Average Disease Burden Research Articles

Impact of Telehealth on Hospitalization of Skilled Nursing Facility Patients During the COVID-19 Pandemic

Importance: This very large claims data analysis documents lower rates of hospitalization among patients receiving telehealth during a skilled nursing facility stay compared to patients who did not receive telehealth. These findings from care during the COVID-19 pandemic support the call for telehealth to become a routine option even after the public health emergency has ended.
 Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. This focused analysis can assist program development for the large population of patients cared for in skilled nursing facilities. 
 Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC) and Telehealth Impact Study to respond to the pandemic. We report trends using a data set of 668,533 patients cared for in skilled nursing facilities (SNF) between January 2020 and March 2021.
 Main Outcomes and Measures: We compared rates of hospitalization within 60 days of admission to the skilled nursing facility for patients who received telehealth and those who did not receive telehealth during their SNF stay. We analyzed subgroups of patients based upon the clinical diagnoses for which they received professional services from physicians and other providers.
 Results: Of the 668,533 patients meeting criteria for an admission to a SNF facility, 97,204 (14.5%) had one or more telehealth visits. 40.1% of patients received one TH visit per 30 days during their SNF stay; 9.4% received ten or more TH visits per 30 days. Patients in all six diagnostic cohorts experienced significantly lower rates of hospitalization compared to patients who received no telehealth despite having a higher average disease burden measured by the Charlson Comorbidity Index. Absolute rates of hospitalization rates dropped between 1.25% (dementia) and 1.87% (orthopedic) for clinical groups. The relative rates of hospitalization dropped between 22% (cardiovascular) and 33% (dementia). 
 Conclusions and Relevance: This study underscores the potential benefits of using virtual care in skilled nursing facilities to lower rates of hospitalization and improve outcomes. We encourage continued study of the use digital health services for patients in post-acute settings and promotion of insurance coverage in the years to come as new best practices emerge.

Comparison of trend in chronic kidney disease burden between China, Japan, the United Kingdom, and the United States.

Chronic kidney disease (CKD) caused heavy burden globally. This study aimed to investigate the patterns and temporal variations in the burden of CKD in China, Japan, the United Kingdom (U.K.), and the United States (U.S.) from 1990 to 2019, and decompose the difference in CKD disease burden between 1990 and 2019 into demographic factors. From 1990 to 2019, although the age-standardized rate (ASR) of incidence remained stable in the four countries, and the ASR of mortality and disability-adjusted life years (DALY) have declined in four countries (except for the increase in U.S.), the number of CKD incidence, death, and DALY increased significantly. The average disease burden per case in U.S. has increased between 1990 and 2019, with an increasing proportion of death-related disease burden. For the CKD due to diabetes and hypertension, whose incidences accounted for < 25% of the total CKD, while it accounts for more than 70% of the deaths (except in U.K. with 54.14% in women and 51.75% in men). CKD due to diabetes and hypertension should be the focus of CKD prevention and control. Considering the high treatment costs of CKD and ESRD, it is urgent and necessary to transform CKD treatment into primary and secondary prevention.

Burden of Psoriatic Arthritis According to Different Definitions of Disease Activity: Comparing Minimal Disease Activity and the Disease Activity Index for Psoriatic Arthritis

ObjectiveTreat‐to‐target strategies have improved outcomes in rheumatic diseases. In psoriatic arthritis (PsA), the proposed targets are the multidimensional target minimal disease activity (MDA) and the articular target Disease Activity index for PsA (DAPSA). The aim of this study was to compare the disease burden of PsA in patients with low disease activity according to the 2 definitions, MDA and DAPSA low disease activity (DAPSA‐LDA), 1 year after diagnosis.MethodsWe obtained data on MDA, DAPSA‐LDA and disease burden 1 year after diagnosis for patients included in the Dutch southwest early PsA cohort. Disease burden was assessed in 2 domains: “Body functions,” including the Short Form 36 bodily pain (SF‐36 BP) measure, and “Activity,” including the Health Assessment Questionnaire (HAQ).ResultsAmong the 292 patients included, 48% achieved MDA and 74% achieved DAPSA‐LDA. Average scores for Body functions and Activity were better in patients who achieved MDA and those who achieved DAPSA‐LDA. The scores were significantly better in the 46% of patients who achieved both MDA and DAPSA‐LDA than in the 29% of patients who achieved only DAPSA‐LDA. The average SF‐36 BP score was higher in patients achieving both targets (73.8; 95% confidence interval [95% CI] 71.1‐76.5) than in patients achieving only DAPSA‐LDA (57.6; 95% CI 54.5‐60.8). Similarly, mean HAQ scores measuring Activity were 0.21 (95% CI 0.15‐0.26) and 0.63 (95% CI 0.53‐0.72), respectively.ConclusionAmong patients with newly diagnosed PsA, 48% achieved MDA and 74% achieved DAPSA‐LDA after 1 year of receiving usual care. The average disease burden was better in patients who achieved MDA and those who achieved DAPSA‐LDA. Also, patients who achieved only DAPSA‐LDA reported worse outcomes than those who also achieved MDA.

Accumulated Health Risk Assessment of Arsenic in Drinking Water of Major Cities of China

Based on the drinking water quality survey data of China's major cities, the existing disease burden calculation method was improved and disability-adjusted life years (DALYs) was taken as the end of evaluation to assess the health risk of arsenic contamination level. The results showed that the concentration of arsenic in drinking water of major cities in China was very low (0.53 μg·L-1), far below the national limit (10 μg·L-1) and the total lifetime cancer incidence was 1.76×10-5. The order of risks of different kinds of cancers was:skin cancer (1.53×10-5) > lung cancer (2.25×10-6) > liver cancer (2.30×10-8) > bladder cancer (1.34×10-10) and the average disease burden was 1.91×10-6 per person-year. Among them, skin cancer and lung cancer accounted for 70.2% and 29.0% respectively, and the disease burdens of bladder cancer and liver cancer were negligible, but the overall cancer risk was still higher than the recommended level of 10-6 per person-year by WHO. Although the arsenic level of drinking water in China was not high, the risk of cancer could not be ignored. Thus more effective and feasible measures should be taken to reduce arsenic concentration to protect people's drinking water safety in the future.

Disease Burden of 32 Infectious Diseases in the Netherlands, 2007-2011.

BackgroundInfectious disease burden estimates provided by a composite health measure give a balanced view of the true impact of a disease on a population, allowing the relative impact of diseases that differ in severity and mortality to be monitored over time. This article presents the first national disease burden estimates for a comprehensive set of 32 infectious diseases in the Netherlands.Methods and FindingsThe average annual disease burden was computed for the period 2007–2011 for selected infectious diseases in the Netherlands using the disability-adjusted life years (DALY) measure. The pathogen- and incidence-based approach was adopted to quantify the burden due to both morbidity and premature mortality associated with all short and long-term consequences of infection. Natural history models, disease progression probabilities, disability weights, and other parameters were adapted from previous research. Annual incidence was obtained from statutory notification and other surveillance systems, which was corrected for under-ascertainment and under-reporting. The highest average annual disease burden was estimated for invasive pneumococcal disease (9444 DALYs/year; 95% uncertainty interval [UI]: 8911–9961) and influenza (8670 DALYs/year; 95% UI: 8468–8874), which represents 16% and 15% of the total burden of all 32 diseases, respectively. The remaining 30 diseases ranked by number of DALYs/year from high to low were: HIV infection, legionellosis, toxoplasmosis, chlamydia, campylobacteriosis, pertussis, tuberculosis, hepatitis C infection, Q fever, norovirus infection, salmonellosis, gonorrhoea, invasive meningococcal disease, hepatitis B infection, invasive Haemophilus influenzae infection, shigellosis, listeriosis, giardiasis, hepatitis A infection, infection with STEC O157, measles, cryptosporidiosis, syphilis, rabies, variant Creutzfeldt-Jakob disease, tetanus, mumps, rubella, diphtheria, and poliomyelitis. The very low burden for the latter five diseases can be attributed to the National Immunisation Programme. The average disease burden per individual varied from 0.2 (95% UI: 0.1–0.4) DALYs per 100 infections for giardiasis, to 5081 and 3581 (95% UI: 3540–3611) DALYs per 100 infections for rabies and variant Creutzfeldt-Jakob disease, respectively.ConclusionsFor guiding and supporting public health policy decisions regarding the prioritisation of interventions and preventive measures, estimates of disease burden and the comparison of burden between diseases can be informative. Although the collection of disease-specific parameters and estimation of incidence is a process subject to continuous improvement, the current study established a baseline for assessing the impact of future public health initiatives.

The disease burden of hepatitis B, influenza, measles and salmonellosis in Germany: first results of the Burden of Communicable Diseases in Europe Study

Setting priorities in the field of infectious diseases requires evidence-based and robust baseline estimates of disease burden. Therefore, the European Centre for Disease Prevention and Control initiated the Burden of Communicable Diseases in Europe (BCoDE) project. The project uses an incidence- and pathogen-based approach to measure the impact of both acute illness and sequelae of infectious diseases expressed in disability-adjusted life years (DALYs). This study presents first estimates of disease burden for four pathogens in Germany. The number of reported incident cases adjusted for underestimation served as model input. For the study period 2005-2007, the average disease burden was estimated at 33 116 DALYs/year for influenza virus, 19 115 DALYs/year for Salmonella spp., 8708 DALYs/year for hepatitis B virus and 740 DALYs/year for measles virus. This methodology highlights the importance of sequelae, particularly for hepatitis B and salmonellosis, because if omitted, the burden would have been underestimated by 98% and 56%, respectively.

Economic Impact of Dengue Illness and the Cost-Effectiveness of Future Vaccination Programs in Singapore

BackgroundDengue illness causes 50–100 million infections worldwide and threatens 2.5 billion people in the tropical and subtropical regions. Little is known about the disease burden and economic impact of dengue in higher resourced countries or the cost-effectiveness of potential dengue vaccines in such settings.Methods and FindingsWe estimate the direct and indirect costs of dengue from hospitalized and ambulatory cases in Singapore. We consider inter alia the impacts of dengue on the economy using the human-capital and the friction cost methods. Disease burden was estimated using disability-adjusted life years (DALYs) and the cost-effectiveness of a potential vaccine program was evaluated. The average economic impact of dengue illness in Singapore from 2000 to 2009 in constant 2010 US$ ranged between $0.85 billion and $1.15 billion, of which control costs constitute 42%–59%. Using empirically derived disability weights, we estimated an annual average disease burden of 9–14 DALYs per 100 000 habitants, making it comparable to diseases such as hepatitis B or syphilis. The proportion of symptomatic dengue cases detected by the national surveillance system was estimated to be low, and to decrease with age. Under population projections by the United Nations, the price per dose threshold for which vaccines stop being more cost-effective than the current vector control program ranged from $50 for mass vaccination requiring 3 doses and only conferring 10 years of immunity to $300 for vaccination requiring 2 doses and conferring lifetime immunity. The thresholds for these vaccine programs to not be cost-effective for Singapore were $100 and $500 per dose respectively.ConclusionsDengue illness presents a serious economic and disease burden in Singapore. Dengue vaccines are expected to be cost-effective if reasonably low prices are adopted and will help to reduce the economic and disease burden of dengue in Singapore substantially.

Physical Health Functioning Among United Methodist Clergy

United Methodist clergy have been found to have higher than average self-reported rates of obesity, diabetes, asthma, arthritis, and high blood pressure. However, health diagnoses differ from physical health functioning, which indicates how much health problems interfere with activities of daily living. Ninety-five percent (n = 1726) of all actively serving United Methodist clergy in North Carolina completed the SF-12, a measure of physical health functioning that has US norms based on self-administered survey data. Sixty-two percent (n = 1074) of our sample completed the SF-12 by self-administered formats. We used mean difference tests among self-administered clergy surveys to compare the clergy SF-12 Physical Composite Scores to US-normed scores. Clergy reported significantly better physical health composite scores than their gender- and age-matched peers, despite above average disease burden in the same sample. Although health interventions tailored to clergy that address chronic disease are urgently needed, it may be difficult to elicit participation given pastors' optimistic view of their physical health functioning.

Community-based study on disease burden of diarrhea in Zhejiang province

To study the status on economic burden of diarrhea in Zhejiang province so as to provide evidence for allocation of health resource as well as decision-making on health issues. Multi-phases stratified random cluster sampling was used to select samples in the population. Data was collected on the incidence of diarrhea in the last two weeks as well as on the related cost due to medical care etc. The overall incidence (person per year) of diarrhea was 0.26, with 0.29 in the rural and 0.22 in the urban areas respectively. The incidence of diarrhea in children less than 5 was 0.66 (person per year), higher than in any of the age groups. The average direct cost of medical treatment was 69.23 Yuan with average direct cost of non-medical care was 8.29 Yuan for every person, while the indirect cost was 48.43 Yuan. In conclusion, the average disease burden of diarrhea in the province was 1.697 billion Yuan per year, which accounted for 1 per thousand of the GDP, with 1.217 billion Yuan in rural area and 0.480 billion Yuan in the urban areas respectively. The direct cost of medical care was 0.886 billion Yuan (52.21%) and the direct cost due to non-medical care was 0.124 billion Yuan (7.31%). The indirect cost appeared to be 0.480 billion Yuan (40.48%). Factors that affecting the cost would relate to: severity of diarrhea, medical insurance, location of residential area, age and education background of the patients, etc. Programs on diarrhea prevention and control should be strengthened to reduce the economic burden caused by this disease while special attention should be paid to those children who are under 5 years of age and living in the rural areas.

Personal meanings in the construction of need for total knee replacement surgery

This study explores patients’ personal meanings of knee osteoarthritis (OA) and total knee replacement (TKR). Personal meanings are important because decisions regarding the need for TKR do not seem to be explained by symptoms alone. A total of 18 semi-structured interviews were conducted with a purposive sample of respondents who were listed for TKR at one UK specialist orthopaedic hospital, and who had lower than average disease burden according to standard quantitative criteria. Data were analysed using interpretive phenomenological analysis. Several themes related to need for TKR emerged: adoption of the medical model, a person's social network, pain, functional loss, feelings of vulnerability, dependency, low mood and fatigue, ideas related to disease progression and expectations of TKR. Results suggest that the decision to undergo TKR is not related to symptoms alone, but to personal meanings. Some of these personal meanings may not be useful in accurately assessing the need for TKR, and may result in mis-targeting of treatment. It is important for health professionals to explore and tackle personal meanings when considering treatment. In particular, it may be important to consider gender differences that may influence when men and women are listed for TKR. For example: women may be less likely to discuss treatment options with their doctor; they may be more likely to have heard negative examples of TKR from friends or family; they may be more likely to discuss pain and mobility issues than activities requiring higher function; and they may be more likely to discuss the effect on their mood and the emotional impact of OA.