Browsing by Author "Pan, Minmin"

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    Genetic variants for Alzheimer’s disease and comorbid conditions
    (Sage, 2024) Pan, Minmin; Lai, Dongbing; Unverzagt, Frederick; Apostolova, Liana; Hendrie, Hugh C.; Saykin, Andrew; Foroud, Tatiana; Gao, Sujuan; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Background: Alzheimer's disease and related dementias (ADRD) frequently co-occur with comorbidities such as diabetes and cardiovascular diseases in elderly populations. Objective: Utilize a life-course approach to identify genetic variants that are associated with the co-occurrence of ADRD and another comorbid condition. Methods: Research data from African American participants of the Indianapolis-Ibadan Dementia Project (IIDP) linked with electronic medical record (EMR) data and genome-wide association study (GWAS) data were utilized. The age of onset for ADRD was obtained from longitudinal follow-up of the IIDP study. Age of onset for comorbid conditions was obtained from EMR. The analysis included 1177 African Americans, among whom 174 were diagnosed with ADRD. A semi-parametric marginal bivariate survival model was used to examine the influence of single nucleotide polymorphisms (SNPs) on dual time-to-event outcomes while adjusting for sex, years of education, and the first principal component of GWAS data. Results: Targeted analysis of 20 SNPs that were reported to be associated with ADRD revealed that six were significantly associated with dual-disease outcomes, specifically congestive heart failure and cancer. In addition, eight novel SNPs were identified for associations with both ADRD and a comorbid condition. Conclusions: Using a bivariate survival model approach, we identified genetic variants associated not only with ADRD, but also with comorbid conditions. Our utilization of dual-disease models represents a novel analytic strategy for uncovering shared genetic variants for multiple disease phenotypes.
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    Palliative Care for People With Moderate-Severe Dementia in the Community: Results of the In-Peace Trial
    (Oxford University Press, 2024-12-31) Sachs, Greg; Johnson, Nina; Gao, Sujuan; Pan, Minmin; Torke, Alexia; Hickman, Susan; Kroenke, Kurt; Medicine, School of Medicine
    Dementia care management programs in the community demonstrate some benefits. Study limitations include limited numbers of people living with dementia (PLWD) with advanced disease or from minoritized populations; lack of palliative care components; and limited success reducing health care utilization. IN-PEACE tested dementia care management integrated with palliative care for PLWD with moderate-severe disease in the community and their caregivers. 201 PLWD-caregiver dyads were randomized to either a dementia care coordinator (99) or usual care (102) and followed for 24 months. Outcomes were neuropsychiatric symptoms (NPI-Q severity) and symptom management (SM-EOLD) in PLWD; distress (NPI-Q distress) and depression symptoms (PHQ-8) in caregivers; and the combined measure of ED visits/hospitalizations. Outcomes were assessed quarterly. Separate mixed effects models were run for each symptom/distress measure and a zero-inflated Poisson model compared the mean number of ED/hospitalization events. Subgroup analyses were conducted based on baseline NPI-Q severity, sex, race, income, and health system. There were no statistically significant differences between groups in any symptoms or distress measures in PLWD or caregivers. PLWD receiving the intervention, however, had substantially fewer ED/hospitalization events (means 1.06 events versus 2.37, p < 0.007). The intervention reduced the proportion of PLWD who had one or more ED/hospitalization events (78.4% of controls vs. 50.5% of intervention, p < 0.001). The relative risk reduction was 35.6% for an event, absolute risk reduction 27.9%, and number needed to treat (NNT) of 3.6. PLWD with higher NPI-Q at baseline and Black PLWD experienced greater reductions in ED visit hospitalization events.
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    Thirty-Day Readmissions Are Largely Not Preventable in Patients With Cirrhosis
    (Wolters Kluwer, 2024) Orman, Eric S.; Desai, Archita P.; Ghabril, Marwan S.; Nephew, Lauren D.; Patidar, Kavish R.; Holden, John; Samala, Niharika R.; Gawrieh, Samer; Vuppalanchi, Raj; Sozio, Margaret; Lacerda, Marco; Vilar-Gomez, Eduardo; Lammert, Craig; Liangpunsakul, Suthat; Crabb, David; Masuoka, Howard; Dakhoul, Lara; Pan, Minmin; Gao, Sujuan; Chalasani, Naga; Medicine, School of Medicine
    Introduction: Hospital readmissions are common in patients with cirrhosis, but there are few studies describing readmission preventability. We aimed to describe the incidence, causes, and risk factors for preventable readmission in this population. Methods: We performed a prospective cohort study of patients with cirrhosis hospitalized at a single center between June 2014 and March 2020 and followed up for 30 days postdischarge. Demographic, clinical, and socioeconomic data, functional status, and quality of life were collected. Readmission preventability was independently and systematically adjudicated by 3 reviewers. Multinomial logistic regression was used to compare those with (i) preventable readmission, (ii) nonpreventable readmission/death, and (iii) no readmission. Results: Of 654 patients, 246 (38%) were readmitted, and 29 (12%) were preventable readmissions. Reviewers agreed on preventability for 70% of readmissions. Twenty-two (including 2 with preventable readmission) died. The most common reasons for readmission were hepatic encephalopathy (22%), gastrointestinal bleeding (13%), acute kidney injury (13%), and ascites (6%), and these reasons were similar between preventable and nonpreventable readmissions. Preventable readmission was often related to paracentesis timeliness, diuretic adjustment monitoring, and hepatic encephalopathy treatment. Compared with nonreadmitted patients, preventable readmission was independently associated with racial and ethnic minoritized individuals (odds ratio [OR] 5.80; 95% CI, 1.96-17.13), nonmarried marital status (OR 2.88; 95% CI, 1.18-7.05), and admission in the prior 30 days (OR 3.45; 95% CI, 1.48-8.04). Discussion: For patients with cirrhosis, readmission is common, but most are not preventable. Preventable readmissions are often related to ascites and hepatic encephalopathy and are associated with racial and ethnic minorities, nonmarried status, and prior admissions.