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Chronic liver disease (CLD) is among the strongest risk factors for adverse prescription opioid-related events. Yet, the current prevalence and factors associated with high-risk opioid prescribing in patients with chronic liver disease (CLD) remain unclear, making it challenging to address opioid safety in this population. Therefore, we aimed to characterize opioid prescribing patterns among patients with CLD. This retrospective cohort study included patients with CLD identified at a single medical center and followed for one year from 10/1/2015-9/30/2016. Multivariable, multinomial regression was used identify the patient characteristics, including demographics, medical conditions, and liver-related factors, that were associated with opioid prescriptions and high-risk prescriptions (≥90mg morphine equivalents per day [MME/day] or co-prescribed with benzodiazepines). Nearly half (47%) of 12,425 patients with CLD were prescribed opioids over a one-year period, with 17% of these receiving high-risk prescriptions. The baseline factors significantly associated with high-risk opioid prescriptions included female gender (adjusted incident rate ratio, AIRR = 1.32, 95% CI = 1.14-1.53), Medicaid insurance (AIRR = 1.68, 95% CI = 1.36-2.06), cirrhosis (AIRR = 1.22, 95% CI = 1.04-1.43) and baseline chronic pain (AIRR = 3.40, 95% CI = 2.94-4.01), depression (AIRR = 1.93, 95% CI = 1.60-2.32), anxiety (AIRR = 1.84, 95% CI = 1.53-2.22), substance use disorder (AIRR = 2.16, 95% CI = 1.67-2.79), and Charlson comorbidity score (AIRR = 1.27, 95% CI = 1.22-1.32). Non-alcoholic fatty liver disease was associated with decreased high-risk opioid prescriptions (AIRR = 0.56, 95% CI = 0.47-0.66). Opioid medications continue to be prescribed to nearly half of patients with CLD, despite efforts to curtail opioid prescribing due to known adverse events in this population.

Background Alcohol cessation is the cornerstone of treatment for alcohol-related cirrhosis. This study evaluated associations between medical conversations about alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality. Methods This retrospective cohort study included all patients with ICD-10 diagnosis codes for cirrhosis and AUD who were engaged in hepatology care in a single healthcare system in 2015. Baseline demographic, medical, liver disease, and AUD treatment data were assessed. AUD treatment discussions and initiation, alcohol cessation, and subsequent 5-year mortality were collected. Multivariable models were used to assess the factors associated with subsequent AUD treatment and 5-year mortality. Results Among 436 patients with cirrhosis due to alcohol, 65 patients (15%) received AUD treatment at baseline, including 48 (11%) receiving behavioral therapy alone, 11 (2%) receiving pharmacotherapy alone, and 6 (1%) receiving both. Over the first year after a baseline hepatology visit, 37 patients engaged in AUD treatment, 51 were retained in treatment, and 14 stopped treatment. Thirty percent of patients had hepatology-documented AUD treatment recommendations and 26% had primary care-documented AUD treatment recommendations. Most hepatology (86%) and primary care (88%) recommendations discussed behavioral therapy alone. Among patients with ongoing alcohol use at baseline, AUD treatment one year later was significantly, independently associated with AUD treatment discussions with hepatology (adjusted odds ratio (aOR): 3.23, 95% confidence interval (CI): 1.58, 6.89) or primary care (aOR: 2.95; 95% CI: 1.44, 6.15) and negatively associated with having Medicaid insurance (aOR: 0.43, 95% CI: 0.18, 0.93). When treatment was discussed in both settings, high rates of treatment ensued (aOR: 10.72, 95% CI: 3.89, 33.52). Over a 5-year follow-up period, 152 (35%) patients died. Ongoing alcohol use, age, hepatic decompensation, and hepatocellular carcinoma were significantly associated with mortality in the final survival model. Conclusion AUD treatment discussions were documented in less than half of hepatology and primary care encounters in patients with alcohol-related cirrhosis, though such discussions were significantly associated with receipt of AUD treatment.

Left ventricular hypertrophy (LVH) is one of the strongest predictors of cardiovascular disease (CVD) and mortality; yet the means to diagnose LVH in resource-constrained settings remain limited. The objectives of this study were to determine LVH prevalence by transthoracic echocardiography (TTE) in a high-risk group, and compare TTE vs. electrocardiography (ECG-LVH) for LVH detection. We analyzed enrollment data from the Haiti cardiovascular disease cohort study on adults (≥ 18 years, n  = 3,005) in Port-au-Prince between 2019 and 2021. All participants underwent questionnaires, vital signs, physical exams, and 12-lead ECGs. TTEs were acquired on those with hypertension or exhibiting CVD symptoms ( n  = 1040, 34.7%). TTE-LVH was defined according to the American Society of Echocardiography guidelines and ECG-LVH by Sokolow-Lyon, Cornell, and Limb-Lead Voltage criteria. The prevalence of TTE-LVH was 39.0% (95% CI 36.6–41.5%) and associated with older age. Only 26% of those with TTE-LVH and elevated blood pressure were on antihypertensives. Prevalence of ECG-LVH ranged from 1.9 to 5.0%, and compared to TTE-LVH had low agreement (κ < 0.20), low sensitivity (< 10%) and high specificity (> 90%). These findings indicate a high prevalence of TTE-LVH among high-risk Haitian adults, and poor detection using ECGs compared to TTEs. For those with TTE-LVH, treatment with antihypertensives may reduce the risk of adverse CVD outcomes.

Background Data on women’s reproductive health in settings facing extreme poverty are limited. We describe the reproductive health characteristics across the life course of women living in urban Port-au-Prince, Haiti, and identify factors associated with adverse pregnancy outcomes (APO). Methods Data were sourced from the Haiti Cardiovascular Disease Cohort Study, a population-based observational study in Port-au-Prince. This analysis includes all women who completed a reproductive health questionnaire, which included self-reported age of menarche, menopause, infertility, menstruation abnormalities, and APO, defined as a history of pregnancy loss, preterm births, and pregnancy complications. We performed univariable and multivariable log-binomial regression to identify factors associated with APO. Results Among 1746 women in the parent cohort, 1,163 (66.6%) women reported reproductive health data. The median age was 43 years (IQR 31–55). The median age at menarche was 14 years (IQR 12–16). A downward trend in the age of menarche was observed over time: women born from 1930 to 1970 reported a median age of 15 years, compared to 13 years among women born from 1990 to 2012 ( p  < 0.001). 11% (11.0%; n  = 130) of the participants reported a history of infertility. The median age of reported menopause was 48 years (IQR, 44–50; n  = 540), with approximately 37.4% ( n  = 203) experiencing menopause before the age of 45. Among 1007 women with ≥  one pregnancy, 61.7% ( n  = 623) experienced an APO, and 20.3% ( n  = 206) reported two or more APO. The most common APO was pregnancy loss ( n  = 515, 51.0%), pregnancy complications ( n  = 244, 24.0%), and preterm births ( n  = 132, 13.0%). Factors associated with a history of APO included hypertension, body mass index > 25 kg/m2, higher education, and a moderate perceived stress score. Conclusion Among women living in extreme poverty in Haiti, we found a high prevalence of adverse reproductive health outcomes, namely APO, and a temporal trend of a decreasing age of menarche across time. Adverse reproductive health outcomes have been associated with increased chronic disease, and additional research is needed to establish if these factors are associated with increased cardiometabolic disease in extremely poor settings to identify targets for future prevention and treatment. Plain English summary Data on women’s reproductive healthcare are not readily available in settings of extreme poverty, including Haiti; yet they are essential for improving women’s health in these contexts. We report data from women participants in the population-based Haiti Cardiovascular Disease Cohort Study. We used regression analysis to identify factors associated with adverse pregnancy outcomes. Among 1163 women, the median age was 43 years. The majority (68%, n  = 791) earned less than 1 USD, and 46% ( n  = 530) had only a primary-level education. We noted a statistically significant decline in the age at which women experience their first menstrual period, from 15 years for those born between 1930 and 1970 to 13 years among those born between 1990 and 2012. The median age at menopause was 48 years ( n  = 540). Among women who had one or more pregnancies, the vast majority, 61.7% ( n  = 623), reported experiencing adverse pregnancy outcomes. Factors associated with these outcomes included hypertension, obesity, and stress. Among women living in extreme poverty in urban Haiti, we found that two-thirds experienced one or more adverse pregnancy outcomes. Adverse pregnancy outcomes have been linked to chronic diseases like heart disease and may help identify women at high risk in low-resource settings, allowing for targeted prevention and treatment.