Higher Rates Of Diabetes Research Articles

Morning blood pressure surge is associated with the severity of stable coronary artery disease in hypertensive patients

ABSTRACT Background: We aimed to investigate the association between morning surge (MS) of blood pressure (BP) and SYNTAX score (SS) which gives information regarding the complexity and extent of coronary artery disease (CAD) in hypertensive patients. Methods: We included 187 hypertensive patients (134 males, 53 females; mean age: 62.5 ± 10.9 years) who underwent elective coronary angiography. Patients with the acute coronary syndrome and a history of coronary intervention were excluded from the study. The MBPS was calculated as the difference between the average BP during the 2 hours after awakening (four BP readings) and the lowest nighttime BP. The severity of coronary lesions was evaluated based on the SS assessed by coronary angiography. Patients were classified into two groups according to SS: low SS (SS ≤ 22) and intermediate-to-high SS (>22). Results: Patients in the intermediate-to-high SS group were found to be older, have higher uric acid levels, average daytime systolic BP (SBP), nighttime SBP, morning SBP, MS of BP and have higher rates of diabetes (DM) and female gender. There was no significant difference in terms of hypertensive treatment. In multivariate analysis, MS of BP (OR: 2.151, p: 0.005) and DM (OR: 0.014, p: 0.015) were independent parameters for predicting intermediate-to-high SS. The cutoff value of MS of BP obtained by ROC curve analysis was 18,5 mmHg for prediction of intermediate–high SS (sensitivity: 76.5%, specificity: 71.2%). The area under the curve was 0.762 (p < .001). Conclusion: MS of BP significantly correlates with the severity of coronary stenosis in hypertensive patients, suggesting that it could be a potential predictive marker of CAD.

Incidence and Risk Factors for Flap Coverage After Total Ankle Arthroplasty.

Wound complications following total ankle arthroplasty (TAA) can have a significant impact on patient morbidity, particularly when they require flap coverage. We sought to determine the risk factors associated with the need for flap coverage after TAA and hypothesized that medical and operative risk factors such as diabetes and additional procedures would be associated with the need for flap coverage after TAA. We performed a single-center retrospective review of TAAs from April 2007 to February 2019. Patient demographics and medical comorbidities were collected, in addition to other procedures performed at the time of TAA. Patients were stratified by the need for flap coverage, and unadjusted inferential statistics were performed to evaluate the risk factors associated with subsequent need for flap coverage. Among 2065 patients undergoing TAA, 28 (1.4%) patients required flap coverage after the index arthroplasty. Patients requiring flap coverage were older (P = .045), had higher Charlson comorbidity indices (P = .017), and had higher rates of diabetes and pulmonary disease (P = .038). Patients requiring flap coverage also had higher rates of additional procedures (P = .043, P = .007). The most common flap was a radial forearm free flap, which was performed in 14 (50%) patients. Twenty-one patients (75%) requiring flap coverage had a stable, plantigrade foot at median 1.5-year follow-up. Patient and operative risk factors, including advanced age, increased comorbidity burden, diabetes, pulmonary disease, and increased number of simultaneous procedures, were significantly associated with need for subsequent flap coverage. This should be considered as the indications for TAA expand. Level III, retrospective, prognostic cohort study.

Using Virtual Reality to Improve Health Care Providers' Cultural Self-Efficacy and Diabetes Attitudes: Pilot Questionnaire Study.

BackgroundIn southeastern Appalachian Ohio, the prevalence of diabetes is 19.9%, nearly double that of the national average of 10.5%. Here, people with diabetes are more likely to have a delayed diagnosis, limited access to health care, and lower health literacy. Despite the high rates of diabetes in the region, the availability of endocrinologists and certified diabetes care and education specialists is limited. Therefore, innovative strategies to address the growing diabetes care demands are needed. One approach is to train the primary care workforce in new and emerging therapies for type 2 diabetes to meet the increasing demands and complexity of diabetes care.ObjectiveThe aim of this study was to assess the effectiveness of a virtual reality training program designed to improve cultural self-efficacy and diabetes attitudes.MethodsHealth care providers and administrators were recruited from large health care systems, private practices, university-owned hospitals or clinics, Federally Qualified Health Centers, local health departments, and AmeriCorps. Providers and administrators participated in a 3-hour virtual reality training program consisting of 360-degree videos produced in a professional, cinematic manner; this technique is called virtual reality cinema (cine-VR). Questionnaires measuring cultural self-efficacy, diabetes attitudes, and presence in cine-VR were administered to providers and administrators before and after the program.ResultsA total of 69 participants completed the study. The mean age of the sample was 42.2 years (SD 13.7), 86% (59/69) identified as female, 83% (57/69) identified as White, 86% (59/69) identified as providers, and 25% (17/69) identified as nurses. Following the training program, we observed positive improvements in all three of the cultural self-efficacy subscales: Cognitive (mean change –1.29; t65=–9.309; P<.001), Practical (mean change –1.85; t65=–9.319; P<.001), and Affective (mean change –0.75; t65=–7.067; P<.001). We observed the largest magnitude of change with the subscale, with a Cohen d of 1.16 indicating a very large effect. In addition, we observed positive improvements in all five of the diabetes attitude subscales: Need for special training (mean change –0.21; t67=–6.154; P<.001), Seriousness of type 2 diabetes (mean change –0.34; t67=–8.114; P<.001), Value of tight glucose control (mean change –0.13; t67=–3.029; P=.001), Psychosocial impact of diabetes (mean change –0.33; t67=–6.610; P<.001), and Attitude toward patient autonomy (mean change –0.17; t67=–3.889; P<.001). We observed the largest magnitude of change with the Psychosocial impact of diabetes subscale, with a Cohen d of 0.87 indicating a large effect. We observed only one significant correlation between presence in cine-VR (ie, Interface Quality) and a positive change score (ie, Affective self-efficacy) (r=.285; P=.03).ConclusionsOur findings support the notion that cine-VR education is an innovative approach to improve cultural self-efficacy and diabetes attitudes among health care providers and administrators. The long-term impact of cine-VR education on cultural self-efficacy and diabetes attitudes needs to be determined.

Home health care after discharge is associated with lower readmission rates for patients with acute myocardial infarction.

We studied the utilization of home health care (HHC) among acute myocardial infarction (AMI) patients, impact of HHC on and predictors of 30-day readmission. We queried the National Readmission Database (NRD) from 2012 to 2014identify patients with AMI discharged home with (HHC+) and without HHC (HHC-). Linkage provided in the data identified patients who had 30-day readmission, our primary end-point. The probability for each patient to receive HHC was calculated by a multivariable logistic regression. Average treatment of treated weights were derived from propensity scores. Weight-adjusted logistic regression was used to determine impact of HHC on readmission. A total of 406 237 patients with AMI were discharged home. Patients in the HHC+ cohort (38 215 patients, 9.4%) were older (mean age 77 vs. 60 years P < 0.001), more likely women (53 vs. 26%, P < 0.001), have heart failure (5 vs. 0.5%, P < 0.001), chronic kidney disease (26 vs. 6%, P < 0.001) and diabetes (35 vs. 26%, P < 0.001). Patients readmitted within 30-days were older with higher rates of diabetes (RR = 1.4, 95% CI: 1.37-1.48) and heart failure (RR = 5.8, 95% CI: 5.5-6.2). Unadjusted 30-day readmission rates were 21 and 8% for HHC+ and HHC- patients, respectively. After adjustment, readmission was lower with HHC (21 vs. 24%, RR = 0.89, 95% CI: 0.82-0.96; P < 0.001). In the United States, AMI patients receiving HHC are older and have more comorbidities; however, HHC was associated with a lower 30-day readmission rate.

Diabetes Fact Sheets in Korea, 2020: An Appraisal of Current Status.

BackgroundThis study aimed to investigate the recent prevalence, management, and comorbidities of diabetes among Korean adults aged ≥30 years by analyzing nationally representative data.MethodsThis study used data from the Korea National Health and Nutrition Examination Survey from 2016 to 2018, and the percentage and total number of people ≥30 years of age with diabetes and impaired fasting glucose (IFG) were estimated.ResultsIn 2018, 13.8% of Korean adults aged ≥30 years had diabetes, and adults aged ≥65 years showed a prevalence rate of 28%. The prevalence of IFG was 26.9% in adults aged ≥30 years. From 2016 to 2018, 35% of the subjects with diabetes were not aware of their condition. Regarding comorbidities, 53.2% and 61.3% were obese and hypertensive, respectively, and 72% had hypercholesterolemia as defined by low-density lipoprotein cholesterol (LDL-C) ≥100 mg/dL in people with diabetes. Of the subjects with diabetes, 43.7% had both hypertension and hypercholesterolemia. With regard to glycemic control, only 28.3% reached the target level of <6.5%. Moreover, only 11.5% of subjects with diabetes met all three targets of glycosylated hemoglobin, blood pressure, and LDL-C. The percentage of energy intake from carbohydrates was higher in diabetes patients than in those without diabetes, while that from protein and fat was lower in subjects with diabetes.ConclusionThe high prevalence and low control rate of diabetes and its comorbidities in Korean adults were confirmed. More stringent efforts are needed to improve the comprehensive management of diabetes to reduce diabetes-related morbidity and mortality.

Association between serum indoxyl sulfate levels with carotid-femoral pulse wave velocity in patients with chronic kidney disease

Background The role of indoxyl sulfate (IS), an important protein-bound uremic toxin, in arterial stiffness (AS) in patients with chronic kidney disease (CKD) is unclear. Materials and methods We investigated the association between serum IS levels and AS in a cross-sectional study of 155 patients with CKD. Patients in the AS group was defined as carotid-femoral pulse wave velocity (cfPWV) value >10 m/s measured by a validated tonometry system (SphygmoCor), while values ≤10 m/s were regarded as without AS group Serum IS was measured by liquid chromatography–mass spectrometry analysis. Results Of these CKD patients, AS was present in 51 (32.9%) patients, who were older, had a higher rate of diabetes, higher systolic blood pressure (SBP), and higher IS levels compared to those without AS. By multivariable logistic regression analysis, IS (adjusted odds ratio [aOR] 1.436, 95% confidence interval [CI] 1.085–1.901, p = 0.011), age (aOR 1.058, 95% CI 1.021–1.097, p = 0.002), and SBP (aOR 1.019, 95%CI 1.000–1.038, p = 0.049) were independent predictors of AS. By multivariable stepwise linear regression analysis, logarithmically transformed IS, age, DM, and SBP were significantly correlated with cfPWV. The area under the receiver-operating characteristic curve for serum log-IS was 0.677 (95%CI 0.598–0.750, p = 0.0001) to predict the development of AS in patients with CKD. Conclusion These finding demonstrate that in addition to older and higher SBP, a high serum IS level is a significant biomarker associated with AS in patients with CKD.

Umami: An Alternative Japanese Approach to Reducing Sodium While Enhancing Taste Desirability

COVID-19 has highlighted the underlying global burden from non-communicable diseases (NCDs) and the lack of resiliency in health systems to tackle highly preventable risk factors, which have left populations vulnerable to acute health crises. The persistent issue of unhealthy behaviors, particularly those related to a high-sodium diet, suggests inadequate policy attention and insufficient funding for public health and behavioral research. This year, Japan will host the Tokyo Nutrition for Growth (N4G) Summit 2021. The summit is being held in the era of COVID-19, offering a historic opportunity to make a difference on the global health agenda for food and nutrition and to reaffirm the global commitment to prevent future health crises by addressing the growing burden of NCDs and building better prepared and more resilient health systems. This perspective article suggests that we, global health researchers and decision-makers, should rethink the value of using “Umami” substances as candidates for a practical salt-reducing alternative that originated in Japan (while maintaining the affordability, accessibility, availability, and desirability of healthy food). Reduced salt intake will help address the global syndemic of COVID-19 pandemic and high rates of hypertension, heart diseases, diabetes, and other NCDs. By addressing these issues, it will make countries more resilient to future pandemic threats.

Status of Novel Coronavirus Disease and Analysis of Mortality in Mexico, Until June 30th, 2020: An Ecological Study

Introduction.Mexico has high number of new cases of Coronavirus Infectious Disease-19 and high rates of diabetes, hypertension, obesity, smoking, that can increase the mortality. The aim was to analyze the evolution of the disease until June 30th, 2020; to know the Cause-SpecificMortality Rate by each state from Mexico and the effect of co-morbidities on mortality for Coronavirus Infectious Disease-19. Methods. An ecological study was designed with public data of National Epidemiological Surveillance System to compare the hospital infrastructure (beds) and Cause-Specific Mortality Rate in each state from Mexico and analyze the effect of co-morbidities in mortality by Coronavirus Infectious Disease.19. It was used t-Student test, Z for two proportions, P-values, and OR, CI95%, and logistic regression .Results. From 509,539 registries, 226,089 (44.37%) were confirmed cases and 27,769 deaths were reported (12.28%). The states with higher mortality were Morelos, Baja California, Chihuahua, Guerrero. There was a lineal relationship between number of beds and cause-specific mortality rate (P&lt;,05). Diabetes, chronic obstructive pulmonary disease, immunosuppression, hypertension, cardiovascular disease, chronic kidney disease and obesity shown a stronger effect on mortality by coronavirus disease (OR higher than 2). Asthma shown a protective effect on mortality from coronavirus disease in Mexican population. Conclusion.The spread on coronavirus disease is active in Mexico. The comorbidities had a stronger effect on mortality of Coronavirus disease.

“A Touch of Sugar”: A Qualitative Study of the Impact of Health Beliefs on Type 1 and Type 2 Diabetes Self-Management Among Black Canadian Adults

ObjectivesBlack Canadians have higher rates of diabetes and complications compared with White Canadians. However, research on diabetes self-management in this community is lacking. We conducted a qualitative study to explore diabetes self-management in the Black Canadian community using the lens of the Health Belief Model. MethodsForty-three individuals who identify as Black Canadians, living with or caring for a person with diabetes, were recruited. Data were collected through focus groups and interviews, and then analyzed using content analysis. ResultsWe found that participants appreciated they are susceptible to diabetes based on family or peer experiences. Perceived severity is variable for which some believe that diabetes is only a “sugar problem,” and the majority highlighted a perceived lack of knowledge about diabetes complications. Perceived benefits to treatment included prolonging life and cleansing one’s body. Perceived barriers included lack of culturally appropriate dietary advice, lack of shared decision-making driven by a language barrier and cultural mismatch between patient and provider, socioeconomic status and difficulty navigating and accessing the Canadian health-care system. Peers, family members, churches and online platforms served as the main information sources and cues to action, influencing each of the 4 aforementioned categories. A number of solutions were proposed by the participants to address the barriers from patient, health-care delivery and health advocacy perspectives. ConclusionsBlack Canadians face unique barriers to diabetes self-management, some of which are rooted within health belief systems. Avenues for intervention include peer education through narratives and a renewed focus on providing culturally appropriate care.

COVID-19 mortality effects of underlying health conditions in India: a modelling study

ObjectiveTo model how known COVID-19 comorbidities affect mortality rates and the age distribution of mortality in a large lower-middle-income country (India), and to identify which health conditions drive differences with...

PDB15 Healthcare Outcomes for Patients with Type 2 Diabetes with and without Comorbid Obesity

The increasing prevalence of diabetes and obesity have led to the co-occurrence being labelled as “twin epidemics.” Given the high rates of comorbid diabetes and obesity, as well as the health benefits associated with lower weight among patients with type 2 diabetes, this research examines the burden of obesity associated with comorbid T2D. This U.S. administrative claims database study uses IBM® MarketScan® Explorys Claims Electronic Medical Records data from January 1, 2012 through April 30, 2019 to identify adults with T2D, two recorded body mass index (BMI) values in the same weight category, and continuous insurance coverage from 1 year prior through 1 year post index date. Patients with index 18.5 kg/m2 ≤ BMI < 30 kg/m2 (normal/overweight) were matched to patients with index BMI ≥ 30 kg/m2 (obese) using propensity score matching (PSM). Using the PSM cohort, multivariable analyses examined the association between obesity and patient comorbidities, resource utilization, and healthcare costs. In the 1:1 matched cohort (16,006 normal/overweight; 16,006 obese), multivariable analyses showed that obesity, compared to normal/overweight, was associated with increased odds of a diabetes-related comorbidity (Odds Ratio [OR] = 1.21; 95% Confidence Interval [CI] 1.14 – 1.28) and an obesity-related comorbidity (OR=1.42; 95% CI 1.29 – 1.56). Obesity was associated with increased odds of the specific obesity or diabetes-related comorbidities of hypertension, hyperlipidemia, cardiovascular disease, nephropathy, neuropathy, peripheral vascular disease, and metabolic disease (all P<0.05). Obesity was also associated with increased resource utilization as well as significantly higher annual diabetes-related ($8,987 v $8,057; P<0.0001) and all-cause total costs ($26,624 v $24,838; P<0.0001). Results increase the knowledge of how patients with T2D and obesity should be of greater concern for healthcare providers compared to T2D patients without comorbid obesity, given their worse comorbidity profile, increased resource utilization, and higher healthcare costs.

COVID‐19 and the Marshallese

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Complications of the third stage of labor in in vitro fertilization pregnancies: an additional expression of abnormal placentation?

To assess the correlation between invitro fertilization (IVF) and complications of the third stage of labor. Retrospective cohort of vaginal deliveries from November 2008 to January 2020. Maternal and obstetric outcomes of singleton deliveries were compared between IVF and non-IVF pregnancies. University hospital. Women with live singleton vaginal deliveries at >24 weeks of gestation. Invitro fertilization-attained pregnancies (compared with spontaneous ones). Complications of the third stage of labor, defined as manual placental removal (either entire removal due to nonseparation or exploration of the uterine cavity due to suspected retained products of conception). Overall, 1,264 IVF pregnancies and 34,166 non-IVF pregnancies were included. Deliveries in the IVF group were characterized by an older maternal age, lower parity, higher rate of diabetes and hypertensive disorders, higher rate of placental abnormalities, earlier gestational age, higher rate of labor induction, chorioamnionitis, and instrumental delivery. Complications of the third stage of labor occurred in 5.9% of IVF deliveries and in 2.8% of controls, and blood transfusion was more prevalent in IVF deliveries. The rate of complications of the third stage were higher in both fresh and frozen transfer cycles as compared with spontaneous pregnancies (5.8%, 8.8%, and 2.8%, respectively), although no difference was noted between fresh and frozen transfers. Invitro fertilization was associated independently with complications of the third stage of labor after adjustment for potential confounders. Invitro fertilization is associated independently with an increased risk of complications of the third stage of labor.

Prognostic impact of elevated baseline CRP levels in primary PCI-treated patients with residual cholesterol risk

Abstract Background Recent large randomized studies have indicated the potential of anti-inflammatory therapies to reduce adverse cardiovascular events in patients with myocardial infarction, with the most pronounced benefit in patients with baseline elevated C-reactive protein (CRP). Purpose Our aim was to assess the association of CRP levels with 30-day and 1-year mortality in patients with acute myocardial infarction treated with primary PCI and with residual cholesterol risk. Methods The study included 1531 patients admitted for primary PCI, with the residual cholesterol risk, i.e. low-density lipoprotein cholesterol (LDL-C) levels of &amp;gt;1.80 mmol/l (70 mg/dl), from a prospectively kept electronic registry of a high-volume tertiary center, for whom in-hospital CRP measurements were available. Elevated CRP was defined as ≥5 mg/l (local laboratory cut off value), measured during index hospitalization. Cox regression models were constructed to assess the impact of elevated CRP on 30-day and 1-year mortality. Results 72% of the included patients with LDL-C &amp;gt;1.80 mmol/l had elevated in-hospital CRP (n=1107). Compared with patients with CRP levels within reference limit, elevated CRP was associated with older age (62 vs. 60, p&amp;lt;0.001), higher rates of diabetes (25.8% vs. 18.5%, p=0.002), renal failure (6.4% vs. 2.1%, p&amp;lt;0.001) and Killip class &amp;gt;1 at presentation (22.5% vs. 12.3%, p&amp;lt;0.001), as well as lower EF (44% vs. 48%, p&amp;lt;0.001) and lower haemoglobin on admission (13.9 g/dl vs. 14.2 g/dl, p&amp;lt;0.001). Crude mortality rates were increased in patients with CRP ≥5mg/l at both 30 days (6.0% vs. 2.4%, p=0.003) and 1 year (13.2% vs. 6.3%, p&amp;lt;0.001) (Figure). After adjusting for the observed baseline differences, CRP ≥5mg/l remained an independent predictor of mortality at 1 year (HR 1.691, 95% CI: 1.050–2.724, p=0.03), but not at 30 days (HR 1.690, 95% CI: 0.859–3.324, p=0.13). Conclusion In primary PCI-treated patients with residual cholesterol risk, elevated in-hospital CRP was independently associated with 1-year mortality. Our findings may thus suggest a potential window of opportunity, for anti-inflammatory therapies to improve outcomes beyond the acute phase. Figure 1 Funding Acknowledgement Type of funding source: None

Elevated Glycated Hemoglobin Is Associated With Liver Fibrosis, as Assessed by Elastography, in a Population-Based Study of Mexican Americans.

Diabetes is associated with liver disease and risk of hepatocellular carcinoma. In this study, we evaluated the association between liver fibrosis measured by transient elastography and four glucose metabolism measures in the Cameron County Hispanic Cohort, a population‐based, randomly selected cohort of Mexican American Hispanics with high rates of diabetes and liver cancer. We measured liver fibrosis (a risk factor for hepatocellular carcinoma) in 774 well‐characterized cohort participants using transient elastography. We evaluated the association of liver fibrosis with glycated hemoglobin (HbA1c), fasting blood glucose, insulin, and insulin resistance using multivariable linear regression models. In multivariable models, log‐transformed HbA1c had the strongest association with liver fibrosis (β = 0.37, 95% confidence interval [CI] 0.04‐0.69, P = 0.038), after controlling for waist circumference, aspartate aminotransferase, alanine aminotransferase, liver fat, and other known confounders. The association was statistically significant among women (β = 0.33, 95% CI 0.10‐0.56, P = 0.009) and similar but nonsignificant among men (β = 0.41, 95% CI −0.17 to 0.98, P = 0.593). Waist circumference, platelet count, aspartate transaminase, and liver steatosis were each associated with liver stiffness. Conclusions: Elevated HbA1c is associated with liver fibrosis, a key risk factor for HCC, particularly among women. Our results indicate that Mexican Americans with uncontrolled HbA1c may benefit from routine screening by liver elastography to identify individuals at risk of liver disease progression.

Effects of COVID-19 on the mental health of black and brown racialized populations in the U.S.

Effects of COVID-19 on the mental health of black and brown racialized populations in the U.S.

Medical pluralism, sorcery belief and health seeking in Vanuatu: a quantitative and descriptive study.

Set in Espiritu Santo, Vanuatu, this study explores the relationship between cultural knowledge and beliefs concerning illness and health-seeking behaviour within the context of medical pluralism. Concentrating on the nation's high rates of diabetes and non-communicable disease (NCD) risk factors, this research analyses the way in which understandings of disease aetiology and healing efficacy impact upon treatment-related decisions. Data were obtained through a mixed-methods community survey of 313 adult respondents developed in collaboration with ni-Vanuatu health experts, community leaders and survey enumerators, and comprised of open and closed-ended questions. As the results demonstrate, framed by cultural and religious beliefs, multifaceted indigenous conceptualizations of health and illness in Vanuatu are directly linked to pluralist health seeking practices, including the concurrent use of formal and informal health services. The interwoven identification of sociocultural, physical and clinical determinants of disease highlights the complex manner in which health is understood and maintained by ni-Vanuatu. In successfully addressing the rising burden of NCDs, it is integral that health interventions and service providers acknowledge the complex conceptualization of disease and ensure the provision of holistic care that embraces rather than ignores the steadfast role of local systems of belief, and of traditional, religious and other informal forms of healthcare provision.

Key stakeholder experiences of an integrated healthcare pilot in Australia: a thematic analysis

BackgroundIn Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally.MethodsWe administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n = 42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts.ResultsKey themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting.ConclusionsPatients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.

S1168 Effect of Alcoholism on Outcomes of Patients With COVID-19 Infection: A Retrospective Analysis

INTRODUCTION: The United States has rapidly emerged as the epicenter for the novel coronavirus (COVID-19) pandemic. Chronic alcohol use (CAU) is associated with worsening outcomes in disorders such as pneumonia, ARDS, and gastrointestinal bleeds. Studies indicate chronic alcohol use may increase the susceptibility to respiratory infections, including potentially COVID-19. However, the effect of chronic alcohol use on outcomes in patients with COVID-19 viral infection is currently unknown. This study aims to assess the effect of chronic alcohol use (CAU) on the outcomes of patients admitted with COVID-19 infection in a suburban safety-net hospital in New York. METHODS: A retrospective single-center study of 640 patients (age ≥ 18 y) admitted to our facility from March 9, 2020 to April 20, 2020 with the diagnosis of COVID-19 infection. Presence of current or past alcohol use was documented in all COVID-19 patients able to provide history. The primary outcome was all-cause in-hospital mortality; other hospitalization outcomes including cardiac arrests, ARDS, arrhythmia, shock, and intubation rate were measured. Chi-square tests and independent T-sample tests were used to analyze categorical and continuous variables, respectively. Multivariate logistic regression analyses were performed to measure the odds of in-patient mortality and other outcomes. All statistical analyses were performed using SPSS. RESULTS: Of total 640 patients, 88 (13.0%) reported a history of chronic alcohol use (CAU), 460 (67%) denied and 91 (13.4%) were unable to provide history. Patients with CAU did not have a statistically elevated risk of mortality than those without alcohol use (25.0% vs. 31.5%, P = 0.031), lower rates of acute kidney injury (14.8% vs. 26.6%, P = 0.027) and higher rates of atrial fibrillation (5.7% vs. 3.3%, P = 0.006). No statistical difference was seen between groups on other factors of morbidity including ICU admission, intubation, cardiac arrest or septic shock. Patients with alcohol use had higher rates of diabetes, and concurrent tobacco and illicit drug use. Mean age in CAU was 55.8 vs. 58.9 in no alcohol use (SD 14.9, P = 0.068). There was no statistical difference between two groups in hospital or ICU length of stay. CONCLUSION: Chronic immunosuppression from alcohol use and associated liver dysfunction may not be a significant contributing factor to worsening outcomes in patients with concomitant COVID 19 infection.Table 1.: Demographic and clinical outcomes of alcohol dependence vs. no alcohol dependence based on documented history

Where Do We Stand Today on Racial and Ethnic Health Inequities? Analysis of Primary Total Knee Arthroplasty from a 2011-2017 National Database.

The objective of this study was to present contemporary national data on the state of racial and ethnic disparities pertaining to primary total knee arthroplasty (TKA) in the USA. The 2011-2017 National Surgical Quality Improvement Program was used to capture all patients who underwent primary TKA. The study outcomes were differences in demographic, comorbidity burden, perioperative factors, procedure utilization, hospital length of stay (LOS), and 30-day outcomes. The five major minority groups as defined by the National Institutes of Health were compared to non-Hispanic Whites. In total, 262,954 patient records were analyzed, with racial identification available on 230,712 patients (87.7%). White patients accounted for 72.5% of all TKA procedures. There were higher rates of diabetes, hypertension, anemia, and prolonged surgery times among racial and ethnic minorities (p < 0.001). Baseline disparities were especially pronounced among non-Hispanic Blacks/African Americans who were also like to have higher rates of tobacco smoking and CHF (p < 0.001). After controlling for baseline differences, significant disparities in outcomes persisted, especially among Blacks/African Americans and Hispanics/Latinos who had higher odds for experiencing complications and readmissions (p < 0.001). All racial and ethnic groups, except Asians, had longer LOS (p < 0.001). Asian patients had significantly lower rates of readmissions, reoperations, and overall complications (p < 0.001). Racial and ethnic disparities remain a public health challenge for patients undergoing TKA. While initiatives aimed at improving preoperative disease-burden and comorbidity profiles represent an important step, they alone are insufficient to fully account for or eliminate the disparities in TKA outcomes.