Changes In Disease Prevalence Research Articles

Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050-Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association.

Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial. Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, we estimated trends in prevalence for cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke. We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics. We estimate that among adults, prevalence of hypertension will increase from 51.2% in 2020 to 61.0% in 2050. Diabetes (16.3% to 26.8%) and obesity (43.1% to 60.6%) will increase, whereas hypercholesterolemia will decline (45.8% to 24.0%). The prevalences of poor diet, inadequate physical activity, and smoking are estimated to improve over time, whereas inadequate sleep will worsen. Prevalences of coronary disease (7.8% to 9.2%), heart failure (2.7% to 3.8%), stroke (3.9% to 6.4%), atrial fibrillation (1.7% to 2.4%), and total cardiovascular disease (11.3% to 15.0%) will rise. Clinical CVD will affect 45 million adults, and CVD including hypertension will affect more than 184 million adults by 2050 (>61%). Similar trends are projected in children. Most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic. The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years. Clinical and public health interventions are needed to effectively manage, stem, and even reverse these adverse trends.

111 Interspinous Process Device Utilization and Reimbursement Vary by Provider Specialty and Care Setting

INTRODUCTION: Interspinous process devices (IPDs) are a popular less invasive treatment option for lumbar degenerative disease. Studies suggest they may yield initial symptomatic relief but are not better than traditional surgery in improving function or quality of life and may increase reoperation and costs. Ideal indications remain contested. METHODS: Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary data sets (2017-2020) were queried by CPT codes for lumbar interlaminar/interspinous process stabilization/distraction devices without fusion. Utilization rates were normalized per 10,000 lumbar fusions. RESULTS: IPD utilization increased by 329% from 2017-2020. Percutaneous IPD utilization increased to 31.8 (+1,267%), while open procedures decreased to 4.4 (-27%). Pain management/anesthesia placed the majority of IPDs and increased utilization the most (27.4, +1,387%). Physical medicine and rehabilitation (PM&R) had the second-highest rate of utilization (3.5, +1,492%). Neurosurgery (2.3, -15%) and orthopedics (0.7, -63%) decreased utilization. Ambulatory surgical centers (ASCs) increased utilization the most (25.8, +907%). Outpatient procedures increased (9.2, +162%), while inpatient procedures decreased (1.2, -49%). IPD reimbursements decreased to $400 (-44.6%), with decreasing trends in percutaneous ($364, -28.6%) and open placement ($776, -6.8%). Reimbursements were highest for orthopedics ($800, +0.6%) and lowest for pain management/anesthesiology ($362, -26.7%). Reimbursements decreased across all settings, especially outpatient (-48.8%) and inpatient (-35.9%). CONCLUSIONS: Despite uncertainty of indications for IPDs, utilization increased by 329% when normalized to lumbar fusions to account for changes in disease prevalence. IPDs are increasingly placed by PM&R and pain management in ASCs and outpatient settings. Utilization does not seem to be driven by reimbursement rates. It is unknown how the rapid increase in IPDs has affected clinical outcomes. Given the magnitude of increased utilization and limited data on the safety and efficacy of IPDs, closer examination of indications is warranted.

National trends in rheumatoid arthritis and osteoarthritis prevalence in South Korea, 1998–2021

Studies on the trends in the prevalence of rheumatoid arthritis (RA) and osteoarthritis (OA) are limited, particularly during the COVID-19 pandemic. This study aimed to analyze the temporal trend of RA and OA in South Korean adults from 1998 to 2021, including the COVID-19 pandemic period. The Korea National Health and Nutrition Examination Survey (KNHANES) data on adults aged ≥ 19 years were analyzed to investigate the prevalence of RA and OA from 1998 to 2021. The prevalence trends were compared by the years, and βdiff (β difference) was calculated. Odds ratios (ORs) were computed for each disease to examine changes in disease prevalence before and during the pandemic in order to determine the impact of the pandemic on disease prevalence. Among 163,221 Korean adults, the prevalence of RA and OA showed a steady decrease from 2005 (RA: from 1.91% in 2005–2007 to 1.55% in 2016–2019 and OA: from 9.75% in 2005–2007 to 8.27% in 2016–2019), but there was a slight increased after the onset of the COVID-19 pandemic (RA: from 1.23% in 2020 to 1.36% in 2021 and OA: from 8.04% in 2020 to 8.27% in 2021). Vulnerable groups, including participants aged ≥ 60 years (versus 19–60 years, ratio of ORs: 1.222; 95% CI 1.011–1.477), urban residents (ratio of ORs: 1.289; 95% CI 1.007–1.650), and participants with higher education level (ratio of ORs: 1.360; 95% CI 1.119–1.653) showed higher ORs of OA, whereas no particularly vulnerable population was observed for RA. Our findings provide an insight into the long-term trends of RA and OA among adult population and highlight a novel perspective on the impact of COVID-19 on disease prevalence.

What drives health care spending in Switzerland? Findings from a decomposition by disease, health service, sex, and age

BackgroundHigh and increasing spending dominates the public discussion on healthcare in Switzerland. However, the drivers of the spending increase are poorly understood. This study decomposes health care spending by diseases and other perspectives and estimates the contribution of single cost drivers to overall healthcare spending growth in Switzerland between 2012 and 2017.MethodsWe decompose total healthcare spending according to National Health Accounts by 48 major diseases, injuries, and other conditions, 20 health services, 21 age groups, and sex of patients. This decomposition is based on micro-data from a multitude of data sources such as the hospital inpatient registry, health and accident insurance claims data, and population surveys. We identify the contribution of four main drivers of spending: population growth, change in population structure (age/sex distribution), changes in disease prevalence, and changes in spending per prevalent patient.ResultsMental disorders were the most expensive major disease group in both 2012 and 2017, followed by musculoskeletal disorders and neurological disorders. Total health care spending increased by 19.7% between 2012 and 2017. An increase in spending per prevalent patient was the most important spending driver (43.5% of total increase), followed by changes in population size (29.8%), in population structure (14.5%), and in disease prevalence (12.2%).ConclusionsA large part of the recent health care spending growth in Switzerland was associated with increases in spending per patient. This may indicate an increase in the treatment intensity. Future research should show if the spending increases were cost-effective.

Colonization and Extirpation of Great Black-Backed Gulls (Larus marinus) Nesting on Lake Ontario and the Upper St. Lawrence River

Colonies of Herring (Larus argentatus) and/or Ring-billed Gulls (L. delawarensis) on Lake Ontario and the upper St. Lawrence River were searched annually, 1981–2018, for nesting Great Black-backed Gulls (L. marinus). Great Black-backed Gulls nested at nine sites where both Herring and Ring-billed Gulls nested, at seven sites with only Herring Gulls, and at one site where they nested solitarily. Nests per site ranged from 1–21 on Lake Ontario and 1–5 on the St. Lawrence River. On Lake Ontario, nest numbers increased from six nests in 1981 to 51 nests in 2001 (+ 11.3%/yr), then declined to zero nests in 2008, where they have remained ever since. The decline in nesting Great Black-backed Gulls was due primarily to mortality from Type E botulism that affected that species to a greater degree than other gull species, probably because of their superior ability to dominate and scavenge toxin-laden carrion. Temporal changes in routes and efficiency of botulinum toxin transfer likely explain why Great Black-back Gulls were initially able to colonize Lake Ontario, but have undergone extirpation in recent times. Our results illustrate how changes in disease prevalence in the Great Lakes can degrade environmental quality to the extent that some species simply cannot persist.

Monitoring the burden of disease in Scotland and the contribution of risk factors

Abstract Background The Scottish Burden of Disease (SBoD) Study monitors the contribution of over 100 diseases and injuries to the population health in Scotland, in the context of disability-adjusted life years (DALYs). Providing robust estimates of burden is the first step in identifying areas of prevention which could have the biggest impact on health; including identification of modifiable risk factors and changes in the underlying risk factor prevalence. Our aim was to estimate DALYs for 2019, to describe the current burden in Scotland and as a baseline for future burden scenarios. Methods The SBoD 2016 study estimated the burden using routine data and patient-level record linkage. For this update, years lived with disability were estimated using 2016 age-sex-deprivation specific rates, assuming no change in disease prevalence from 2016, but taking account of changes to the population structure. Years of life lost were calculated from 2019 observed deaths and the application of the Global Burden of Disease (GBD) aspirational life table. Population attributable fractions (PAFs) were sourced from the GBD 2019 and risk factor prevalence from the Scottish Health Survey. Results In 2019 the leading causes of burden were ischaemic heart disease (IHD), Alzheimer's/other dementias, lung cancer, drug-use disorders and cerebrovascular disease, representing over a quarter (27%) of the total DALYs in Scotland. Application of PAFs shows that a proportion of the burden for each of these causes can be attributed to modifiable risk factors. Conclusions IHD continues to be the leading cause of health burden in Scotland in 2019. However recent years show an increase in burden of social causes and diseases affecting the ageing population. Application of PAFs demonstrate the importance of continuing to monitor both the burden of disease in Scotland and the prevalence of risk factors, to provide robust evidence for planning of local and national services. Key messages • The Scottish Burden of Disease continues to monitor the population health landscape of Scotland. • Ischaemic heart disease continues to be the leading cause of burden in Scotland.

Pathway-specific population attributable fractions.

A population attributable fraction represents the relative change in disease prevalence that one might expect if a particular exposure was absent from the population. Often, one might be interested in what percentage of this effect acts through particular pathways. For instance, the effect of a sedentary lifestyle on stroke risk may be mediated by blood pressure, body mass index and several other intermediate risk factors. We define a new metric, the pathway-specific population attributable fraction (PS-PAF), for mediating pathways of interest. PS-PAFs can be informally defined as the relative change in disease prevalence from an intervention that shifts the distribution of the mediator to its expected distribution if the risk factor were eliminated, and sometimes more simply as the relative change in disease prevalence if the mediating pathway were disabled. A potential outcomes framework is used for formal definitions and associated estimands are derived via relevant identifiability conditions. Computationally efficient estimators for PS-PAFs are derived based on these identifiability conditions. Calculations are demonstrated using INTERSTROKE-an international case-control study designed to quantify disease burden attributable to a number of known causal risk factors. The applied results suggest that mediating pathways from physical activity through blood pressure, blood lipids and body size explain comparable proportions of stroke disease burden, but a large proportion of the disease burden due to physical inactivity may be explained by alternative pathways. PS-PAFs measure disease burden attributable to differing mediating pathways and can generate insights into the dominant mechanisms by which a risk factor affects disease at a population level.

Quantifying the burden of disease in Scotland in 2018: a Scottish Burden of Disease study

Abstract Background The Scottish Burden of Disease (SBoD) Study monitors the contribution of over 100 diseases and injuries to the population health in Scotland. Providing robust estimates of the burden is important as recent evidence has highlighted stalling life expectancy and worsening trends in self-assessed general health and understanding the burden of disease is the first step in identifying areas of prevention which could have the biggest impact on health. Our aim was to estimate disability-adjusted life years (DALYs) for 2018, for all causes of disease and injury. Methods The SBoD 2016 study estimated the burden for 132 causes of injury and disease using routine data and patient-level record linkage. For this update, years lived with disability were estimated using 2016 age-sex-deprivation specific rates, assuming no change in disease prevalence from 2016, but taking account of changes to the population structure. Years of life lost were calculated from 2018 observed deaths and the application of the Global Burden of Disease aspirational life table. Results In 2018 the leading causes of burden were ischaemic heart disease, Alzheimer's/other dementias, lung cancer, drug-use disorders and cerebrovascular disease, representing over a quarter (27%) of the total DALYs in Scotland. Of the 10 leading causes of disease burden, four are wholly attributable to ill-health, demonstrating the added-value of considering DALYs in conjunction with traditional measures of mortality and morbidity. Conclusions Ischaemic heart disease continues to be the leading cause of burden of disease in Scotland, however recent years show an increase in burden of social causes and diseases primarily affecting the ageing population. These changes in leading causes demonstrate the importance of continuing to monitor the burden of disease in Scotland, to provide robust evidence for planning of local and national services. Key messages The study demonstrates the added-value of considering the burden of disease, in conjunction with traditional measures of morbidity and mortality. Ischaemic heart disease continues to be the leading cause of burden of disease in Scotland.

Mortality and Morbidity Among Persons Deprived of Liberty During the COVID-19 Pandemic in Brazil.

Health EquityVol. 5, No. 1 Letter to the EditorOpen AccessCreative Commons licenseMortality and Morbidity Among Persons Deprived of Liberty During the COVID-19 Pandemic in BrazilMatheus Lins-Rocha, Liliane Lins-Kusterer, José Menezes, and Ailton MeloMatheus Lins-Rocha*Address correspondence to: Matheus Lins-Rocha, ML, Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Rua Doutor Augusto Viana, S/N—Canela, Salvador 40110-060, Brazil, E-mail Address: matheuslins@linselins.com.brhttps://orcid.org/0000-0002-8682-0901Postgraduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil.Postgraduate Program in Law, Governance and Public Policy, Salvador University—UNIFACS, Salvador, Brazil.Search for more papers by this author, Liliane Lins-Kustererhttps://orcid.org/0000-0003-3736-0002Postgraduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil.Search for more papers by this author, José Menezeshttps://orcid.org/0000-0001-7839-7931Postgraduate Program in Law, Governance and Public Policy, Salvador University—UNIFACS, Salvador, Brazil.Search for more papers by this author, and Ailton Melohttps://orcid.org/0000-0001-7457-0573Postgraduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil.Search for more papers by this authorPublished Online:20 Aug 2021https://doi.org/10.1089/heq.2021.0057AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Dear Editor:In Brazil, persons deprived of liberty (PDL) have a high risk of COVID-19 infection due to the overcrowded and deficiently ventilated cells, restricted access to basic sanitation, and a lack of health units.1 Brazilian health services in prisons should be distributed according to the prison population and organized following the national primary care model, achieving the universality of the Unified Health System and guaranteeing the constitutional right to health for prisoners.2 Brazilian prisons present considerable challenges for the implementation of preventive health policies. A recent ecological study evaluated the five Brazilian macro-regions, including the Federal District. Results showed 14 spatial risk clusters for COVID-19 among PDL, and the highest-risk cluster was in the Federal District.1The health of PDL is not an object of great concern by society. The provision of specialized health services has declined during the COVID-19 pandemic in Brazil. In this context, a similar or even worse situation is expected to occur concerning the health of Brazilian prisoners. We compared general morbidity and mortality of prisoners in the State of Bahia, Brazil, in the second half of 2019 and the first half of 2020.A retrospective study analyzed data from the Brazilian Penitentiary statistical information system (INFOPEN),3 for the State of Bahia, Brazil, concerning periods before (second half of 2019) and at the beginning of (first half of 2020) the COVID-19 pandemic. Prevalence of specific diseases and mortality rates for the two semesters were compared by using the OpenEpi tool (www.OpenEpi.com).4Comparing the two semesters, the prevalence of other causes of illness increased substantially among men (13.1 times) and women (5.98 times). A decrease (29%) in the prevalence of tuberculosis among men was also observed. Mortality by criminal causes and suicide increased 7.92 and 3.17 times among men, comparing semesters before and during the COVID-19 pandemic. Women accounted for 2.8% and 3.3% of the prisoners' total populations, in the first half of 2019 and 2020, respectively. There was only one case of death in the first half of 2020 (Table 1).Table 1. Prevalence (per 10,000) of Diseases and Mortality (per 100,000) per Cause in Persons Deprived of Liberty According to Sex and Semester, State of Bahia, BrazilDisease/sex2019 (second half)2020 (first half)PR (2020.1/2019.2)95% CInPrevalencenPrevalenceMale (n=14,687)Male (n=13,911) Hepatitis5940.26848.91.210.85–1.72 HIV155105.5145104.20.980.78–1.23 Syphilis422287.3374268.90.930.81–1.07 Tuberculosis169115.111582.70.710.57–0.91 Others96.111280.513.16.67–25.90Female (n=421)Female (n=469) Hepatitis247.5121.30.450.04–4.93 HIV10237.510213.20.900.38–2.13 Syphilis18427.525533.01.250.69–2.25 Tuberculosis247.500.0—— Others371.320426.45.981.79–20.0Cause2019 (second half) (n=14,687)2020 (first half) (n=13,911)MRR (2020.1/2019.2)95% CInMortalitynMortalityMale Health causes854.514100.61.850.77–4.40 Suicide213.6643.13.170.64–15.70 Criminal427.230215.77.922.80–22.47 Unknown427.2321.60.790.18–3.54 Total18122.653381.03.111.82–5.30Source: Sistema de Informações do Departamento Penitenciário Nacional, 2019.MRR, mortality rate ratio; PR, prevalence ratio..A report issued by the Catholic Church in Brazil entitled The Pandemic of Torture in Prison, published by the Prison Ministry Office of the Bishops' Conference of Brazil, registered 90 complaints of ill treatment. The complaints included physical abuse, humiliating treatments, deprivations, and violations of the constitutional right to health care in PDL.5,6 Most of the complaints were ignored by judiciary authorities. Of the 90 reported complaints, only 8 were followed by an investigation.6The advent of the COVID-19 pandemic was associated with changes in disease prevalence and mortality among PDL in the State of Bahia penitentiary system. We emphasize the increase of violent deaths, reflecting the stressful situation of the inmates. Public Policies for PDL need to be effective in reducing the number of crimes or enabling the reintegration of prisoners into society. They should also include health accessibility, and guarantee constitutional humans rights, preventing violence and torture.

Variation in the prices of oncology medicines across Europe and the implications for the future

Introduction/Objectives: Health authorities are facing increasing challenges to the sustainability of their healthcare systems because of the growing expenditures on medicines, including new, high-priced oncology medicines, and changes in disease prevalence in their ageing populations. Medicine prices in European countries are greatly affected by the ability to negotiate reasonable prices. Concerns have been expressed that prices of patented medicines do not fall sufficiently after the introduction of lower-cost generic oncology medicines. The objective of this study was to examine the associations over time in selected European countries between the prices of oral oncology medicines, population size, and gross domestic product (GDP) before and after the introduction of generic versions. Evidence of periodic reassessments of the price, value, and place in treatment of these medicines was also looked for. The goal of this review was to stimulate debate about possible improvements in approaches to reimbursement negotiations. Methodology: Analysis was performed of reimbursed prices of three oral oncology medicines (imatinib, erlotinib and fludarabine) between 2013 and 2017 across Europe. Correlations were explored between GDP, population size, and prices. Findings were compared with previous research regarding prices of generic oral oncology medicines. Results: The prices of imatinib, erlotinib and fludarabine varied among European countries, and there was limited price erosion over time in the absence of generics. There appeared to be no correlation between population size and price, but higher prices of on-patent oral cancer medicines were seen among countries with higher GDP per capita. Conclusion: Limited price erosion for patented medicines contributed to increases in oncology medicine budgets across the region. There was also a concerning lack of evidence re-assessments of the price, value, and place in treatment of patented oncology medicines following the loss of patent protection of standard medicines. The use of such proactive re-assessments in negotiating tactics might positively impact global expenditures for oncology medicines.

Is vaccination a viable method to control Johne's disease caused by Mycobacterium avium subsp. paratuberculosis? Data from 12 million ovine vaccinations and 7.6 million carcass examinations in New South Wales, Australia from 1999-2009.

Mycobacterium avium subsp. paratuberculosis (MAP) causes Johne's disease (or paratuberculosis), a chronic wasting disease of ruminants and other animals resulting from granulomatous enteritis. There are increasing concerns that MAP is zoonotic. The prevalence of Johne's disease is increasing worldwide. In an attempt to control an epidemic of ovine Johne's disease (OJD) in New South Wales (NSW), a government/industry sponsored voluntary vaccination/on-farm management program commenced in 2000. We report herein an observational study of changes in disease prevalence as vaccination progressed, based on abattoir surveillance data for OJD from 1999 to 2009. We also discuss the epidemiological, policy, regulatory, research, economic and sociological elements that contributed to the development of a mature control program, whose aim was to halt the epidemic spread of OJD in a naïve sheep population. NSW was divided into areas of "High" (HPA), "Medium" (MPA) and "Low" (LPA) OJD prevalence. A killed whole cell vaccine (Gudair®) was administered to sheep from 2000 to 2009. Trained examiners evaluated the viscera of adult sheep carcasses at slaughter for gross evidence of OJD. MAP infection was confirmed by histopathology. From 2000-2009, 12 million vaccine doses were administered in NSW (91%; 10.9 million in the HPA). Many of the vaccinated flocks were suffering > 5% annual mortality in adult sheep, with some individual flocks with 10-15% losses attributable to OJD. A total of 7.6 million carcasses were examined (38%; 2.9 million from the HPA). Overall, 16% of slaughter consignments (sheep consigned to the abattoir from a single vendor) were positive for OJD, of which 94% were from the HPA. In the HPA, the percentage of animals with lesions attributable to OJD at slaughter fell progressively from 2.4% (10,406/432,860) at commencement of vaccination in 2000 to 0.8% (1,573/189,564) by 2009. Herd immunity from vaccination in the HPA was estimated at 70% by 2009, the target commonly espoused for an effective control program based on vaccination. This coincided with a progressive decrease in reports of clinical disease and mortalities in vaccinated flocks. We show a decrease in the prevalence of lesions attributable to OJD in NSW concomitant with initiation of voluntary vaccination, on-farm management plans, abattoir monitoring and feedback of animal prevalence data to sheep producers. We conclude that a target of ≤ 1% regional prevalence of OJD affected sheep at slaughter is achievable using these interventions.

Spending on Cardiovascular Disease and Cardiovascular Risk Factors in the United States: 1996 to 2016.

Spending on cardiovascular disease and cardiovascular risk factors (cardiovascular spending) accounts for a significant portion of overall US health care spending. Our objective was to describe US adult cardiovascular spending patterns in 2016, changes from 1996 to 2016, and factors associated with changes over time. We extracted information on adult cardiovascular spending from the Institute for Health Metrics and Evaluation's disease expenditure project, which combines data on insurance claims, emergency department and ambulatory care visits, inpatient and nursing care facility stays, and drug prescriptions to estimate >85% of all US health care spending. Cardiovascular spending (2016 US dollars) was stratified by age, sex, type of care, payer, and cardiovascular cause. Time trend and decomposition analyses quantified contributions of epidemiology, service price and intensity (spending per unit of utilization, eg, spending per inpatient bed-day), and population growth and aging to the increase in cardiovascular spending from 1996 to 2016. Adult cardiovascular spending increased from $212 billion in 1996 to $320 billion in 2016, a period when the US population increased by >52 million people, and median age increased from 33.2 to 36.9 years. Over this period, public insurance was responsible for the majority of cardiovascular spending (54%), followed by private insurance (37%) and out-of-pocket spending (9%). Health services for ischemic heart disease ($80 billion) and hypertension ($71 billion) led to the most spending in 2016. Increased spending between 1996 and 2016 was primarily driven by treatment of hypertension, hyperlipidemia, and atrial fibrillation/flutter, for which spending rose by $42 billion, $18 billion, and $16 billion, respectively. Increasing service price and intensity alone were associated with a 51%, or $88 billion, cardiovascular spending increase from 1996 to 2016, whereas changes in disease prevalence were associated with a 37%, or $36 billion, spending reduction over the same period, after taking into account population growth and population aging. US adult cardiovascular spending increased by >$100 billion from 1996 to 2016. Policies tailored to control service price and intensity and preferentially reimburse higher quality care could help counteract future spending increases caused by population aging and growth.

Impact of ICD-9 to ICD-10 Coding Transition on Prevalence Trends in Neurology.

To determine the effect of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) coding transition on the point prevalence and longitudinal trends of 16 neurologic diagnoses. We used 2014-2017 data from the National Inpatient Sample to identify hospitalizations with one of 16 common neurologic diagnoses. We used published ICD-9-CM codes to identify hospitalizations from January 1, 2014, to September 30, 2015, and used the Agency for Healthcare Research and Quality's MapIt tool to convert them to equivalent ICD-10-CM codes for October 1, 2015-December 31, 2017. We compared the prevalence of each diagnosis before vs after the ICD coding transition using logistic regression and used interrupted time series regression to model the longitudinal change in disease prevalence across time. The average monthly prevalence of subarachnoid hemorrhage was stable before the coding transition (average monthly increase of 4.32 admissions, 99.7% confidence interval [CI]: -8.38 to 17.01) but increased after the coding transition (average monthly increase of 24.32 admissions, 99.7% CI: 15.71-32.93). Otherwise, there were no significant differences in the longitudinal rate of change in disease prevalence over time between ICD-9-CM and ICD-10-CM. Six of 16 neurologic diagnoses (37.5%) experienced significant changes in cross-sectional prevalence during the coding transition, most notably for status epilepticus (odds ratio 0.30, 99.7% CI: 0.26-0.34). The transition from ICD-9-CM to ICD-10-CM coding affects prevalence estimates for status epilepticus and other neurologic disorders, a potential source of bias for future longitudinal neurologic studies. Studies should limit to 1 coding system or use interrupted time series models to adjust for changes in coding patterns until new neurology-specific ICD-9 to ICD-10 conversion maps can be developed.

The Swiss Prison Study (SWIPS): Protocol for Establishing a Public Health Registry of Prisoners in Switzerland.

BackgroundThe health aspects, disease frequencies, and specific health interests of prisoners and refugees are poorly understood. Importantly, access to the health care system is limited for this vulnerable population. There has been no systematic investigation to understand the health issues of inmates in Switzerland. Furthermore, little is known on how recent migration flows in Europe may have affected the health conditions of inmates.ObjectiveThe Swiss Prison Study (SWIPS) is a large-scale observational study with the aim of establishing a public health registry in northern-central Switzerland. The primary objective is to establish a central database to assess disease prevalence (ie, International Classification of Diseases-10 codes [German modification]) among prisoners. The secondary objectives include the following: (1) to compare the 2015 versus 2020 disease prevalence among inmates against a representative sample from the local resident population, (2) to assess longitudinal changes in disease prevalence from 2015 to 2020 by using cross-sectional medical records from all inmates at the Police Prison Zurich, Switzerland, and (3) to identify unrecognized health problems to prepare successful public health strategies.MethodsDemographic and health-related data such as age, sex, country of origin, duration of imprisonment, medication (including the drug name, brand, dosage, and release), and medical history (including the International Classification of Diseases-10 codes [German modification] for all diagnoses and external results that are part of the medical history in the prison) have been deposited in a central register over a span of 5 years (January 2015 to August 2020). The final cohort is expected to comprise approximately 50,000 to 60,000 prisoners from the Police Prison Zurich, Switzerland.ResultsThis study was approved on August 5, 2019 by the ethical committee of the Canton of Zurich with the registration code KEK-ZH No. 2019-01055 and funded in August 2020 by the “Walter and Gertrud Siegenthaler” foundation and the “Theodor and Ida Herzog-Egli” foundation. This study is registered with the International Standard Randomized Controlled Trial Number registry. Data collection started in August 2019 and results are expected to be published in 2021. Findings will be disseminated through scientific papers as well as presentations and public events.ConclusionsThis study will construct a valuable database of information regarding the health of inmates and refugees in Swiss prisons and will act as groundwork for future interventions in this vulnerable population.Trial RegistrationISRCTN registry ISRCTN11714665; http://www.isrctn.com/ISRCTN11714665International Registered Report Identifier (IRRID)DERR1-10.2196/23973

A health inequality impact assessment from reduction in overweight and obesity

BackgroundIn recent years, social differences in overweight and obesity (OWOB) have become more pronounced. Health impact assessments provide population-level scenario evaluations of changes in disease prevalence and risk factors. The objective of this study was to simulate the health effects of reducing the prevalence of overweight and obesity in populations with short and medium education.MethodsThe DYNAMO-HIA tool was used to conduct a health inequality impact assessment of the future reduced disease prevalence (ischemic heart disease (IHD), diabetes, stroke, and multi-morbidity) and changes in life expectancy for the 2040-population of Copenhagen, Denmark (n = 742,130). We simulated an equalized weight scenario where the prevalence of OWOB in the population with short and medium education was reduced to the levels of the population with long education.ResultsA higher proportion of the population with short and medium education were OWOB relative to the population with long education. They also had a higher prevalence of cardiometabolic diseases. In the equalized weight scenario, the prevalence of diabetes in the population with short education was reduced by 8–10% for men and 12–13% for women. Life expectancy increased by one year among women with short education. Only small changes in prevalence and life expectancy related to stroke and IHD were observed.ConclusionReducing the prevalence of OWOB in populations with short and medium education will reduce the future prevalence of cardiometabolic diseases, increase life expectancy, and reduce the social inequality in health. These simulations serve as reference points for public health debates.

Changing Disease Prevalence, Incidence, and Mortality Among Older Cohorts: The Health and Retirement Study.

This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study. We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years. The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke. While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive.

Impact of gas flaring in Ubeji metropolis of Delta State Nigeria: a comparative survey of environment health effects

<p class="abstract"><strong>Background:</strong> The impact of gas flaring in Ubeji metropolis, relative to other communities of Delta is of interest. This study assessed the environmental impact of gas flaring in Ubeji metropolis of Delta State. The objective of this study is to study the comparative assessment of the environmental impacts of gas flaring on five communities of unequal distance from gas flaring site.</p><p class="abstract"><strong>Methods:</strong> Questionnaire survey was used to evaluate three research questions that included the level of knowledge in the survey communities regarding health impact of gas flaring; prevalence level of assessed health conditions in Ubeji metropolis relative to communities farther from or nearer to Warri gas flaring site; and perceived impact of gas flaring on air quality indicated by health and environmental toxicity indices. </p><p class="abstract"><strong>Results:</strong> Descriptive evaluation of data shows Ubeji appears to have the highest proportion of persons suffering respiratory problems, but the figure for family members is less than some other communities. The respondents nearer flaring site show more awareness compared to those farther away. Critical evaluation showed no directional change in prevalence of disease linked to gas flaring. There is linear relationship between ‘distance to gas flare site’ and ‘toxic impact on air quality’.</p><p class="abstract"><strong>Conclusions:</strong> This report submits further data to the discourse that, on the basis of nearness to gas flaring site, there is significant difference between communities experience of environmental and health impact.</p><p> </p>

Impact of ICD-10-CM Transition on Mental Health Diagnoses Recording.

Objective:This study examines the impact of the transition from ICD-9-CM to ICD-10-CM diagnosis coding on the recording of mental health disorders in electronic health records (EHRs) and claims data in ten large health systems. We present rates of these diagnoses across two years spanning the October 2015 transition.Methods:Mental health diagnoses were identified from claims and EHR data at ten health care systems in the Mental Health Research Network (MHRN). Corresponding ICD-9-CM and ICD-10-CM codes were compiled and monthly rates of people receiving these diagnoses were calculated for one year before and after the coding transition.Results:For seven of eight diagnostic categories, monthly rates were comparable during the year before and the year after the ICD-10-CM transition. In the remaining category, psychosis excluding schizophrenia spectrum disorders, aggregate monthly rates of decreased markedly with the ICD-10-CM transition, from 48 to 33 per 100,000. We propose that the change is due to features of General Equivalence Mappings (GEMS) embedded in the EHR.Conclusions:For most mental health conditions, the transition to ICD-10-CM appears to have had minimal impact. The decrease seen for psychosis diagnoses in these health systems is likely due to changes associated with EHR implementation of ICD-10-CM coding rather than an actual change in disease prevalence. It is important to consider the impact of the ICD-10-CM transition for all diagnostic criteria used in research studies, quality measurement, and financial analysis during this interval.

Suboptimal performance of rotavirus testing in a vaccinated community population should prompt laboratories to review their rotavirus testing algorithms in response to changes in disease prevalence

Rotavirus vaccine has reduced disease prevalence in many countries. Consequently, we aimed to assess the reliability of a rotavirus immunoassay in the community population of Auckland and Northland, New Zealand. Between 22 October 2015 and 31 December 2016, 2873 fecal samples were tested by enzyme immunoassay (EIA, Rotascreen II, Microgen, UK) from 2748 patients (median age 8 years, range 0–101 years). Eighty-nine (3.1%) samples were reactive; 86 samples were tested by a second method. Rotavirus was confirmed in 49/86 (57%). Positive rotavirus EIAs were more likely to be confirmed in samples from cases ≥1 year of age (positive predictive value [PPV] 61%, 95% confidence interval [CI] 50–72%, P = 0.049) and in spring/summer (PPV 67%, 95% CI 55–78%, P = 0.003). Reactive rotavirus tests required confirmatory testing regardless of demographic, vaccine, or seasonal factors; a review of rotavirus testing algorithms may be necessary in other vaccinated community populations.

Factors Associated With Increases in US Health Care Spending, 1996-2013

Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth. To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity. Data on the 5 factors from 1996 through 2013 were extracted for 155 health conditions, 36 age and sex groups, and 6 types of care from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation's US Disease Expenditure 2013 project. Decomposition analysis was performed to estimate the association between changes in these factors and changes in health care spending and to estimate the variability across health conditions and types of care. Change in population size, population aging, disease prevalence or incidence, service utilization, or service price and intensity. Change in health care spending from 1996 through 2013. After adjustments for price inflation, annual health care spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased by $933.5 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion. Increases in US population size were associated with a 23.1% (uncertainty interval [UI], 23.1%-23.1%), or $269.5 (UI, $269.0-$270.0) billion, spending increase; aging of the population was associated with an 11.6% (UI, 11.4%-11.8%), or $135.7 (UI, $133.3-$137.7) billion, spending increase. Changes in disease prevalence or incidence were associated with spending reductions of 2.4% (UI, 0.9%-3.8%), or $28.2 (UI, $10.5-$44.4) billion, whereas changes in service utilization were not associated with a statistically significant change in spending. Changes in service price and intensity were associated with a 50.0% (UI, 45.0%-55.0%), or $583.5 (UI, $525.2-$641.4) billion, spending increase. The influence of these 5 factors varied by health condition and type of care. For example, the increase in annual diabetes spending between 1996 and 2013 was $64.4 (UI, $57.9-$70.6) billion; $44.4 (UI, $38.7-$49.6) billion of this increase was pharmaceutical spending. Increases in US health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending.