Browsing by Author "Swartz, Richard H."

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    Sex differences in direct healthcare costs following stroke: a population-based cohort study
    (2021-06-29) Yu, Amy Y. X.; Krahn, Murray; Austin, Peter C.; Rashid, Mohammed; Fang, Jiming; Porter, Joan; Vyas, Manav V.; Bronskill, Susan E.; Smith, Eric E.; Swartz, Richard H.; Kapral, Moira K.
    Abstract Background The economic burden of stroke on the healthcare system has been previously described, but sex differences in healthcare costs have not been well characterized. We described the direct person-level healthcare cost in men and women as well as the various health settings in which costs were incurred following stroke. Methods In this population-based cohort study of patients admitted to hospital with stroke between 2008 and 2017 in Ontario, Canada, we used linked administrative data to calculate direct person-level costs in Canadian dollars in the one-year following stroke. We used a generalized linear model with a gamma distribution and a log link function to compare costs in women and men with and without adjustment for baseline clinical differences. We also assessed for an interaction between age and sex using restricted cubic splines to model the association of age with costs. Results We identified 101,252 patients (49% were women, median age [Q1-Q3] was 76 years [65–84]). Unadjusted costs following stroke were higher in women compared to men (mean ± standard deviation cost was $54,012 ± 54,766 for women versus $52,829 ± 59,955 for men, and median cost was $36,703 [$16,496–$72,227] for women versus $32,903 [$15,485–$66,007] for men). However, after adjustment, women had 3% lower costs compared to men (relative cost ratio and 95% confidence interval 0.97 [0.96,0.98]). The lower cost in women compared to men was most prominent among people aged over 85 years (p for interaction = 0.03). Women incurred lower costs than men in outpatient care and rehabilitation, but higher costs in complex continuing care, long-term care, and home care. Conclusions Patterns of resource utilization and direct medical costs were different between men and women after stroke. Our findings inform public payers of the drivers of costs following stroke and suggest the need for sex-based cost-effectiveness evaluation of stroke interventions with consideration of costs in all care settings.
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    White matter hyperintensities and smaller cortical thickness are associated with neuropsychiatric symptoms in neurodegenerative and cerebrovascular diseases
    (2023-06-20) Ozzoude, Miracle; Varriano, Brenda; Beaton, Derek; Ramirez, Joel; Adamo, Sabrina; Holmes, Melissa F.; Scott, Christopher J. M.; Gao, Fuqiang; Sunderland, Kelly M.; McLaughlin, Paula; Goubran, Maged; Kwan, Donna; Roberts, Angela; Bartha, Robert; Symons, Sean; Tan, Brian; Swartz, Richard H.; Abrahao, Agessandro; Saposnik, Gustavo; Masellis, Mario; Lang, Anthony E.; Marras, Connie; Zinman, Lorne; Shoesmith, Christen; Borrie, Michael; Fischer, Corinne E.; Frank, Andrew; Freedman, Morris; Montero-Odasso, Manuel; Kumar, Sanjeev; Pasternak, Stephen; Strother, Stephen C.; Pollock, Bruce G.; Rajji, Tarek K.; Seitz, Dallas; Tang-Wai, David F.; Turnbull, John; Dowlatshahi, Dar; Hassan, Ayman; Casaubon, Leanne; Mandzia, Jennifer; Sahlas, Demetrios; Breen, David P.; Grimes, David; Jog, Mandar; Steeves, Thomas D. L.; Arnott, Stephen R.; Black, Sandra E.; Finger, Elizabeth; Rabin, Jennifer; Tartaglia, Maria C.
    Abstract Background Neuropsychiatric symptoms (NPS) are a core feature of most neurodegenerative and cerebrovascular diseases. White matter hyperintensities and brain atrophy have been implicated in NPS. We aimed to investigate the relative contribution of white matter hyperintensities and cortical thickness to NPS in participants across neurodegenerative and cerebrovascular diseases. Methods Five hundred thirteen participants with one of these conditions, i.e. Alzheimer’s Disease/Mild Cognitive Impairment, Amyotrophic Lateral Sclerosis, Frontotemporal Dementia, Parkinson’s Disease, or Cerebrovascular Disease, were included in the study. NPS were assessed using the Neuropsychiatric Inventory – Questionnaire and grouped into hyperactivity, psychotic, affective, and apathy subsyndromes. White matter hyperintensities were quantified using a semi-automatic segmentation technique and FreeSurfer cortical thickness was used to measure regional grey matter loss. Results Although NPS were frequent across the five disease groups, participants with frontotemporal dementia had the highest frequency of hyperactivity, apathy, and affective subsyndromes compared to other groups, whilst psychotic subsyndrome was high in both frontotemporal dementia and Parkinson’s disease. Results from univariate and multivariate results showed that various predictors were associated with neuropsychiatric subsyndromes, especially cortical thickness in the inferior frontal, cingulate, and insula regions, sex(female), global cognition, and basal ganglia-thalamus white matter hyperintensities. Conclusions In participants with neurodegenerative and cerebrovascular diseases, our results suggest that smaller cortical thickness and white matter hyperintensity burden in several cortical-subcortical structures may contribute to the development of NPS. Further studies investigating the mechanisms that determine the progression of NPS in various neurodegenerative and cerebrovascular diseases are needed.