Differences In Prevalence Of Disease Research Articles

An Analysis of Healthy City Criteria Case Study: District 6 of Isfahan- Iran

The growth of population and urbanization and consequently, the emergence of urban problems such as insufficient urban infrastructures, housing, green areas, etc., increase of various pollutions, degradation of air quality and as a result, prevalence of different diseases and physical and mental disorders among citizens have made the subject of “healthy man” the “center of sustained development”, so that urban science scholars consider a “healthy city” as one of the routes to achieving “sustained urban development.” A healthy city is one the quality of which is continuously improving and one which keeps providing its citizens with new opportunities. Therefore, urban health is very important and in this regard, economic, health, environmental, social and cultural factors of development play a crucial role. This study has analyzed and evaluated the conditions of district 6 of Isfahan, using 20 indicators (4 criteria) in terms of health, socio-cultural, economic and infrastructural-environmental aspects. Descriptive-analytic method has been employed and the data have been collected mainly through a questionnaire which has been analyzed using SPSS and statistical tests such as independent and one-sample T-test as well as Pearson correlation coefficient. Results indicate that district 6 of Isfahan is not in favorable conditions in terms of healthy city criteria. Economic, infrastructural-environmental and health criteria are lower than the average level. Among the four criteria, only the socio-cultural criterion is higher than the average. There also exists a significant relation between the levels of these criteria, and citizens’ gender and educational levels have had no impact on their attitudes toward healthy city criteria in district 6 of Isfahan. Finally, some suggestions have been presented for the improvement of healthy city criteria and indices in general and for district 6 of Isfahan in particular.

Disease incidence and mortality among older Americans and Europeans.

Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79.

Morph‐specific differences in disease prevalence and pathogen‐induced mortality in a terrestrial polymorphic salamander

AbstractPolymorphic species provide an excellent system to study population divergence because different phenotypes often face diverse selection pressures within their shared environment. Previous studies have demonstrated that different color morphs of Plethodon cinereus (striped and unstriped), which vary in their degree of melanin‐based coloration, vary temporally in their seasonal activity and differ in metrics associated with stress physiology. Despite the known association between melanin‐based coloration and disease resistance among vertebrates, few studies have examined this relationship in amphibians. In a laboratory experiment, we exposed juvenile and adult P. cinereus to the pathogenic chytrid fungus [Batrachochytrium dendrobatidis (Bd)] and tested the hypothesis that the different color morphs would differ in their response to Bd. If the degree of melanization is positively associated with immune traits in this species, we predicted that unstriped salamanders would be more resistant to Bd and would exhibit higher survival rates compared to striped salamanders. Our results suggest that unstriped salamanders have a higher prevalence of infection when they do not behaviorally avoid Bd. Unstriped salamanders also exhibited higher rates of Bd‐induced mortality compared to striped salamanders. These results conflict with our initial predictions and with general findings suggesting that individuals with higher levels of melanin production are more resistant to disease. Behavioral traits of the unstriped morph, including responses to predators and interactions with territorial opponents, may contribute to increased levels of stress and reduced resistance to infection. Future studies that directly manipulate glucocorticoid levels and/or temperature are needed to better understand the differences in Bd resistance in this species.

Disease dynamics and potential mitigation among restored and wild staghorn coral, Acropora cervicornis.

The threatened status (both ecologically and legally) of Caribbean staghorn coral, Acropora cervicornis, has prompted rapidly expanding efforts in culture and restocking, although tissue loss diseases continue to affect populations. In this study, disease surveillance and histopathological characterization were used to compare disease dynamics and conditions in both restored and extant wild populations. Disease had devastating effects on both wild and restored populations, but dynamics were highly variable and appeared to be site-specific with no significant differences in disease prevalence between wild versus restored sites. A subset of 20 haphazardly selected colonies at each site observed over a four-month period revealed widely varying disease incidence, although not between restored and wild sites, and a case fatality rate of 8%. A tropical storm was the only discernable environmental trigger associated with a consistent spike in incidence across all sites. Lastly, two field mitigation techniques, (1) excision of apparently healthy branch tips from a diseased colony, and (2) placement of a band of epoxy fully enclosing the diseased margin, gave equivocal results with no significant benefit detected for either treatment compared to controls. Tissue condition of associated samples was fair to very poor; unsuccessful mitigation treatment samples had severe degeneration of mesenterial filament cnidoglandular bands. Polyp mucocytes in all samples were infected with suspect rickettsia-like organisms; however, no bacterial aggregates were found. No histological differences were found between disease lesions with gross signs fitting literature descriptions of white-band disease (WBD) and rapid tissue loss (RTL). Overall, our results do not support differing disease quality, quantity, dynamics, nor health management strategies between restored and wild colonies of A. cervicornis in the Florida Keys.

Longer Liver Transplant Waiting Lists Associated With Sicker Patients in Donor Service Areas.

BACKGROUND: Listing rates for liver transplantation vary significantly from one DSA to another on a per capita basis. We hypothesized that differences in disease prevalence and listing practices might contribute. METHODS: Data on patients listed for liver transplantation was obtained from the SRTR Standard Analysis File. Prevalence of end stage liver disease (ESLD) was estimated by the sum of liver transplants plus liver disease-related deaths from Centers for Disease Control death files. Population data was obtained from the US Census. RESULTS: DSA listing rates per 100 ESLD ranged from 1.3 to 14. Higher listing rates were associated with more transplant centers per DSA (P = 0.02) and more transplant centers per ESLD (P = 0.0006). There was no association with number of transplant centers per 100 liver transplants (P = 0.06) or MELD at transplant (P = 0.49). Higher listing rates were also associated with a greater percentage of candidates with age over 65 (OR 1.06, P < 0.0001), chronic obstructive pulmonary disease (OR 1.06, P = 0.0003), cardiovascular disease (OR 1.06, P < 0.0001), previous malignancy (OR 1.03, P < 0.0001), and BMI > 40 (OR 1.05, P < 0.0001). Higher listing rates were associated with lower percentage of candidates with portal vein thrombosis (OR 0.96, P=0.0007) and serum sodium<=120 (OR 0.94, P = 0.03). CONCLUSIONS: Higher listing rates are associated with more transplant centers per DSA and per capita, but not with MELD at transplant. Higher listing rates were associated with wait list candidates with older age and additional comorbidities, suggesting that a higher density of transplant centers may be associated with greater access to care for patients with ESLD.

Causes of diplopia in the emergency department

Studies on frequency and underlying diseases causing binocular diplopia in patients presenting to the emergency department (ED) are lacking. To evaluate the prevalence of different diseases causing diplopia and the role of medical history, clinical examination, and unenhanced head computed tomography (UHCT) in the identification of secondary diplopia. Diplopic patients presenting to the ED were enrolled prospectively. Cardiovascular risk factors and associated neurological signs and symptoms were reported. UHCT was performed in the ED. Secondary diplopia was diagnosed in 93 of 260 (35.8%) diplopic patients. Among patients with secondary diplopia, the most frequent diagnoses were stroke (45.2%), multiple sclerosis (18.3%), brain tumors (11.8%), and cerebral aneurysms (7.5%). The prevalence of cardiovascular risk factors was similar in primary and secondary diplopia. Among the 118 (45.4%) patients without associated neurological signs or symptoms (isolated diplopia), secondary diplopia was diagnosed in 13 (11%); UHCT was negative in all 13 cases, with a derived null sensitivity. Eighty of 142 (56.3%) patients with associated signs or symptoms had secondary diplopia. The presence of signs or symptoms associated with diplopia showed a sensitivity of 87% [95% confidence interval (CI): 80-92%] and a specificity of 63% (95% CI: 59-66%) for the diagnosis of secondary diplopia. In this group, UHCT identified 30 of 80 (37.5%) cases, increasing the specificity to 98% (95% CI: 96-99%). One-third of diplopic patients had secondary diplopia. In patients with isolated diplopia, UHCT does not increase diagnostic sensitivity. In patients with associated neurological signs or symptoms, the prevalence of secondary diplopia was high and UHCT showed incremental diagnostic value.

Occurrence of Diseases and Case of Clinical Diagnosis on Watermelon in South Korea, 2008-2012

The socio-network activities for regional governments, agricultural research institutes, developing agencies and policy makers of any countries are very crucial and important to take into account the root cause of current problems faced by farmers. The survey was conducted in South Korea during the period January, 2008 to August, 2012 in order to shed light on prevalence of different diseases on watermelon in different regions and to better understand farmers' knowledge and perceptions for following watemelon's growing procedures and practices. A total of 590 cases were reported on 573 watermelon growers with highest 87.1% in Jeonbuk, 4.7% in Jeonnam, and 8.2% in other regions such as Gyeongbuk, Gyeongnam, Chungnam, Gwangju, Gyeonggi, Daegu, Gangwon, Changwon and Seoul. The maximum percentages of cases recorded were related to diseases and insect pest (38.6%) followed by physiological disorder (29.7%), cultural practices (18.8%), soil and fertilizer (9.0%), herbicide (2.9%) and others (1.0%). It was observed that the manifestation aspects of the diseases were changed due to increasing in proportion of 'in-facility' cultivation to 12,995 ha compared to 'open-field' cultivation (2,722 ha). The present survey revealed the necessity to reduce the damages incurred at watermelon farms as soon as possible through the breeding program to develop resistant cultivar, use of pathogen-free propagating plants, and efficient prevention of pathogen by regular monitoring of watermelon plants at farms.

Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis.

Numerous population-based studies of age-related macular degeneration have been reported around the world, with the results of some studies suggesting racial or ethnic differences in disease prevalence. Integrating these resources to provide summarised data to establish worldwide prevalence and to project the number of people with age-related macular degeneration from 2020 to 2040 would be a useful guide for global strategies. We did a systematic literature review to identify all population-based studies of age-related macular degeneration published before May, 2013. Only studies using retinal photographs and standardised grading classifications (the Wisconsin age-related maculopathy grading system, the international classification for age-related macular degeneration, or the Rotterdam staging system) were included. Hierarchical Bayesian approaches were used to estimate the pooled prevalence, the 95% credible intervals (CrI), and to examine the difference in prevalence by ethnicity (European, African, Hispanic, Asian) and region (Africa, Asia, Europe, Latin America and the Caribbean, North America, and Oceania). UN World Population Prospects were used to project the number of people affected in 2014 and 2040. Bayes factor was calculated as a measure of statistical evidence, with a score above three indicating substantial evidence. Analysis of 129,664 individuals (aged 30-97 years), with 12,727 cases from 39 studies, showed the pooled prevalence (mapped to an age range of 45-85 years) of early, late, and any age-related macular degeneration to be 8.01% (95% CrI 3.98-15.49), 0.37% (0.18-0.77), and 8.69% (4.26-17.40), respectively. We found a higher prevalence of early and any age-related macular degeneration in Europeans than in Asians (early: 11.2% vs 6.8%, Bayes factor 3.9; any: 12.3% vs 7.4%, Bayes factor 4.3), and early, late, and any age-related macular degeneration to be more prevalent in Europeans than in Africans (early: 11.2% vs 7.1%, Bayes factor 12.2; late: 0.5% vs 0.3%, 3.7; any: 12.3% vs 7.5%, 31.3). There was no difference in prevalence between Asians and Africans (all Bayes factors <1). Europeans had a higher prevalence of geographic atrophy subtype (1.11%, 95% CrI 0.53-2.08) than Africans (0.14%, 0.04-0.45), Asians (0.21%, 0.04-0.87), and Hispanics (0.16%, 0.05-0.46). Between geographical regions, cases of early and any age-related macular degeneration were less prevalent in Asia than in Europe and North America (early: 6.3% vs 14.3% and 12.8% [Bayes factor 2.3 and 7.6]; any: 6.9% vs 18.3% and 14.3% [3.0 and 3.8]). No significant gender effect was noted in prevalence (Bayes factor <1.0). The projected number of people with age-related macular degeneration in 2020 is 196 million (95% CrI 140-261), increasing to 288 million in 2040 (205-399). These estimates indicate the substantial global burden of age-related macular degeneration. Summarised data provide information for understanding the effect of the condition and provide data towards designing eye-care strategies and health services around the world. National Medical Research Council, Singapore.

Individuals of Pacific Asian origin with IgA nephropathy have an increased risk of progression to end-stage renal disease

IgA nephropathy (IgAN) accounts for a far higher proportion of end-stage renal disease (ESRD) in Asia compared with North America. It is not known whether this is entirely because of differences in disease prevalence or a higher risk of disease progression. The lack of a racially diverse population cohort followed longitudinally has previously precluded the ability to address this question. To determine whether Asians in North America with IgAN are at higher risk for ESRD, we analyzed a cohort of 202 patients of self-reported Pacific Asian origin and 467 of other origin from the Toronto GN Registry followed up for a median of 46.4 months. The primary outcome of ESRD (dialysis, transplantation, or eGFR below 15) was analyzed using Cox regression analysis. Baseline eGFR was 59.6 ml/min/1.73 m(2), and median proteinuria was 1.8 g/day. ESRD occurred in 213 patients. By univariable analysis, the risk of ESRD was similar between the two groups (hazard ratio 0.98, 95% CI 0.73, 1.31); however, after adjusting for age, gender, eGFR, medication use, blood pressure, and proteinuria, the risk of ESRD was significantly higher in Pacific Asian individuals (hazard ratio 1.56, 95% CI 1.10, 2.22). This was supported by a significant 1.62 ml/min/1.73 m(2)/year faster rate of eGFR decline (95% CI -3.19, -0.5) and an increased risk of a reduction in eGFR by half (hazard ratio 1.81, 95% CI 1.25, 2.62). Thus, in a large multiracial cohort of patients with IgAN, individuals of Pacific Asian origin have a higher risk of progression to ESRD.

The Problem of Controlling for Imperfectly Measured Confounders on Dissimilar Populations: A Database Simulation Study

Observational database research frequently relies on imperfect administrative markers to determine comorbid status, and it is difficult to infer to what extent the associated misclassification impacts validity in multivariable analyses. The effect that imperfect markers of disease will have on validity in situations in which researchers attempt to match populations that have strong baseline health differences is underemphasized as a limitation in some otherwise high-quality observational studies. The present simulations were designed as a quantitative demonstration of the importance of this common and underappreciated issue. Two groups of Monte Carlo simulations were performed. The first demonstrated the degree to which controlling for a series of imperfect markers of disease between different populations taking 2 hypothetically harmless drugs would lead to spurious associations between drug assignment and mortality. The second Monte Carlo simulation applied this principle to a recent study in the field of anesthesiology that purported to show increased perioperative mortality in patients taking metoprolol versus atenolol. None. Simulation 1: High type-1 error (ie, false positive findings of an independent association between drug assignment and mortality) was observed as sensitivity and specificity declined and as systematic differences in disease prevalence increased. Simulation 2: Propensity score matching across several imperfect markers was unlikely to eliminate important baseline health disparities in the referenced study. In situations in which large baseline health disparities exist between populations, matching on imperfect markers of disease may result in strong bias away from the null hypothesis.

Disease Incidence and Mortality Among Older Americans and Europeans

Recent research has shown a widening gap in life expectancy at age 50 between the U.S. and Europe, as well as large differences in the prevalence of diseases at these ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This paper uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the U.S. and a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, it finds that Americans have higher disease prevalence. However, incidence of most diseases and survival conditional on disease is higher in Europe at older ages, in particular after age 60. The survival advantage in Europe tends to disappear when we control for co-morbidities but does not suggest a survival advantage in the U.S. Therefore, the origin of the higher disease prevalence at older ages in the U.S. is to be found in higher incidence and prevalence earlier in the life course.

SP0083 Gender as Predictors and as a Confounder in RMDs

Differences in sex ratios have since long been recognized in several common chronic diseases and are particularly common in rheumatic diseases, inflammatory as well as non-inflammatory.The present presentation will focus...

Disability weights in the Global Burden of Disease 2010: Unclear meaning and overstatement of international agreement

The Global Burden of Disease Project (GBD) is a huge international enterprise that provides vast amounts of valuable data on (a) the prevalence of different diseases in the world as a whole, in regions and in individual countries, (b) their causes (risk factors), and (c) their burden on populations in terms of Disability Adjusted Life Years (DALYs). However, the methods used for disability weighting of life years are problematic. After a long history of changing concepts and methods the GBD in its 2010 version has landed on ‘health’ as a unidimensional construct to be used for weighing multi-dimensional non-fatal health problems against each other and against death. The unidimensional health construct does not have a clear meaning. It likely also leads to biases in assessments of conditions that in everyday language are associated with ‘being ill’ as opposed to conditions which are not associated with ‘being ill’ (states of physical disability and the state dead). Furthermore, the transformation of ordinal data from paired comparisons into disability weights with purported ratio scale properties is not validated nor explained in a way that allows judgements of face validity. There are also issues related to the way in which different health problems were described to respondents. Lastly, international agreement on disability weights is clearly overstated. Policy makers at national and international levels should understand the GBD 2010 methods properly and carefully consider their validity before deciding to implement the methods, or the disability weights estimated so far by means of them, in further projects and studies. Considerable local adjustments of the weights offered presently are a likely outcome of such methodological scrutiny.

The relationship between self-rated health and objective health status: a population-based study.

BackgroundSelf-rated health (SRH), a subjective assessment of health status, is extensively used in the public health field. However, whether SRH can reflect the objective health status is still debatable. We aim to reveal the relationship between SRH and objective health status in the general population.MethodsWe assessed the relationship between SRH and objective health status by examining the prevalence of diseases, laboratory parameters, and some health-related factors in different SRH groups. Data were collected from 18,000 residents randomly sampled from the general population in five cities of China (3,600 in each city). SRH was assessed by a single-item health measure with five options: “very good,” “good,” “fair,” “bad,” and “very bad.” The differences in prevalence of diseases, laboratory parameters, and health-related factors between the “healthy” (very good plus good), “relatively healthy” (fair), and “unhealthy” (bad plus very bad) groups were examined. The odds ratios (ORs) referenced by the healthy group were calculated using logistic regression analysis.ResultsThe prevalence of all diseases was associated with poorer SRH. The tendency was more prominent in cardio-cerebral vascular diseases, visual impairment, and mental illnesses with larger ORs. Residents with abnormalities in laboratory parameters tended to have poorer SRH, with ORs ranging from 1.62 (for triglyceride) to 3.48 (for hemoglobin among men) in a comparison of the unhealthy and healthy groups. Most of the health-related factors regarded as risks were associated with poorer SRH. Among them, life and work pressure, poor spiritual status, and poor quality of interpersonal relationships were the most significant factors.ConclusionsSRH is consistent with objective health status and can serve as a global measure of health status in the general population.

Genetic risk, ethnic variations and pharmacogenetic biomarkers in AMD and polypoidal choroidal vasculopathy

In recent years, there has been increasing evidence of ethnic differences in the epidemiology, risk factors, clinical presentation and manifestation of age-related macular degeneration (AMD). Although phenotypically very similar to AMD, polypoidal choroidal vasculopathy has a very different natural history, treatment response to anti-VEGF agents and photodynamic therapy and marked ethnic differences in disease prevalence. Despite these differences, there is supporting evidence, particularly from a genetics perspective, that links these two disease entities. In this review, the authors compare and contrast AMD and polypoidal choroidal vasculopathy with particular reference to ethnic variation, genetic disease risk assessment and potential for pharmacogenetic interventions. With advances in massively parallel next-generation sequencing and decreased cost of such technologies, investigators will be able to more thoroughly assess rare variants and their contribution to disease susceptibility.

Sex-specific environmental influences affecting MS development

Vitamin D status, smoking, and Epstein-Barr virus infection (EBV) may all contribute to explain differences in disease prevalence and incidence of Multiple Sclerosis (MS). MS affects women more often than men, and recent cross-sectional study assessments provide evidence of increased female to male prevalence in relapsing remitting MS patients, suggesting that sex hormones may exert an active role in disease pathogenesis. Studies in both humans and animal disease models demonstrate a functional synergy for the immunomodulatory effects of Vitamin D3 and 17-β estradiol. Both smoking and EBV infection clearly increase MS risk, and smoking history has also been associated with poorer disease prognosis. However, neither factor can explain the recent trend indicating greater female prevalence. Therefore, large population-based case-control studies from well defined geographic areas with homogeneous populations should be performed, in order to define environmental factor effects, and sex hormone influences, to better understand prevalence and incidence gender differences observed.

Orthopaedic Healthcare Worldwide: Shared Medical Decision Making in Orthopaedics

Orthopaedic Healthcare Worldwide: Shared Medical Decision Making in Orthopaedics

Combating the Epidemic of Heart Disease

AT THE BEGINNING OF THE 20TH CENTURY, THE 3 leading causes of death in the United States were infectious diseases—pneumonia, tuberculosis, and diarrhea—which in combination claimed 539 lives per 100 000. Lurking in the background as the fourth leading cause of death was heart disease (137 deaths per 100 000). But this would change. With life expectancy of only 47 years at the beginning of the century, people did not live long enough for heart disease to claim many lives. Without a means for accurate diagnosis, many deaths from heart disease went unrecognized. With the advent of the electrocardiogram to facilitate the diagnosis of heart disease, antibiotics to treat infectious diseases, and increasing life expectancy, the number and proportion of deaths due to heart disease soared. During the Great Depression, the number of deaths due to heart disease was twice that of the next leading cause of death (pneumonia). In 1945, at the time of President Roosevelt’s fatal brain hemorrhage due to decades of uncontrolled hypertension, heart disease accounted for more deaths in the United States than the next 3 causes combined. Deaths due to heart disease peaked in 1968 at 374 per 100 000. Necropsy studies of soldiers killed in the wars in Korea and Vietnam provided an opportunity to define the prevalence of subclinical coronary atherosclerosis in young people. In 1953 Enos et al described coronary lesions discovered at autopsy in 300 male soldiers (mean age, 22 years) killed in the Korean War. Gross evidence of coronary disease was present in 77% of the decedents: 35% with fibrous thickening, 26% with a coronary artery narrowed by 10% to 49%, and 15% with a coronary occlusion of 50% or more. In 1971, McNamara et al reported evidence of coronary atherosclerosis in 45% of 105 Vietnam War combat deaths (mean age, 22 years), with 5% having severe coronary disease. In their concise descriptive narratives, these studies provided unequivocal evidence of the silent burden of coronary atherosclerosis in young, otherwise healthy adults, and in finding a “reservoir” of carriers of disease, they helped explain the emergence of heart disease as a 20th century epidemic among middle-aged and older adults. In this issue of JAMA, Webber and colleagues report on the prevalence of coronary and aortic atherosclerosis in 3832 US service members who died from combat or unintentional injuries from 2001 to 2011 while serving in support of military operations in Iraq or Afghanistan. With a mean age of 27 years, the service members’ prevalence of coronary atherosclerosis of any degree was 8.5%, a value considerably lower than reported by Enos et al (77%) and McNamara et al (45%). Minimal, moderate, and severe coronary atherosclerosis were present in only 1.5%, 4.7%, and 2.3% of the recent decedents, respectively. The large sample size of the study provided robust estimates of the low burden of subclinical atherosclerotic disease and permitted an exploration of differences in prevalence of disease across various demographic strata. The prevalence of atherosclerosis increased with age and was greater in those with lower education levels but was not associated with occupation, ethnicity, service branch, or military rank. Taken together, the reports by Enos et al, McNamara et al, and Webber et al offer cross-sectional perspectives on subclinical atherosclerosis in healthy young military service members, but unlike standardized, population-based, cross-sectional studies (eg, the National Health and Nutrition Examination Survey [NHANES], for example), these studies are not directly comparable and also might not be generalizable to the US population of young adults. Unlike NHANES, the 3 autopsy studies were conducted at irregular intervals and were restricted to military personnel who were likely to be healthier than the US population as a whole. The restrictive criteria used by Webber et al to establish the presence of cardiovascular disease risk factors, along with the “healthy warrior effect,” may have resulted in low measures of prevalence of key risk factors. Specifically, the prevalence of obesity (4%), smoking (3%), hypertension (1%), dyslipidemia (0.7%), and impaired fasting glucose (0.2%) were markedly lower than among comparable age groups in the US population or compared with published estimates of risk factor prevalence in the military. The methods used for ascertainment of several risk factors likely underrepresented their true prevalence and limited the authors’ ability to draw conclusions about risk factor associations with

Assessing Health Status Differences Between Veterans Affairs Home-Based Primary Care and State Medicaid Waiver Program Clients

Comprehensive health care for older adults is complex, involving multiple comorbidities and functional impairments of varying degrees and numbers. In response to this complexity and associated barriers to care, home-based care models have become prevalent. The home-based primary care (HBPC) model, based at a Michigan Department of Veterans Affairs Medical Center, and the Michigan Waiver Program (MWP) that includes home-based care are 2 of these. Although both models are formatted to address barriers to effective and efficient health care, there are differences in disease prevalence and functional performance between groups. The objective of this study was to explore the differences between the 2 groups, to shed some light on potential trends that could suggest areas for resource allocation by service providers. Using a retrospective analysis of data collected using the interRAI-home care, we examined a cross-sectional representation of clients enrolled in HBPC and MWP in 2008. The HBPC sample had 89 participants. The MWP database contained 9324 participants from across the State of Michigan and were weighted to be comparable to the HBPC population in sex and age, and to simulate the HBPC sample size. Veterans were more independent in basic activities of daily living performance, but there was no difference in the rate of reported falls between the 2 groups. Veterans had more pain and a higher prevalence of coronary artery disease (z = 7.0; P < .001), Chronic obstructive pulmonary disease (z = 3.9; P < .001), and cancer (z = 8.5; P < .001). There was no statistically significant difference between the 2 groups in terms of the prevalence of geriatric syndromes. Scores on subscales of the interRAI-home care indicated a lower risk of serious health decline and adverse outcomes for MWP compared with HBPC clients (1.4 ± 1.1 vs 0.9 ± 0.1; z = 2.5; P = .012). Veterans receiving home-based care through the Veterans Affairs Medical Center were more burdened by chronic disease and had higher degrees of loneliness than their MWP counterparts- factors, which may increase their likelihood of hospitalizations. MWP participants had more cases of cerebrovascular accident (z = 2.1; P = .039), as well as a higher rate of diagnosed dementias (z = 2.7; P = .006). Though not different, stress among caregivers in both groups, and depression in clients of both groups were substantial. Overall, sleep, pain, coronary artery disease, chronic obstructive pulmonary disease, and cancer are significant issues for Veteran clients, and clients treated through MWP home-care in Michigan have higher than national average rates of dementias, diabetes, hypertension, and coronary artery disease. With expanded home care models of service on the horizon, comparisons such as the one presented here could identify more efficient and effective service, with potential for improved client health outcomes.

Geographic Differences in Genetic Susceptibility to IgA Nephropathy: GWAS Replication Study and Geospatial Risk Analysis

IgA nephropathy (IgAN), major cause of kidney failure worldwide, is common in Asians, moderately prevalent in Europeans, and rare in Africans. It is not known if these differences represent variation in genes, environment, or ascertainment. In a recent GWAS, we localized five IgAN susceptibility loci on Chr.6p21 (HLA-DQB1/DRB1, PSMB9/TAP1, and DPA1/DPB2 loci), Chr.1q32 (CFHR3/R1 locus), and Chr.22q12 (HORMAD2 locus). These IgAN loci are associated with risk of other immune-mediated disorders such as type I diabetes, multiple sclerosis, or inflammatory bowel disease. We tested association of these loci in eight new independent cohorts of Asian, European, and African-American ancestry (N = 4,789), followed by meta-analysis with risk-score modeling in 12 cohorts (N = 10,755) and geospatial analysis in 85 world populations. Four susceptibility loci robustly replicated and all five loci were genome-wide significant in the combined cohort (P = 5×10−32–3×10−10), with heterogeneity detected only at the PSMB9/TAP1 locus (I2 = 0.60). Conditional analyses identified two new independent risk alleles within the HLA-DQB1/DRB1 locus, defining multiple risk and protective haplotypes within this interval. We also detected a significant genetic interaction, whereby the odds ratio for the HORMAD2 protective allele was reversed in homozygotes for a CFHR3/R1 deletion (P = 2.5×10−4). A seven–SNP genetic risk score, which explained 4.7% of overall IgAN risk, increased sharply with Eastward and Northward distance from Africa (r = 0.30, P = 3×10−128). This model paralleled the known East–West gradient in disease risk. Moreover, the prediction of a South–North axis was confirmed by registry data showing that the prevalence of IgAN–attributable kidney failure is increased in Northern Europe, similar to multiple sclerosis and type I diabetes. Variation at IgAN susceptibility loci correlates with differences in disease prevalence among world populations. These findings inform genetic, biological, and epidemiological investigations of IgAN and permit cross-comparison with other complex traits that share genetic risk loci and geographic patterns with IgAN.