The covariation of multiple risk factors in primary care: a latent class analysis.
There is a need to advance the quality of healthcare by increasing knowledge about multiple risk factors and how to intervene to improve health outcomes. In an effort to better describe the presentation of multiple risks, this study involved a database review to describe the prevalence and covariation of multiple risk factors in individuals presenting to primary care. Patients with a primary care encounter from January 1, 2005 to June 30, 2005 (N = 10,043) were identified from the Department of Veteran's Affair's medical database and information about the following risk factors was extracted: alcohol use, psychiatric distress, body mass, smoking status, blood pressure, and posttraumatic stress. Exploratory and confirmatory latent class analyses identified three classes of individuals. Class 1 consisted of individuals with an overall lower level of risk for health problems, but a moderately high likelihood of elevated blood pressure. Individuals in Class 2 appeared to have the greatest need for intervention because they had a moderate to high likelihood of reporting at risk alcohol use, smoking, depression, and posttraumatic stress. Class 3 consisted of individuals reporting the co-occurrence of at risk alcohol use, smoking, and elevated blood pressure. Similar to past research, the findings highlight the need for addressing multiple risk factors in primary care. In addition, this study expands on the literature by identifying specific patterns of covariation among different risk factors that suggest avenues for research and program development.
Funderburk
Jennifer S
JS
Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY, USA. Jennifer.Funderburk@va.gov
Maisto
Stephen A
SA
Sugarman
Dawn E
DE
Wade
Mike
M
D000428:Alcohol Drinking / Q000453:epidemiology*; D001794:Blood Pressure; D016000:Cluster Analysis; D016208:Databases, Factual; D005260:Female; D015438:Health Behavior; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening; D015233:Models, Statistical; D016017:Odds Ratio; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014728:Veterans
Gen Hosp Psychiatry. 2004 Nov-Dec;26(6):430-6
15567208
Psychosom Med. 2008 Jan;70(1):20-6
17991816
Ann Fam Med. 2005 Jul-Aug;3 Suppl 2:S4-11
16049083
J Consult Clin Psychol. 1995 Feb;63(1):133-40
7896978
JAMA. 1989 Oct 6;262(13):1801-7
2778913
Am J Prev Med. 2004 Aug;27(2 Suppl):25-33
15275671
Am J Prev Med. 2004 Aug;27(2 Suppl):4-17
15275669
Arch Intern Med. 2007 Jun 11;167(11):1152-8
17563023
J Behav Med. 2006 Oct;29(5):411-8
16865552
JAMA. 1993 Nov 10;270(18):2207-12
8411605
Am J Prev Med. 2004 Aug;27(2 Suppl):1-3
15275668
J Pers Soc Psychol. 1997 Nov;73(5):1052-63
9364760
BMJ. 1994 Jan 29;308(6924):313-20
8124121
Diabetes Educ. 2007 Jun;33 Suppl 6:139S-144S
17620393
Gen Hosp Psychiatry. 2005 May-Jun;27(3):169-79
15882763
Addiction. 1993 Jun;88(6):791-804
8329970
Hypertension. 1991 Sep;18(3 Suppl):I115-20
1889852
J Affect Disord. 2004 Sep;81(3):241-9
15337328
Alcohol Clin Exp Res. 2005 Jun;29(6):989-98
15976525
Alcohol Clin Exp Res. 2007 Jul;31(7):1208-17
17451397
J Adv Nurs. 2007 Apr;58(1):23-34
17394613
Gen Hosp Psychiatry. 2000 Jul-Aug;22(4):261-9
10936633
Alcohol Clin Exp Res. 2005 May;29(5):844-54
15897730
Prev Med. 2000 Aug;31(2 Pt 1):140-7
10938214
Patient Educ Couns. 2006 Jan;60(1):32-40
16332468
Am J Prev Med. 2004 Aug;27(2 Suppl):34-41
15275672
Ann Med. 2000 May;32(4):239-51
10852140
Psychiatr Clin North Am. 2004 Dec;27(4):675-87
15550287
West J Nurs Res. 2006 Mar;28(2):190-209; discussion 210-5
16513919
JAMA. 1982 Sep 24;248(12):1465-77
7050440
Prev Med. 2008 Mar;46(3):203-8
17904212
Atherosclerosis. 1993 Oct;103(1):81-91
8280188
BMJ. 1994 Oct 15;309(6960):993-6
7950723