Predictors of binge drinking in elderly Americans.

BACKGROUND: The increasing trend in elderly binge drinking in the U.S. is cause for alarm. We sought to describe the predictors of binge drinking in elderly men and women and evaluate the relationship between binge drinking and mental health disorders in this population. METHODS: The 2008 Centers for Disease Control's Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 4,815 individuals in the U.S. of age 65 or older. The primary outcome of interest was self-reported binge drinking, defined as an affirmative response to the question: "How many times in the past 30 days have you had more than five drinks (in men) or more than four drinks (in women) on an occasion?" RESULTS: Among 4,815 elderly participants studied, a total of 466 (9.7%) participants reported binge drinking over the past 30 days while 4,349 (90.3%) participants reported no binge drinking. Binge drinking was not associated with anxiety or depressive disorders in the overall population, however, elderly women reporting binge drinking had higher rates of depressive disorders. In multivariate analysis, independent predictors of binge drinking in elderly participants included younger age, male gender, smoking, absence of college education, lower annual income, and absence of coronary artery disease. Predictors of binge drinking differed in elderly men and women. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Younger age, male gender, smoking, lack of college education, lower annual income, and absence of coronary artery disease are independently associated with higher rates of binge drinking among elderly Americans. Elderly men and women had disparate predictors of binge drinking. This study provides valuable information to be applied to the substance abuse screening process in elderly men and women.

The impact of financial barriers on access to care, quality of care and vascular morbidity among patients with diabetes and coronary heart disease.

BACKGROUND: The prevalence and consequences of financial barriers to health care among patients with multiple chronic diseases are poorly understood. OBJECTIVE: We sought to assess the prevalence of self-reported financial barriers to health care among individuals with diabetes and coronary heart disease (CHD) and to determine their association with access to care, quality of care and clinical outcomes. DESIGN: The 2007 Centers for Disease Control Behavioral Risk Factor Surveillance Survey. PARTICIPANTS: Diabetic patients with CHD. MAIN MEASURES: Financial barriers to health care were defined by a self-reported time in the past 12 months when the respondent needed to see a doctor but could not because of cost. The primary clinical outcome was vascular morbidity­a composite of stroke, retinopathy, nonhealing foot sores or bilateral foot amputations. KEY RESULTS: Among the 11,274 diabetics with CHD, 1,541 (13.7 %) reported financial barriers to health care. Compared to individuals without financial barriers, those with financial barriers had significantly reduced rates of medical assessments within the past 2 years, hemoglobin (Hgb) A1C measurements in the past year, cholesterol measurements at any time, eye and foot examinations within the past year, diabetic education, antihypertensive treatment, aspirin use and a higher prevalence of vascular morbidity. In multivariable analyses, financial barriers to health care were independently associated with reduced odds of medical checkups (Odds Ratio [OR], 0.61; 95 % Confidence Intervals [CI], 0.55­0.67), Hgb A1C measurement (OR, 0.85; 95 % CI, 0.77­0.94), cholesterol measurement (OR, 0.76; 95 % CI, 0.67­0.86), eye (OR, 0.85; 95 % CI, 0.79­0.92) and foot (OR, 0.92; 95 % CI, 0.84­1.00) examinations, diabetic education (OR, 0.93; 95 % CI, 0.87­0.99), aspirin use (OR, 0.88; 95 % CI, 0.81­0.96) and increased odds of vascular morbidity (OR, 1.23; 95 % CI, 1.14­1.33). CONCLUSIONS: In diabetic adults with CHD, financial barriers to health care were associated with impaired access to medical care, inferior quality of care and greater vascular morbidity. Eliminating financial barriers and adherence to guideline-based recommendations may improve the health of individuals with multiple chronic diseases.