = {The Journal of Pain: Official Journal of the American Pain Society}, volume = {18}, year = {2017}, pages = {1459-1467}, abstract = {The U.S. National Pain Strategy calls for increased population research on "high impact chronic pain," i.e., longstanding pain that substantially limits participation in daily activities. Using data from the nationally-representative Health and Retirement Study (HRS), we investigated the prevalence of high-impact chronic pain in U.S. adults over age 50 overall and within population subgroups. We also explored sociodemographic variation in pain-related disability within specific activity domains. Data are from a subsample of HRS respondents (n=1,925) who were randomly selected for a supplementary pain module in 2010. Our outcome was operationalized as pain duration of >7 months and a disability rating of >7 (0 to 10 scale) in at least one domain: family/home, leisure, social activities, work, or basic activities. Overall, 8.2\% (95\% C.I. = 6.7 to 10.1\%) of adults over age 50 met criteria for high-impact chronic pain. This proportion rose to 17.1\% (95\% C.I. = 12.3 to 23.4\%) among individuals in the lowest wealth quartile. Prevalence differences by education, race/ethnicity and age were not significant. Arthritis and depression were significantly associated with high-impact pain in multivariable analysis. Among adults with any chronic pain, African Americans and individuals in the lowest wealth quartile reported more pain-related disability across activity domains.

PERSPECTIVE: High-impact chronic pain is unequally distributed among midlife and older U.S. adults. Efforts to reduce the burden of disabling chronic pain should prioritize socioeconomically vulnerable groups, who may have the least access to multi-modal pain treatment to improve function.}, keywords = {Chronic pain, Racial/ethnic differences, Socioeconomic factors}, issn = {1528-8447}, doi = {10.1016/j.jpain.2017.07.005}, author = {Mary R Janevic and Sara J McLaughlin and Alicia A Heapy and Thacker, Casey and John D Piette} }