Chronic Disease Categories Research Articles

Racial or Ethnic and Multimorbidity Differences in Functional Limitation Trajectories Among Older Americans

Racial/ethnic minority groups in the U.S. are at risk for greater co-existing chronic disease (multimorbidity) burden and experience greater functional limitations relative to non-Hispanic white peers. To target programs designed to preserve functional independence, this study aims to identify temporal trends of functional limitation among race/ethnic groups and within the context of multimorbidity. Data from the Health & Retirement Study (2000-2014, N=16,959, 65 years of age and older, community-dwelling adults) were used in generalized estimating equation (GEE) models to assess changes in functional limitations over time (combined activities of daily living [ADL] and instrumental activities of daily living [IADL], range 0-11). Models were adjusted for race/ethnicity (non-Hispanic black, Hispanic, non-Hispanic white), self-reported chronic disease categories (no/one, ≥2 somatic, somatic-depression; of arthritis, cancer, diabetes, heart disease, high depressive symptoms [CES-D8≥4], hypertension, lung disease, stroke), age at baseline, sex, body-mass index, education, partnered, net worth, and time. In adjusted GEE models, Hispanic and black respondents experience 1.4 times greater counts of functional limitations, respectively, relative to white respondents (incidence rate ratio [IRR]= 1.4, 95% CI[1.17, 1.66], IRR=1.4, CI[1.26, 1.61]); however, temporal trends were similar. With regard to multimorbidity categories, somatic or somatic-depression multimorbidity were each associated with 2.2 or 3.5 times greater functional limitations, respectively, relative to having no/one condition (IRR=2.2, CI[2.06, 2.39], IRR=3.5, CI[3.18, 3.74]). There are marked differences in functional limitation levels between minority ethnic and white groups, as well as among chronic disease combination groups, suggesting the need to intervene in middle-age to reduce disparities.

The Association between MUC5B Rs35705950 and Risks of Idiopathic Interstitial Pneumonia, Systemic Sclerosis Interstitial Lung Disease, and Familial Interstitial Pneumonia: A Meta-Analysis.

Background:Interstitial lung disease (ILD) is a category of chronic lung diseases with more than 200 subtypes. Idiopathic interstitial pneumonia (IIP), systemic sclerosis (SSc) ILD, and familial interstitial pneumonia (FIP) are three major groups of lung diseases with different causes or with unknown causes. Mucin5B (MUC5B) belongs to the mucin family, which contribute to the lubricating and viscoelastic properties of the whole saliva, normal lung mucus, and cervical mucus. The association between MUC5B rs35705950 and ILDs risks has been widely studied. However, the results were inconclusive and inconsistent.Methods:In the present meta-analysis, the database PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI and Chinese Biomedical Literature Database were searched till Aug 20th, 2018. Overall 16 publications with 28 studies, 76345 cases and 18402 controls were included.Results:The results indicated a significant increase of overall IIP risk for TT genotype and T allele of the rs35705950 in all genetic models (TT vs GG, OR=9.11; TT vs GT+TT, OR=5.80; GT+TT vs GG, OR=4.34; T vs G, OR=4.03. P<0.0001). Subgroup analysis by subtypes of IIP revealed higher risks of TT genotype and T allele for IPF and iNSIP (P<0.05). A significant increase of FIP risk was also found for the TT genotype and T allele of the rs35705950 (TT vs GG, OR=17.08; GT+TT vs GG, OR=6.02; T vs G, OR=1.64.P<0.05).Conclusion:No significant relations existed between the rs35705950 and SSc-ILD risks. MUC5B rs35705950 might be a predictor for the susceptibility of IIP and FIP.

Type 3 Diabetes Mellitus: A Link Between Alzheimer's Disease and Type 2 Diabetes Mellitus.

Chronic diseases, as their name suggests, are progressive and can have overlapping features. Similar to this, Alzheimer's disease (AD) and diabetes mellitus (DM) fall into the category of chronic degenerative diseases. The global burden of these two ailments is manifold; hence, it seems important to view the pathophysiologic mechanisms of DM in the worsening of AD. Genetic as well as environmental factors are seen to play a role in the disease pathogenesis. Several genes, metabolic pathways, electrolytes, and dietary habits are seen to hasten brain atrophy. Lying behind this is the accumulation of amyloid precursor and tau - the misfolded proteins - within the brain substance. This mechanism is usually innate to AD itself, but the impact of insulin resistance, disturbing the homeostatic milieu, is seen as a powerful contributing factor aggravating the neuronal loss impairing an individual's memory. Since this neuronal loss is permanent, it may lead to complications as seen with AD. To reach a consensus, we conducted an electronic literature review search using different databases. This aided us in understanding the common aspects between AD and DM on genetic, molecular, cellular levels, as well as the impact of minerals and diet on the disease manifestation. We also found that despite exceptional work, additional efforts are needed to explore the relationship between the two entities. This will help physicians, researchers, and pharmaceuticals to frame remedies targeting the cause and avoid the progression of AD.

Noninvasive measurement of venous wall deformation induced by changes in transmural pressure shows altered viscoelasticity in patients with chronic venous disease

The noninvasive measurement of venous wall deformation induced by changes in transmural pressure could allow for the assessment of viscoelasticity and differentiating normal from diseased veins. In 57 patients with limbs in the C1s (telangiectasia or reticular veins and symptoms), C3 (edema), or C5 (healed venous ulcer) CEAP (clinical, etiologic, anatomic, pathophysiologic) category of chronic venous disease and 54 matched healthy controls, we measured the changes in the cross-sectional area of the small saphenous vein and a deep calf vein in the supine and standing positions and under compression with an ultrasound probe using ultrasonography. The small saphenous vein, but not the deep calf vein, cross-sectional area was smaller in the limbs of the controls than in the limbs with C3 or C5 disease but was not different from that in C1s limbs. When changing from the supine to the standing position, a greater force was required to collapse the leg veins. Their cross-sectional area increased in most subjects but decreased in 31.5% of them as for the small saphenous veins and 40.5% for the deep calf vein. The small saphenous vein area vs compression force function followed a hysteresis loop, demonstrating viscoelastic features. Its area, which represents the viscosity component, was greater (P< .001) in the pooled C3 and C5 limbs (median, 2.40N⋅mm2; lower quartile [Q1] to upper quartile [Q3], 1.65-3.88N⋅mm2) than in the controls (median, 1.24N⋅mm2; Q1-Q3, 0.64-2.14N⋅mm2) and C1s limbs (median, 1.15N⋅mm2; Q1-Q3, 0.71-2.97N⋅mm2). The area increased (P< .0001) in the standing position in all groups. Postural changes in the cross-sectional area of the leg veins were highly diverse among patients with chronic venous disease and among healthy subjects and appear unsuitable for pathophysiologic characterization. In contrast, small saphenous vein viscoelasticity increased consistently in the standing position and the viscosity was greater in limbs with C3 and C5 CEAP disease than in controls.

Transcending the Cutaneous Barrier Through Nanocarrier Exploration for Passive Delivery of Anti-hypertensive Drugs: A Critical Review.

Hypertension comes under the category of chronic disease, which requires long term treatment. Hypertension is usually treated by oral administration of various therapeutic agents. There are several limitations of the oral route, making pharmaceutical scientists to discover an alternative route for drug delivery. The transdermal route may be a better alternative as it shows various advantages like lack of first-pass effect and high patient compliance. The skin may act as a primary barrier for the transdermal delivery of anti-hypertensive drugs; therefore, new approaches are required to cross this barrier. Nanocarrier systems come under these new approaches to cross the skin barrier. Various nanocarrier systems explored for transdermal delivery of antihypertensive drugs are liposomes, elastic liposomes, ethosomes, transethosomes, oleic acid vesicles, niosomes, solid lipid nanoparticles, nanostructured lipid carriers, nanoemulsions/microemulsions, and carbon nanotubes. This review summarizes the potential of advanced nanocarrier systems for effective management of hypertension following the transdermal route. The entire literature search regarding the utility of nanocarrier systems in transdermal delivery of antihypertensive drugs was done by using Pubmed and Google Scholar. Nanocarrier systems are capable of reducing various drawbacks of conventional formulations of antihypertensive drugs like excessive first-pass effects, high dosing frequency, and toxicity promoting high patient compliance. However, the clinical efficacy determination of such nanocarrier systems is still a challenge and it will govern their presence in the global pharmaceutical market.

Influenza coverage rates in subjects with chronic heart diseases: results obtained in four consecutive immunisation seasons in the Local Health Unit of Ferrara (North Italy)\u201d

BackgroundSeasonal influenza epidemics yearly affects 5–15% of the world’s population, resulting in 3–5 million serious cases and up to 650,000 deaths. According to the 2017–2019 Italian National Immunisation Plan, free immunisation is offered to the categories at increased risk of experience the complications of the infection (over 65 years old subjects, pregnant women and individuals with underlying conditions, including chronic heart diseases). Rising evidence suggests that influenza can trigger adverse cardiovascular events therefore the vaccination is recommended for secondary prevention of cardiovascular diseases. Despite this, the influenza coverage rate in subjects with chronic heart disease is underestimated.MethodsThe study investigated the coverage rate in four consecutive influenza seasons (from 2011/2012 to 2014/2015) in subjects that benefit from exemption from paying healthcare costs for chronic heart disease living in Local Health Unit (LHU) of Ferrara (Italy), comparing the databases of exemptions and immunisations.ResultsThe levels of influenza vaccine uptake were unstable, reaching the 50.3% in 2011/2012 immunisation season and falling to 42.2% in the following year. Coverage rates increased with increasing age, without achieving the 75% target, neither in over 65 years old subjects. The logistic regression analysis showed that influenza coverage rates were statistically significant different (p < 0.0001, 0.003 only for category of disease in 2011/2012 immunisation season) according to age, district of residence, category of chronic heart disease and length of exemption, but not influenced by gender.ConclusionsThe recommendation of influenza immunisation was weakly followed in individuals with chronic heart diseases. A collaboration between cardiologists, GPs, scientific societies and patient associations could successfully support influenza vaccine uptake.

Associations Between Arterial Stiffness Indices and Chronic Kidney Disease Categories in Essential Hypertensive Patients.

This study investigated the association between arterial stiffness indices and asymptomatic chronic kidney disease (CKD) risk categories in hypertensive patients. Arterial stiffness indices, including 24-hour brachial and aortic systolic blood pressure (SBP) and pulse wave velocity (PWV), were measured by an oscillometric Mobil-O-Graph device, brachial-ankle PWV (baPWV) by a volume-plethysmographic method, and renal resistive index (RI) by ultrasonography, in 184 essential hypertensive patients (66.0 ± 17.1 years, 47.3% male). CKD was categorized into 3 stages based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using a combination of estimated glomerular filtration and albuminuria. The 24-hour aortic PWV (aPWV), baPWV, and RI increased with worsening severity of CKD risk category (all P < 0.01 for trend). Multivariate logistic regression analysis found that a 1 SD increase of nighttime aortic SBP (odds ratio [OR] 1.52), PWV (OR 4.80), or RI (OR 1.75) was an independent predictor of high or very-high CKD stage (all P < 0.05). After adjustment for potential confounders, day-to-night change in brachial SBP as well as in aPWV differed among groups (P < 0.05, respectively). In a multivariate regression model, day-to-night changes in aortic SBP and PWV, and RI were independently associated with day-to-night brachial SBP change. In hypertension, circadian hemodynamics in high CKD stage are characterized by higher nighttime values of aortic SBP and PWV and disturbed intrarenal hemodynamics. Further, the blunted nocturnal BP reduction in these patients might be mediated via disturbed intrarenal hemodynamics and circadian hemodynamic variation in aortic SBP and arterial stiffness.

Sodium bicarbonate to improve physical function in patients over 60 years with advanced chronic kidney disease: the BiCARB RCT.

Advanced chronic kidney disease is common in older people and is frequently accompanied by metabolic acidosis. Oral sodium bicarbonate is used to treat this acidosis, but evidence is lacking on whether or not this provides a net gain in health or quality of life for older people. The objectives were to determine whether or not oral bicarbonate therapy improves physical function, quality of life, markers of renal function, bone turnover and vascular health compared with placebo in older people with chronic kidney disease and mild acidosis; to assess the safety of oral bicarbonate; and to establish whether or not oral bicarbonate therapy is cost-effective in this setting. A parallel-group, double-blind, placebo-controlled randomised trial. The setting was nephrology and geriatric medicine outpatient departments in 27 UK hospitals. Participants were adults aged ≥ 60 years with advanced chronic kidney disease (glomerular filtration rate category 4 or 5, not on dialysis) with a serum bicarbonate concentration of < 22 mmol/l. Eligible participants were randomised 1 : 1 to oral sodium bicarbonate or matching placebo. Dosing started at 500 mg three times daily, increasing to 1 g three times daily if the serum bicarbonate concentration was < 22 mmol/l at 3 months. The primary outcome was the between-group difference in the Short Physical Performance Battery score at 12 months, adjusted for baseline. Other outcome measures included generic and disease-specific health-related quality of life, anthropometry, 6-minute walk speed, grip strength, renal function, markers of bone turnover, blood pressure and brain natriuretic peptide. All adverse events were recorded, including commencement of renal replacement therapy. For the health economic analysis, the incremental cost per quality-adjusted life-year was the main outcome. In total, 300 participants were randomised, 152 to bicarbonate and 148 to placebo. The mean age of participants was 74 years and 86 (29%) were female. Adherence to study medication was 73% in both groups. A total of 220 (73%) participants were assessed at the 12-month visit. No significant treatment effect was evident for the primary outcome of the between-group difference in the Short Physical Performance Battery score at 12 months (-0.4 points, 95% confidence interval -0.9 to 0.1 points; p = 0.15). No significant treatment benefit was seen for any of the secondary outcomes. Adverse events were more frequent in the bicarbonate arm (457 vs. 400). Time to commencement of renal replacement therapy was similar in both groups (hazard ratio 1.22, 95% confidence interval 0.74 to 2.02; p = 0.43). Health economic analysis showed higher costs and lower quality of life in the bicarbonate arm at 1 year, with additional costs of £564 (95% confidence interval £88 to £1154) and a quality-adjusted life-year difference of -0.05 (95% confidence interval -0.08 to -0.01); placebo dominated bicarbonate under all sensitivity analyses for incremental cost-effectiveness. The trial population was predominantly white and male, limiting generalisability. The increment in serum bicarbonate concentrations achieved was small and a benefit from larger doses of bicarbonate cannot be excluded. Oral sodium bicarbonate did not improve a range of health measures in people aged ≥ 60 years with chronic kidney disease category 4 or 5 and mild acidosis, and is unlikely to be cost-effective for use in the NHS in this patient group. Once other current trials of bicarbonate therapy in chronic kidney disease are complete, an individual participant meta-analysis would be helpful to determine which subgroups, if any, are more likely to benefit and which treatment regimens are more beneficial. Current Controlled Trials ISRCTN09486651 and EudraCT 2011-005271-16. The systematic review is registered as PROSPERO CRD42018112908. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 27. See the NIHR Journals Library website for further project information.

Perceived self-efficacy and self-managing of chronic diseases among elderly patients in a clinic setting: how capable are elders in promoting their own health?

Introduction: Non-communicable diseases and elderly population are on the rise worldwide. It has created a massive burden on health systems, economies and society. Sri Lanka is no exception. The situation indicates the need for risk factor prevention and control through effective behaviour change programmes. Self-efficacy is postulated as fundamental to achieve behaviour change of individuals to fill the present gap of risk factor control. Objectives: To assess the perceived self-efficacy in managing chronic diseases to provide an insight into how confident the elderly are in self-managing their diseases Methods: A hospital-based descriptive cross-sectional study was conducted among elderly patients attending the medical clinic at BH Mulleriyawa. By systematic sampling method, 461 eligible patients diagnosed with one or more five major chronic disease categories were selected. An interviewer-administered chronic disease selfefficacy questionnaire validated for Western countries was used to collect data. Mean perceived self-efficacy score was calculated by adding scores of 10 domains. Adjusted odds ratios (AOR) with 95% confidence interval (CI) were calculated to find associations with the control of risk factors. Results: The response rate was 92% (n=424). The study population had a mean perceived self-efficacy score of 3.64 (SD=0.54) out of 5. The existence of multiple co-morbidities among the elderly was significantly associated with perceived self-efficacy (p=0.02). Respondents with a single disease showed ‘good’ perceived self-efficacy compared to those with two or more co-morbidities. With respect to disease control status, a statistically significant association was found between ‘good’ perceived self-efficacy and blood pressure control ( Conclusions: The elderly patients’overall perceived self-efficacy level was found to be well above the average. Targeted interventions to improve self-efficacy may have a beneficial effect on disease control factors such as blood pressure. Further research studies are needed to longitudinally assess the temporality of perceived selfefficacy and its determinants.

Uninsured citizens in the period of the Greek economic crisis: Health, income, housing. The case of an Attica Region Municipality.

Introduction: In Greece, the implementation of the Fiscal Adjustment Programs was combined with policies of economic austerity resulting in high levels of unemployment and exclusion from health insurance for a large proportion of the population. Aim: This study explores the demographic and socio-economic characteristics and the health status of the uninsured citizens in one of the biggest Municipalities in Attica region. The study covers the period 2012-2016, during the economic crisis in Greece. Methods: Data stemming from official documents, from individual files of 1,738 uninsured citizens were processed. Possible associations between population characteristics and chronic disease categories were examined, using the chi-square test and univariable/multivariable analysis for chronic disease as an outcome. Results: Almost forty-two percent (41.7%) of the study population suffered from a chronic disease; with the 48% of those patients having zero real annual income and 60.4% being hosted by a relative or an acquaintance. Of the sample diagnosed with a mental illness 71% lived as guests to friends or relatives. Diagnosis with cancer appeared to be more related to zero income, compared to other chronic disease categories (72.7%, p &lt;0.001). In the multivariable model, male gender (OR=1.70 95% CI: 1.35-2.13), age (OR=1.03 95% CI: 1.02-1.04) and guest status (OR=1.57 95% CI: 1.24-2.00) were associated with a chronic disease. Conclusions: In Greece, in the midst of the economic crisis, uninsured citizens with chronic illness are called upon to manage their health problem with zero income and housing problems. A key strategy to address such a prospect of further health degradation of the particular population group can only be the strengthening and reorganization of the provision of social protection and health services around a primary care model developed and functioning at community level, with as its basic principle, universal and equal access to it, for all citizens.

P5291Is the obesity paradox in cardiac surgery really a myth? Effect of body mass index on early and late clinical outcomes

Abstract Introduction Obesity has been considered a risk factor for cardiovascular death and for poor outcomes from a variety of surgical procedures, recent studies suggest that overweight (OW) and obese (OB) patients may paradoxically have a better prognosis in cardiac surgery (CS) compared with patients with normal body mass index (BMI). We aimed to investigate the obesity paradox and assess the effect of BMI on early and late clinical outcomes after CS Methods A retrospective cohort study of consecutive patients undergoing CS from January 2007 to January 2019 was carried out. Patients were divided into 4 groups defined by BMI:underweight (UW) (≤18,5 kg/m2):0.5%, n=27; normal weight (NW) (18,5–25 kg/m2): 25.7%, n=1393; OW (25–30 kg/m2): 44.7%, n=2423; OB (≥30 kg/m2): 29.1%, n=1576. Multivariable analyses was used to compare the outcomes among the different BMI groups. Overall 1-year survival of BMI categories were determined by the Kaplan-Meier method. Results We included 5419 patients (72% male, mean age 65,8±12.1). The BMI groups were significantly different regarding pre-surgical variables, UW patients were statistically more comorbid and severe clinical presentation. Categorical mortality was 7% in UW, 5,2% in NW, 3,2% in OW, 4,3% in the OB group, P=0,016. The risk of death according to BMI exhibited a reverse J-shaped curve. Low cardiac output syndrome, medical and surgical bleeding and longer hospital stay was more frequent in the UW group (P&lt;0,05), and mediastinitis, hyperglycemia and prolonged mechanical ventilation in OB group (P&lt;0,05). Univariable regression detected the following significant predictors of in-hospital mortality: Age, female, non-elective surgery, non isolated coronary surgery, vascular peripheral disease, chronic obstructive pulmonary disease, severe left ventricular fraction ejection, chronic renal disease, anemia, stroke, myocardial infarction, heart failure and BMI categories (P&lt;0.05): NW (odds ratio (OR), 1,49; 95% CI: 1,09–1,9, P=0,01), in contrast, OW had a significantly lower risk of death (OR 0,66; 95% CI: 0,5–0,88, P=0,005), with no statistical significance in the UW and OB categories. After adjusting for other risk factors at the multivariate analysis, BMI as a continuous variable was not an independent predictor of in-hospital mortality. One-year follow-up was completed in 95%, during this period 223 (4,12%) died. The analysis of unadjusted long-term mortality did not show a significant difference between BMI categories (P log rank = 0,16). Conclusion In our population OW patients had lower mortality and better outcomes after cardiac surgery. However, when other preoperative variables are taken into account, BMI did not have independent effect on in-hospital and one-year mortality, questioning the existence of an “obesity paradox”. Its effect on mortality could be indirect, being mediated through other comorbidities.

The metabolic syndrome and its components are differentially associated with chronic diseases in a high-risk population of 350 000 adults: A cross-sectional study.

We compared strengths of associations conferred by the metabolic syndrome (MetS) and its components across four chronic disease categories (cancer, cardiovascular diseases [CVDs], chronic kidney disease [CKD], and chronic obstructive pulmonary disease [COPD]) in a community-dwelling high-risk population. This is a cross-sectional analysis of Israeli adults insured in a single health maintenance organization during 2010 to 2013 and having greater than or equal to two MetS components (hypertension, dysglycemia, low high-density lipoprotein level, high plasma triglyceride level, and obesity). Data regarding MetS components, chronic disease prevalence, and sociodemographic variables were retrieved from electronic health records and disease registries. Among 347 244 eligible members, 54.2% had MetS. MetS was negatively associated with cancer, (prevalence ratio [PR]=0.86; 95% confidence interval, 0.79-0.93) and positively associated with CKD (PR=1.07, [1.01-1.13]). Some MetS components conferred different associations across the chronic diseases: a high triglyceride level was positively associated with cancer (PR=1.15, 1.12-1.18) and CKD (PR=1.37, 1.32-1.41) but negatively associated with CVD (PR=0.88, 0.86-0.90) and COPD (PR=0.93, 0.88-0.98). In the presence of MetS, those with dysglycemia had higher cancer prevalence than those with normoglycemia (PR-interaction MetS*dysglycemia on cancer=1.14, 1.06-1.22). Likewise, in the presence of MetS, men were more likely than women to present with CVD (PR-interaction MetS*sex on CVD=1.12, [1.05-1.20]). Prevalences of the MetS and MetS components distribute unequally across four chronic diseases. MetS including dysglycemia may warrant screening for cancer, and MetS in males may indicate the presence of CVD. Longitudinal studies may reveal if MetS is associated with different risks or merely indicates better prognosis once having a chronic illness.

Characteristics of Adults With Type 2 Diabetes Mellitus by Category of Chronic Kidney Disease and Presence of Cardiovascular Disease in Alberta Canada: A Cross-Sectional Study.

Background:Type 2 diabetes mellitus (T2DM) is associated with an excess risk of cardiovascular disease (CVD) and chronic kidney disease (CKD). Although CVD, CKD, and use of antihyperglycemic treatments are all key drivers of the costs and consequences experienced by people with diabetes, no recent Canadian data describe these characteristics among adults with diabetes.Objective:To describe prevalence of CVD, CKD, and use of antihyperglycemic treatments among adults with diabetes.Design:Retrospective population-based, cross-sectional study.Setting:Alberta, Canada.Patients:All adults with T2DM as of March 31, 2017.Measurements:We described the demographic and clinical characteristics by CKD stage and CVD status and type. CKD stage was categorized according to international guidelines and based on estimated glomerular filtration rate (eGFR) and severity of albuminuria.Methods:Clinical and demographic characteristics were defined using provincial administrative data; medication use was based on data from the provincial drug plan. Additional analyses examined subgroups based on demographic characteristics, clinical characteristics, and medication use.Results:There were 260 903 participants, all of whom had T2DM. Median age was 64 years; 53.6% were male; and 10.9% lived in rural communities. Median duration of diabetes was 7.7 years. Half of the participants had A1C <7%. Overall, 33.0% had CKD; among these most had eGFR <60 mL/min/1.73 m2; 11.1%, 5.6%, and 2.9% had CKD stages 3a, 3b, and 4/5, respectively. The overall prevalence of CVD (prior myocardial infarction, stroke/transient ischemic attack, or peripheral artery disease) was 22.5%; prevalence increased in parallel with the presence of CKD: 14.4%, 28.8%, 35.7%, 44.3%, and 50.9% for stages 1, 2, 3a, 3b, and 4/5, respectively. Prescriptions for antihyperglycemic medications were more common in people with CKD as compared with those without. However, the use of all antihyperglycemic medications except insulin and meglitinide was progressively lower in the presence of more severe CKD.Limitations:The study is based on administrative data; therefore, the findings could be influenced by measurement error (eg, accuracy of diagnostic and procedural codes and prescription drug codes used).Conclusions:These findings will be useful to policy makers seeking to understand the burden of diabetes-related kidney disease as well as the potential budget implications and potential clinical benefits of expanded use of antihyperglycemic use in this population.

Evaluating a Media Strategy to Provide Health Messages to Medically Underserved Populations

For nearly every category of chronic disease, blacks with African American ancestry (AAs) bear a disproportionate disease burden in comparison to their non-Hispanic white (NHW) counterparts. The purpose of this study was to evaluate perceptions of a radio-based health communication strategy, geared towards AA adults and the medically underserved. The radio broadcast, titled “Closing the Gap in Healthcare, Inc. (CGHI),” is delivered by a well-known AA male physician in South Carolina. The mission of CGHI is to decrease health disparities in a four-county area of the South Carolina coastal region, defined as the “Lowcountry,” by providing evidence-based health information to a broad community audience via radio broadcast messaging. To evaluate the impact of the CGHI, investigators conducted 12 focus groups (FGs) with community members from the broadcast coverage area to evaluate responses to FG questions based on 11 attributes of effective health communication. Potential FG participants were identified/recruited via a South Carolina-based marketing firm. The FGs conducted in the Sea Islands were culturally and racially homogenous. The investigators developed a FG interview guide. Before each FG started, the informed consent process was administered to each participant. Each two-hour FG was digitally recorded.

Aging phenotype(s) in kidneys of diabetic mice are p66ShcA dependent.

The p66ShcA protein controls cellular responses to oxidative stress, senescence, and apoptosis. Here, we test the hypothesis that aging phenotype(s) commonly associated with the broad category of chronic kidney disease are accelerated in diabetic kidneys and linked to the p66ShcA locus. At the organ level, tissue stem cells antagonize senescent phenotypes by replacing old dysfunctional cells. Using established methods, we isolated a highly purified population of stem cell antigen-1-positive mesenchymal stem cells (Sca-1+ MSCs) from kidneys of wild-type (WT) and p66 knockout (p66 KO) mice. Cells were plated in culture medium containing normal glucose (NG) or high glucose (HG). Reactive oxygen species (ROS) metabolism was substantially increased in WT MSCs in HG medium in association with increased cell death by apoptosis and acquisition of the senescent phenotype. DNA microarray analysis detected striking differences in the expression profiles of WT and p66 KO-MSCs in HG medium. Unexpectedly, the analysis for p66 KO-MSCs revealed upregulation of Wnt genes implicated in self-renewal and differentiation. To test the in vivo consequences of constitutive p66 expression in diabetic kidneys, we crossed the Akita diabetic mouse with the p66KO mouse. Homozygous mutation at the p66 locus delays or prevents aging phenotype(s) in the kidney that may be precursors to diabetic nephropathy.

Assessment of the use of ED Chief Complaint Data for monitoring Chronic Diseases

ObjectiveTo create chronic disease categories for emergency department (ED) chief complaint data and evaluate the categories for validity against ED data with discharge diagnoses and hospital discharge data.IntroductionSyndromic Surveillance (SS), traditionally applied to infectious diseases, is more recently being adapted to chronic disease prevention. Its usefulness rests on the large number of diverse individuals visiting emergency rooms with the possibility of real-time monitoring of acute health effects, including effects from environmental events and its potential ability to examine more long-term health effects and trends of chronic diseases on a local level [1-3].MethodsEmergency department chief complaint (CC) data captured by the Cook County Department of Public Health local instance of ESSENCE from Jan 1, 2006 – Dec 31, 2013 was utilized to generate chronic disease categories for: CVD, AMI, ACS, angina, stroke, diabetes, hypertension, asthma, and COPD based on disease symptoms, natural language processing for free text chief complaints, and associated terms present in EMR system menus.A standard category was created for each chronic disease category based on discharge diagnoses (ICD-9 code), and their associated terms. The ICD-9 based categories were applied to the discharge diagnosis field within the ED data. The chief complaint based chronic disease category definitions were compared to the standard classification by determining the sensitivity, specificity, positive predictive value, and negative predictive value.The standard chronic disease categories created with ICD-9 codes for the chronic disease category validation were also applied to Illinois hospital discharge data for Cook County from Jan 1, 2006 – Dec 31, 2013. This data was compared to the chief complaint categories from the ED data for the same time period by visual analysis through time series and strength of correlation by Pearson correlation coefficient analysis. ESSENCE version 1.17 was utilized for the free-text query development and SAS 9.4 was utilized to perform the analyses.ResultsFor the validation analysis, 1,366,525 (24.76%) ED visits of individuals 40 years and older and 867,509 (15.72%) ED visits of individuals less than 18 years of age with a valid chief complaint and discharge diagnosis were included. Validation results are presented in Table 1. Specificity was generally high for most of the categories, with the narrow definitions having a higher specificity (Narrow AMI = 0.9996, Broad AMI = 0.9119). However, the loss in sensitivity is substantial in moving from the broader definition to the narrow definition (Broad AMI = 0.5444, Narrow AMI = 0.1040). The positive predictive values had a wide range from 0.0128 for the Broad ACS category to 0.7199 for the Narrow Asthma definition. The negative predictive values were high for all chronic disease categories ranging from 0.9501 for the Narrow CVD category to 0.9996 for Angina.The Pearson correlation coefficients are presented in Table 2. Graphs showing the comparisons of the chief complaint based ED data to the hospitalization data by chronic disease category definition are presented in Figure 1. Pearson correlations ranged from 0.9323 for Narrow Asthma to 0.1992 for Hypertension.ConclusionsBased on the high specificity and correlation coefficients in comparison to hospital discharge data, emergency department chief complaint data captured with syndromic surveillance could be utilized to examine chronic disease categories: asthma, COPD, CVD, AMI, ACS, stroke, and diabetes at a local, state or national level.

ED visits for AMI, Stroke, ACS &amp; COPD after the Statewide Smoking Ban in Cook Co., IL

ObjectiveTo utilize ED chief complaint data obtained from syndromic surveillance to quantify the effect of the Illinois smoking ban on acute myocardial infarction (AMI), acute coronary syndrome (ACS), stroke, and chronic obstructive pulmonary disease (COPD) related ED visits in adults in Cook County, IL.IntroductionTobacco use is the leading global cause of preventable death, killing more than five million people per year [1]. In addition, exposure to secondhand smoke is estimated to kill an additional 600,000 people globally each year [1]. In 1986, the US Surgeon General’s Report declared secondhand smoke to be a cause of lung cancer in healthy nonsmokers [2].The first law restricting smoking in public places was enacted in 1973 in Arizona that followed the 1972 Surgeon General’s Report providing awareness of the negative health effects associated with the exposure to air pollution from tobacco smoke [3]. Smoke-free laws were slowly enacted after this time point with most occurring after the year 2000 [4].In July 2007, the Smoke Free Illinois Act (SB0500, Public Act 095-0017) was passed in IL [5]. The ban went into effect on Jan 1, 2008 and Illinois joined 22 other states in prohibiting smoking in virtually all public places and workplaces including offices, theaters, museums, libraries, schools, commercial establishments, retail stores, bars, private clubs, and gaming facilities [5-6].While many studies have examined the effect of smoking bans on hospitalizations, this study would be the first to examine the effect of the comprehensive smoking ban in IL on ED visits by utilizing chronic disease categories created with ED chief complaint data captured by syndromic surveillance [7]. The author hypothesizes that the comprehensive smoking ban in IL significantly reduced the ED visits associated with AMI, ACS, stroke, and COPD in adults in Cook County, IL.MethodsED visits with chief complaints consistent with categories for AMI, ACS, stroke and COPD captured by the Cook Co. Dept. of Public Health local instance of ESSENCE from Jan 1, 2006 – Dec 31, 2013 were included in the analysis. Proc Genmod with a log link and negative binomial distribution was utilized for the analysis. All data was aggregated at the monthly level. The total number of ED visits of the health effect of interest was the dependent variable. The total ED visits during the same period of time, was used as the offset variable, sub-grouped by age and gender where appropriate. A binary variable was utilized to capture the effect of the time period after the implementation of the statewide smoking ban; 0 for before the ban and 1 for after the ban. When examining the effect of the statewide ban, Cook Co. as an entirety was examined as well as ED visits stratified by zip codes that already had a smoking ban in place at that time point and those that did not, and stratifying by urban (Chicago) vs. suburban Cook Co. Seasonality was addressed by including month, month squared and month cubed in the model. Influenza was addressed by including a binary variable to indicate when influenza was occurring in the area based on percent influenza-like-illness ED visits that were occurring above the threshold for the area during that time period. Age and gender were also evaluated as confounders and effect modifiers. SAS 9.4 was utilized to perform the analyses.ResultsResults are presented in Table 1. Reductions of ED visits after the smoking ban implementation were seen in AMI and ACS disease categories for the overall adjusted model, at 3% and 3.5% respectively. Stroke associated ED visits were not affected by the smoking ban. COPD associated ED visits were not reduced immediately by the smoking ban, but did have a significant reduction 6 months after implementation of the ban at 3.6%. Stronger effects were seen in individuals 70 years and older, females, the urban population, and zip codes without a prior ban for AMI, ACS, and COPD.ConclusionsAn immediate, significant reduction in ED visits associated with AMI and ACS was associated with the IL statewide smoking ban in Cook Co., IL. COPD associated ED visits were significantly reduced 6 months after the ban implementation. The effect was greater in individuals 70 years and older, females, the urban population, and zip codes without a prior ban.

Accuracy of a New Algorithm to Identify Asthma–COPD Overlap (ACO) Patients in a Cohort of Patients with Chronic Obstructive Airway Disease

ObjectivesWe aimed to characterize the clinical, functional and inflammatory features of patients diagnosed diagnosed with ACO according to a new algorithm and to compare them with those of other chronic obstructive airway disease (COAD) categories (asthma and COPD). MethodsACO was diagnosed in a cohort of COAD patients in those patients with COPD who were either diagnosed with current asthma or showed significant blood eosinophilia (≥300cells/μl) and/or a very positive bronchodilator response (>400ml and >15% in FEV1). ResultsEighty-seven (29.8%) out of 292 patients fulfilled the ACO diagnostic criteria (12.8% asthmatics who smoked <20 pack-years, 100% of asthmatics who smoked ≥20 pack-years, 47.7% of COPD with >200eosinophils/μl in blood and none with non-eosinophilic COPD). ACO, asthma and COPD patients showed no differences in symptoms or exacerbation rate. Mean pre-bronchodilator FEV1 in ACO and asthma were similar (1741 vs 1771ml), higher than in COPD (1431ml, p<0.05). DLCO was lower in ACO than in asthma (68.1 vs 84.1%) and similar to COPD (64.5%). Mean blood eosinophil count was similar in ACO and asthma (360 vs 305cells/μl) and higher than in COPD (170cells/μl). Periostin levels were similar in ACO to COPD (36.6 and 36.5IU/ml) and lower than in asthma (41.5IU/ml, p<0.05), whereas FeNO levels in ACO were intermediate. ConclusionThis algorithm classifies as ACO all smoking asthmatics with non-fully reversible airway obstruction and a considerable proportion of e-COPD patients, highlighting those who can benefit from inhaled corticosteroids.

The multimorbidity cluster analysis tool: identifying combinations and permutations of multiple chronic diseases using a record-level computational analysis

IntroductionMultimorbidity, or the co-occurrence of multiple chronic health conditions within an individual, is an increasingly dominant presence and burden in modern health care systems. To fully capture its complexity, further...

Accuracy of a New Algorithm to Identify Asthma–COPD Overlap (ACO) Patients in a Cohort of Patients with Chronic Obstructive Airway Disease

ObjectivesWe aimed to characterize the clinical, functional and inflammatory features of patients diagnosed diagnosed with ACO according to a new algorithm and to compare them with those of other chronic obstructive airway disease (COAD) categories (asthma and COPD). MethodsACO was diagnosed in a cohort of COAD patients in those patients with COPD who were either diagnosed with current asthma or showed significant blood eosinophilia (≥300cells/μl) and/or a very positive bronchodilator response (>400ml and >15% in FEV1). ResultsEighty-seven (29.8%) out of 292 patients fulfilled the ACO diagnostic criteria (12.8% asthmatics who smoked <20 pack-years, 100% of asthmatics who smoked ≥20 pack-years, 47.7% of COPD with >200eosinophils/μl in blood and none with non-eosinophilic COPD). ACO, asthma and COPD patients showed no differences in symptoms or exacerbation rate. Mean pre-bronchodilator FEV1 in ACO and asthma were similar (1741 vs 1771ml), higher than in COPD (1431ml, p<0.05). DLCO was lower in ACO than in asthma (68.1 vs 84.1%) and similar to COPD (64.5%). Mean blood eosinophil count was similar in ACO and asthma (360 vs 305cells/μl) and higher than in COPD (170cells/μl). Periostin levels were similar in ACO to COPD (36.6 and 36.5IU/ml) and lower than in asthma (41.5IU/ml, p<0.05), whereas FeNO levels in ACO were intermediate. ConclusionThis algorithm classifies as ACO all smoking asthmatics with non-fully reversible airway obstruction and a considerable proportion of e-COPD patients, highlighting those who can benefit from inhaled corticosteroids.