Semester

Spring

Date of Graduation

2023

Document Type

Dissertation

Degree Type

PhD

College

School of Pharmacy

Department

Pharmaceutical Systems and Policy

Committee Chair

Khalid Kamal

Committee Member

Usha Sambamoorthi

Committee Member

Traci LeMasters

Committee Member

Chan Shen

Committee Member

Ranjita Misra

Abstract

A significant proportion of adults in the United States (US) suffer from various inflammatory chronic conditions (ICCs). They include a wide range of diseases such as diabetes, rheumatoid arthritis, asthma, and chronic obstructive pulmonary diseases. ICCs are not curable, and their management typically involves medications such as NSAIDs and corticosteroids. Recently, a whole health approach that places patients’ well-being at the center is increasingly being used for better management of ICCs. The whole health approach uses an integrated approach that includes multimodal management with complementary and alternative medicines (CAM) and prescription drugs. However, the use of CAM and prescription drugs can be influenced by many factors such as social determinants of health (SDoH), biological, natural, social, and policy factors. There is limited knowledge on how SDoH contributes to disparities in CAM and prescription drugs use. High blood pressure is one of the critical areas of ICC management as chronic inflammation is also associated with elevated blood pressure. It is essential to understand blood pressure control among adults with ICCs as there is a bidirectional relationship between chronic inflammation and blood pressure. Blood pressure control in adults with ICCs can be influenced by several factors, which can provide useful information for managing the ICCs. Furthermore, ICCs can lead to a high economic burden. Limited evidence suggests that adults with ICCs experience higher missed workdays and wage loss. However, the contribution of ICCs as a disease group to missed workdays and wage loss is not well-understood.

Given the limited literature on the clinical and economic burden of ICCs, this dissertation pursued three aims: 1) Examine the association of SDoH with complementary and alternative medicine and prescription drugs use among adults with ICCs, 2) Examine the association of ICCs with blood pressure control among adults in the US, 3) Estimate the incremental indirect costs associated with ICCs among working-age employed adults in the US. Data from multiple nationally representative surveys were used. They include the National Health Interview Survey (NHIS-2012 and 2017), Medical Expenditure Panel Survey (MEPS- 2013 and 2018) for Aim 1, and National Health and Nutrition Examination Survey (NHANES 2013-2018) for Aim 2, and MEPS (2019) for Aim 3.

Findings from Aim 1 using multinomial logistic regression showed that unfavorable SDoH factors such as lower income levels (poor-AOR = 0.45, 95%CI (0.28, 0.72), p = 0.001, near poor-AOR = 0.64, 95%CI (0.44, 0.93), p

Overall, this dissertation's findings suggest that disparities in ICC treatment exist, and ICCs impose a significant economic burden on working-age adults.

Implications: Findings suggest that addressing SDoH can improve ICC treatment. Sustained efforts need to be made to improve blood pressure control among those with ICCs because a majority of adults did not achieve blood pressure control. Integrated wellness programs from employers may help to reduce missed workdays and productivity loss.

Embargo Reason

Publication Pending

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