Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer's Disease: an observational analysis.

BACKGROUND: Alzheimer's Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. METHODS: This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). RESULTS: The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks' nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics' nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant. CONCLUSIONS: Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.

Prolonged mobile phone use is associated with depressive symptoms in Chinese adolescents.

BACKGROUND: Prolonged screen time has negative impacts on health and well-being. This study examined the association between the duration of mobile phone use (DMPU) and depressive symptoms in a large sample of Chinese adolescents. METHODS: 11,831 adolescent students participated in the baseline Shandong Adolescent Behavior and Health Cohort (SABHC) survey in Shandong, China in 2015. A self-administered questionnaire was used to measure DMPU on weekdays and the weekend, sleep, mental health, and family environment. The Center for Epidemiologic Studies Depression Scale (CES-D) and Youth Self-Report (YSR) depression scales were used to assess depressive symptoms. RESULTS: The mean age of participants was 15.0 (SD = 1.5) and 51% were male. The prevalence of depressive symptoms increased with prolonged DMPU. After adjusting for adolescent and family covariates, DMPU ≥ 2 h/day on weekdays (OR = 1.78, 95%CI = 1.48-2.15) and ≥ 5 h/day on the weekend (OR = 1.67, 95%CI = 1.41-1.98) was associated with increased risk of depressive symptoms as assessed by CES-D. The DMPU-depression association was found to be partially mediated by short sleep duration or insomnia. Similar associations were observed for depression as assessed by YSR. STUDY LIMITATION: This is a cross-sectional survey. Mobile phone use and depressive symptoms were measured by self-report. CONCLUSIONS: Prolonged mobile phone use of ≥ 2 h on weekdays and ≥ 5 h on the weekend is associated with an increased risk of depressive symptoms. The association appears to be partially mediated by sleep disturbances.