Health insurance coverage among persons with schizophrenia in the United States.

OBJECTIVE: This study estimated the rates of health insurance coverage in the U.S. civilian noninstitutionalized population with schizophrenia and assessed whether basic access to health care varied across health insurance categories. METHODS: Data from the Medical Expenditures Panel Survey collected between 2002 and 2006 were used. RESULTS: The sample contained 328 records representing 493,006 noninstitutionalized civilian persons with schizophrenia. Eighty-seven percent had Medicaid or Medicare, 8% received care through the Veterans Health Administration, and 15% had private insurance for at least one day during the year. About 7% were uninsured all of the year. The uninsured tended to be male (92%), nonwhite (54%), and unmarried (97%), and 30% of the uninsured had not had a medical checkup in more than five years. CONCLUSIONS: Almost all U.S. adults with schizophrenia were found to receive government health insurance, yet a measurable minority remained uninsured. These national estimates highlight opportunities for improving health service delivery for this vulnerable population.

Pattern of mortality in a sample of Maryland residents with severe mental illness.

In a cohort of Maryland Medicaid recipients with severe mental illness followed from 1993-2001, we compared mortality with rates in the Maryland general population including race and gender subgroups. Persons with severe mental illness died at a mean age of 51.8 years, with a standardized mortality ratio of 3.7 (95%CI, 3.6-3.7).

Behavioral problems and the occurrence of tobacco, cannabis, and coca paste smoking in Chile: evidence based on multivariate response models for school survey data.

BACKGROUND: In this study we estimate suspected links between youthful behavioral problems and smoking of tobacco, cannabis, and coca paste. METHODS: In the Republic of Chile, school-attending youths were sampled from all 13 regions of the country, with sample size of 46,907 youths from 8th to 12th grades. A Generalized Estimating Equations (GEE) approach to multiple logistic regression was used to address three interdependent response variables, tobacco smoking, cannabis smoking, and coca paste smoking, and to estimate associations. RESULTS: Drug-specific adjusted slope estimates indicate that youths at the highest levels of behavioral problems are an estimated 1.1 times more likely to have started smoking tobacco, an estimated 1.6 times more likely to have started cannabis smoking, and an estimated 2.0 times more likely to have started coca paste smoking, as compared to youths at the lowest level of behavioral problems (p<0.001). CONCLUSION: In Chile, there is an association linking behavioral problems with onsets of smoking tobacco and cannabis, as well as coca paste; strength of association is modestly greater for coca paste smoking.

Adverse events during medical and surgical hospitalizations for persons with schizophrenia.

CONTEXT: Persons with schizophrenia have a high risk of premature mortality. It is not clear if greater risk for adverse events during hospitalization is a contributing factor. OBJECTIVES: To estimate the prevalence of adverse events in medical and surgical hospitalizations for persons with schizophrenia compared with those for persons without schizophrenia and to examine the relation between adverse events and intensive care unit admission, in-hospital death, length of stay, and total charges for hospitalizations for persons with schizophrenia. DESIGN: Cross-sectional study. SETTING: We studied discharges from all Maryland acute care hospitals' medical and surgical services in 2001 and 2002. Patients There were 1746 medical and surgical hospitalizations for adults with a secondary diagnosis of schizophrenia and 732 158 for adults without schizophrenia. MAIN OUTCOME MEASURES: For primary outcomes, we applied the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs), which were developed to detect adverse events in administrative data. We compared PSIs for hospitalizations for patients with a secondary diagnosis of schizophrenia with those for patients without and determined the association between schizophrenia and each PSI adjusting for patient and hospital characteristics. For hospitalizations for patients with schizophrenia, for secondary outcomes we examined the association between each PSI and intensive care unit admission, in-hospital death, length of stay, and total charges. RESULTS: Hospitalizations for patients with schizophrenia had the following higher adjusted relative odds of having PSIs compared with those for patients without schizophrenia: infections due to medical care (odds ratio [OR], 2.49 [95% confidence interval (CI), 1.28 to 4.88]); postoperative respiratory failure (OR, 2.08 [95% CI, 1.41 to 3.06]); postoperative deep venous thrombosis (OR, 1.96 [95% CI, 1.18 to 3.26]); and postoperative sepsis (OR, 2.29 [95% CI, 1.49 to 3.51]). For hospitalizations for patients with schizophrenia, having respiratory failure or sepsis resulted in at least twice the adjusted odds for intensive care unit admission and death. The median adjusted increase in length of stay was at least 10 days, and median hospital charges were elevated by at least $20 000 for infections due to medical care, respiratory failure, deep venous thrombosis, and sepsis. CONCLUSIONS: Medical and surgical hospitalizations for persons with schizophrenia had at least twice the odds of several types of adverse events than those for persons without schizophrenia. These adverse events were associated with poor clinical and economic outcomes during the hospital admission. Efforts to reduce these adverse events should become a research priority.

Behavioral problems and tobacco use among adolescents in Chile.

OBJECTIVE: To examine the association between behavioral problems and tobacco smoking among adolescent students in Chile. METHODS: Data were drawn from a study that included questionnaire surveys of 46 907 school-attending adolescents in all 13 of the administrative regions of Chile. Assessments were based on an adapted, Spanish-language version of the Drug Use Screening Inventory. The conditional form of the logistic regression model was used for analysis, with matching of students on individual schools, and with further statistical adjustments for sex, age, and selected risk factors. RESULTS: The prevalence of tobacco smoking among the adolescents was very high across all of Chile, with a level between 56% and 65% in each of the 13 regions. The estimated odds of tobacco use in youths at the highest level of behavioral problems was about twice that for youths at the lowest levels, both before and after controlling for sex, age, lack of participation in recreational activities, level of irritability, and levels of problems with school, family attention, and mental health. CONCLUSIONS: These findings help to complement and complete the evidence of prior studies on tobacco smoking among adolescents with behavior problems, including recent research on Central American youths. Although the magnitude of observed associations in Chile was not as great as that for the associations found in Central America, both the strength of these associations and their statistical significance were observed throughout Chile. This is the first study in Chile on potentially causal relationships such as these.

Behavioral problems and tobacco use among adolescents in Chile

OBJECTIVE: To examine the association between behavioral problems and tobacco smoking among adolescent students in Chile. METHODS: Data were drawn from a study that included questionnaire surveys of 46 907 school-attending adolescents in all 13 of the administrative regions of Chile. Assessments were based on an adapted, Spanish-language version of the Drug Use Screening Inventory. The conditional form of the logistic regression model was used for analysis, with matching of students on individual schools, and with further statistical adjustments for sex, age, and selected risk factors. RESULTS: The prevalence of tobacco smoking among the adolescents was very high across all of Chile, with a level between 56 percent and 65 percent in each of the 13 regions. The estimated odds of tobacco use in youths at the highest level of behavioral problems was about twice that for youths at the lowest levels, both before and after controlling for sex, age, lack of participation in recreational activities, level of irritability, and levels of problems with school, family attention, and mental health. CONCLUSIONS: These findings help to complement and complete the evidence of prior studies on tobacco smoking among adolescents with behavior problems, including recent research on Central American youths. Although the magnitude of observed associations in Chile was not as great as that for the associations found in Central America, both the strength of these associations and their statistical significance were observed throughout Chile. This is the first study in Chile on potentially causal relationships such as these.