non-US Populations Research Articles

Symbolic power in the US Government Counterinsurgency Guide: US security, (non-) combatant civilians, and the refugee-in-place

Framed by symbolic power as a theory of performance, this essay takes as its subject the state’s use of performance transience for oppressive ends. For Pierre Bourdieu, the symbolic field is about group misrecognition of existing power differentials as legitimate distinctions. Building from this theory, I examine the 2009 US Government Counterinsurgency Guide’s work in the symbolic field. At once a military, social, and performance theory, the Guide creates categorization schemas that differentially define states and people based off of performances of loyalty to US interests. Through the concept of the “non-combatant civilian,” these hierarchies position non-US populations as always already threatening, and acquire social authorization through the threat of further violence. By generating roles for groups of people and framing the means of enforcing those roles, the Guide uses performance transience to structure a symbolic order with deeply racializing consequences.

Potential Impact of the 2017 High Blood Pressure Guideline Beyond the United States: A Case Study of the People's Republic of China.

The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) (US) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults expanded the definition of hypertension and now considers atherosclerotic cardiovascular disease (ASCVD) risk in determining treatment for people with hypertension. US guidelines are influential around the world and it is therefore justified to study their impact in other settings. Our study determined the impact of adopting the 2017 ACC/AHA guideline in China. We analyzed the population impact of the 2017 ACC/AHA guideline using the 2011-2012 year of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative sample of Chinese adults 45-74 years of age (n = 11,822). Our analysis was unique because for the first time it used a population-appropriate equation to calculate ASCVD risk instead of the US Pooled Cohort Equation (the latter misrepresents risk in non-US populations). Adopting the 2017 ACC/AHA guideline in China would increase the prevalence of hypertension from 44.1% to 56.4% (12.3 percentage points) and increase the number of adults recommended for antihypertensive medication from 41.6% to 49.1% (7.5 percentage points) in the 45-74-year age range. According to Chinese (but not US) risk calculations, the 2017 ACC/AHA guideline more selectively assigns antihypertensive medication to patients at higher risk for ASCVD. The 2017 ACC/AHA guideline brings potential for risk reduction in China and selectively recommends medication for those who would benefit most. Realizing such benefits would ultimately depend on the acceptance, adherence, and feasibility of adopting this guideline.

Abstract P478: Trends in Concurrent Heart Failure and Acute Coronary Syndrome Hospitalizations: A Literature Review

Purpose: Patients who present with concurrent heart failure (HF) and acute coronary syndrome (ACS) have an increased risk of mortality, but changes in clinical practice have improved clinical outcomes. We sought to examine recent trends in concurrent HF and ACS hospitalizations in the United States (US) through review of published literature. Methods: We searched the Medline and PubMed databases for studies published after January 1, 2000 reporting the hospitalizations for HF with concurrent acute coronary syndromes. We included studies performed in the US or with at least 25% US participants, that reported the proportion with concurrent HF and ACS, and used a clinical definition of HF (e.g. Killip Class II or III, NYHA Class, or Framingham Criteria). Studies were reviewed by and data was extracted using a standardized form. We extracted study and patient characteristics, definition of HF, and rates of concurrent HF and ACS hospitalizations. We categorized included studies by ACS type: (1) non-specific myocardial infarction (MI) or ACS, (2) non-ST elevation (NSTE) MI or NSTE-ACS, or (3) ST elevation (STE) MI. We descriptively examined recent trends in hospitalizations for concurrent HF and ACS over time; rates reported for multiple time periods or ACS types were considered separately. Results: We identified 23 observational studies, systematic reviews, and randomized clinical trials. Of these, we excluded 13 due to non-US populations, use of non-clinical definitions of HF (i.e., diagnosis codes), or not reporting rates of concurrent HF and ACS. Of the 10 included studies, 7 reported concurrent HF with non-specific MI or ACS from 1975 through 2005 across multiple registries and literature reviews. Rates ranged from 12.5% to 48.0% with no clear time-related trends. We identified 3 studies reporting concurrent HF with NSTEMI or NSTE-ACS from pooled analysis or the Global Registry of Acute Coronary Events (GRACE) registry from 1994 to 2008. Reported rates ranged from 8.2%-15.7% for studies starting in the 1990s with one study reporting and 6.1% in 2005. We identified 4 studies reporting concurrent HF with STEMI, including a pooled analysis, the GRACE registry, and a clinical trial. Rates of concurrent HF with STEMI appeared to decrease over time from 32.5% in 1990 to 1998, 15.6%-19.5% from 1999 to 2001, and 2.6%-11.0% in 2005. Conclusion: Our literature review found that there may be a decrease in concurrent HF and STEMI hospitalizations in recent decades, but no apparent trends with other types of ACS. This may be related to emphasis on early revascularization strategies, improved primary prevention, and/or earlier time to presentation due to increasing public awareness.. However, there was a dearth of data reporting concurrent HF and ACS hospitalization within the last decade. Further research is needed to understand the impact of multiple changes in clinical practice on secular trends.

Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

Introduction: Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. Methods: This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, t test, χ² test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. Results: Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, p = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). Conclusion: Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

Electromagnetic Energy Absorption in a Head Approaching a Radiofrequency Identification (RFID) Reader Operating at 13.56 MHz in Users of Hearing Implants Versus Non-Users.

The aim of this study was to model the absorption in the head of an electromagnetic field (EMF) emitted by a radiofrequency identification reader operating at a frequency of 13.56 MHz (recognized as an RFID HF reader), with respect to the direct biophysical effects evaluated by the specific absorption rate (SAR), averaged over the entire head or locally, over any 10 g of tissues. The exposure effects were compared between the head of a user of a hearing implant with an acoustic sensor and a person without such an implant, used as a referenced case. The RFID HF reader, such as is used in shops or libraries, was modeled as a loop antenna (35 × 35 cm). SAR was calculated in a multi-layer ellipsoidal model of the head—with or without models of hearing implants of two types: Bonebridge (MED-EL, Austria) or bone anchored hearing aid attract (BAHA) (Cochlear, Sweden). Relative SAR values were calculated as the ratio between the SAR in the head of the implant user and the non-user. It was found that the use of BAHA hearing implants increased the effects of 13.56 MHz EMF exposure in the head in comparison to non-user—up to 2.1 times higher localized SAR in the worst case exposure scenario, and it is statistically significant higher than when Bonebridge implants are used (Kruscal–Wallis test with Bonferroni correction, p < 0.017). The evaluation of EMF exposure from an RFID reader with respect to limits established for the implant non-user population may be insufficient to protect an implant user when exposure approaches these limits, but the significant difference between exposure effects in users of various types of implants need to be considered.

Abstract P316: A Longitudinal Assessment of Exercise Participation From Mid- to Late-Life: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Physical activity is a modifiable behavior with cumulative health benefits across the lifespan. Most studies of adult exercise patterns have been cross-sectional and limited to non-US populations. Describing longitudinal changes in exercise from mid- to late-life can provide insight into targeted exercise recommendations for middle-aged and older adults. Objective: In the biracial ARIC Study (n=15792), we report trends in the type and duration of exercise among adults aged 45-64 years who were followed for over 20 years. We further examined exercise patterns in a subset of adults who reported engaging in exercise at each ARIC visit (n=1254). Methods: Individuals self-reported type and duration of up to 4 exercises participated in the past year at four visits. Participant’s total minutes/week of exercise was estimated as a composite of the 4 exercises. Type of exercise was categorized as defined in Table 1. Participants were identified as having engaged in &lt;30 minutes or ≥30 minutes/week for each exercise category. Results: Overall, 9,866 adults (female n=5,288; Black n=1,874) reported engaging in exercise at baseline (Table 1). Adults who reported exercise participation at all visits (n=1254; female n=658; Black n=163) had, on average, increased and then decreased their exercise duration from visits 1 to 6. Consistently active adults participated in exercises for a longer duration over time, while among the whole cohort, duration decreased. Walking was the most frequently reported exercise overall for the whole and consistently active cohort. The number of consistently active adults who walked for at least 30 minutes/week increased from 704 to 790 at visits 1 and 6, respectively Conclusion: Exercise patterns differed for adults reporting participation in exercise at a minimum at visit 1 compared to consistently active adults. Further exploration of predictors (i.e. retirement or health status) of exercise change should be examined to guide recommendations that aim to optimize energy expenditure in adulthood.

362: Interpregnancy interval and neonatal outcomes in a large US cohort

Interpregnancy Interval (IPI) is the time between delivery and subsequent conception. An IPI of 18-24 months is considered ideal and an IPI<18 months has been associated with adverse neonatal outcomes including preterm birth and low birth weight, however data is largely from small cohort studies or non-US populations. We sought to evaluate the association between short IPI and adverse neonatal outcomes in a large, diverse data set. We conducted a retrospective cohort study using vital statistics birth certificate records between 2012-2015. Women with a singleton, non-anomalous pregnancy and at least one prior live birth were included for analysis. Women were stratified by the IPI as follows: <6 months, 6-11 months, 12 months-18 months, 18-23 months and >=24 months. Neonatal morbidity was the outcome of interest including preterm birth, low birth weight (<2500g), very low birth weight (<1500g), NICU admission, Apgar <7, and seizures. Maternal medical conditions and socioeconomic factors known to be associated with preterm birth were evaluated and controlled for in multivariable logistic regression. We identified 8,013,471 women with pregnancies meeting our inclusion criteria. Of those, 1,989,686 (31.3%) had an IPI of <18 months and 516.021 (6.44%) had a very short IPI of <6 months. Short IPI was associated with preterm birth, low birth weight and very low birth weight, 5 min Apgar less than 7, NICU admission and neonatal seizures. Maternal characteristics associated with short IPI included Black, Hispanic and Native American ethnicity, limited prenatal care, tobacco use in pregnancy, and Medicaid as payer source for delivery. Diabetes and hypertensive disorder, advanced maternal age and white and Asian race/ethnicity were not associated with short IPI. When controlling for multiple potential confounding variables, short IPI remained significantly associated with preterm birth, but no other adverse neonatal outcomes. The association appears inversely proportional to the IPI with an adjusted odds ratio of 1.05 (95%CI 1.04-1.06) and 1.42 (95%CI 1.41-1.44) for IPI <18 months and <6 months respectively. In this large, diverse data set, short IPI was significantly associated with preterm birth, but was not significantly associated with other adverse neonatal outcomes.

Social media’s have-nots: an era of social disenfranchisement

PurposeThe purpose of this paper is to investigate the motivations, concerns, benefits and consequences associated with non-use of social media. In doing so, it extends Wyatt’s commonly used taxonomy of non-use by identifying new dimensions in which to understand non-use of social media. This framework encompasses a previously unidentified category of non-use that is critical to understand in today’s social media environment.Design/methodology/approachThis is an exploratory interview study with 17 self-identified social media non-users distributed across age groups and socioeconomic backgrounds. A thematic analysis is conducted based on a novel extension of Wyatt’s framework and the risk-benefits framework. This is supplemented by open coding to allow for emerging themes.FindingsThis paper provides empirical insights into a formerly uninvestigated population of non-users who are prevented from using social media because of social engagement (rather than functional) barriers. It identifies how these individuals face social consequences both on and off social media, resulting in social disenfranchisement.Research limitations/implicationsThis is an initial exploration of the phenomenon using an interview study. For generalizability, future research should investigate non-use with a broader and random sample.Practical implicationsThis paper includes design recommendations and implications for social media platform designers to mitigate the consequences experienced by socially disenfranchised non-users.Social implicationsAddressing concerns of this newly identified class of non-users is of utmost importance. As others are increasingly connected, these non-users are left behind and even ostracized – showing the dark sides of social media use and non-use.Originality/valueThis work identifies types of non-use of social media previously unrecognized in the literature.

Abstract 031: Thresholds for Defining Home Blood Pressure Elevation Among US adults

Background: Most hypertension guidelines have recommended lower home than clinic BP thresholds based on epidemiological studies conducted in non-US populations. However, diagnostic thresholds to define home BP elevation have never been determined in the general population in the United States. Methods: We analyzed data from 2 US cohorts with home and clinic BP data in the same participants, the Dallas Heart Study (DHS, n=5,768) and the North Carolina Masked Hypertension study (NCMH, n = 420). Home BP thresholds for stage 1 (BP ≥ 130/80 mmHg) and stage 2 hypertension (BP ≥ 140/90 mmHg) were identified using a regression-based approach in both cohorts and an outcome-derived approach in the DHS cohort. The composite of all-cause mortality or a cardiovascular disease (CVD) event was used in the outcome-derived approach. For this approach, BP thresholds were identified only for systolic BP (SBP) as clinic diastolic BP (DBP) was not associated with the outcome. Results: Among untreated participants in DHS, the regression-derived thresholds for home BP corresponding to clinic BP for stage 1 and stage 2 hypertension were 130/81 and 137/88 mmHg in blacks and 127/79 and 135/86 mmHg in nonblacks, respectively. The results are virtually identical in the NCMH cohort. The 11-year composite CVD and mortality events corresponding to stage 1 (clinic SBP ≥ 130) and stage 2 (clinic SBP ≥ 140 mmHg) were higher in untreated blacks than untreated non-blacks [13.3 (11.06-15.54) and 17.59 (14.8-20.37)% vs. 6.78 (5.17-8.39) and 9.86 (6.94-12.77)%, respectively]. Using a race/ethnicity-specific composite outcome, the outcome-derived thresholds from the DHS for home SBP corresponding to stage 1 and stage 2 hypertension were 131 and 140 mmHg in untreated blacks and 130 and 139 mmHg in untreated nonblacks, respectively. Conclusions: Based on the regression-derived approach, we found home BP thresholds for stage 1 and 2 hypertension from both cohorts to be similar to the current ACC/AHA guidelines. The outcome-derived approach also identified similar home SBP thresholds for stage 1 hypertension but slightly higher home SBP thresholds for stage 2 hypertension than recommended guidelines.

Acute respiratory distress syndrome subphenotypes and differential response to simvastatin: secondary analysis of a randomised controlled trial

Precision medicine approaches that target patients on the basis of disease subtype have transformed treatment approaches to cancer, asthma, and other heterogeneous syndromes. Two distinct subphenotypes of acute respiratory distress syndrome (ARDS) have been identified in three US-based clinical trials, and these subphenotypes respond differently to positive end-expiratory pressure and fluid management. We aimed to investigate whether these subphenotypes exist in non-US patient populations and respond differently to pharmacotherapies. HARP-2 was a multicentre, randomised controlled trial of simvastatin (80 mg) versus placebo done in general intensive care units (ICUs) at 40 hospitals in the UK and Ireland within 48 h of onset of ARDS. The primary outcome was ventilator-free days, and secondary outcomes included non-pulmonary organ failure-free days and mortality. In a secondary analysis of HARP-2, we applied latent class analysis to baseline data without consideration of outcomes to identify subphenotypes, and we compared clinical outcomes across subphenotypes and treatment groups. 540 patients were recruited to HARP-2. One patient withdrew consent for the use of their data, so data from 539 patients were analysed. In our secondary analysis, a two-class (two subphenotype) model was an improvement over a one-class model (p<0·0001), with 353 (65%) patients in the hypoinflammatory subphenotype group and 186 (35%) in the hyperinflammatory subphenotype group. Additional classes did not improve model fit. Clinical and biological characteristics of the two subphenotypes were similar to previous studies. Patients with the hyperinflammatory subphenotype had fewer ventilator-free days (median 2 days [IQR 0-17] vs 18 [IQR 0-23]; p<0·0001), fewer non-pulmonary organ failure-free days (15 [0-25] vs 27 [21-28]; p<0·0001), and higher 28-day mortality (73 [39%] vs 59 [17%]; p<0·0001) than did those with the hypoinflammatory subphenotype. Although HARP-2 found no difference in 28-day survival between placebo and simvastatin, significantly different survival was identified across patients stratified by treatment and subphenotype (p<0·0001). Specifically, within the hyperinflammatory subphenotype, patients treated with simvastatin had significantly higher 28-day survival than did those given placebo (p=0·008). A similar pattern was observed for 90-day survival. Two subphenotypes of ARDS were identified in the HARP-2 cohort, with distinct clinical and biological features and disparate clinical outcomes. The hyperinflammatory subphenotype had improved survival with simvastatin compared with placebo. These findings support further pursuit of predictive enrichment strategies in critical care clinical trials. UK Efficacy and Mechanism Evaluation Programme and National Institutes of Health.

An Empirical Dietary Inflammatory Pattern Score Is Associated with Circulating Inflammatory Biomarkers in a Multi-Ethnic Population of Postmenopausal Women in the United States

The empirical dietary inflammatory pattern (EDIP) score has been associated with concentrations of circulating inflammatory biomarkers in European Americans. We used the EDIP score, a weighted sum of 18 food groups that characterizes dietary inflammatory potential based on circulating concentrations of inflammatory biomarkers, to test the hypothesis that a pro-inflammatory dietary pattern is associated with inflammatory biomarker concentrations in a US multi-ethnic population. In this cross-sectional study, we calculated EDIP scores using baseline food frequency questionnaire data from 31,472 women, aged 50-79 y, in the Women's Health Initiative observational study and clinical trials. Circulating biomarkers outcomes at baseline were: C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF)-α, TNF receptor (TNFR) 1 and 2, and adiponectin. We used multivariable-adjusted linear regression analyses to estimate absolute concentrations and relative differences in biomarker concentrations, overall and in subgroups of race/ethnicity and BMI (body mass index) categories. Independent of energy intake, BMI, physical activity, and other potential confounding variables, higher EDIP scores were significantly associated with higher (lower for adiponectin) absolute concentrations of all 6 biomarkers. On the relative scale, the percentage of difference in the concentration of biomarkers, among women in the highest compared to the lowest EDIP quintile, was: CRP, +13% (P-trend<0.0001); IL-6, +15% (P-trend<0.0001); TNF-α, +7% (P-trend=0.0007); TNFR1, +4% (P-trend=0.0009); TNFR2, +5% (P-trend<0.0001); and adiponectin, -13% (P-trend <0.0001). These associations differed by racial/ethnic groups and by BMI categories. Whereas the absolute biomarker concentrations were lower among European-American women and among normal-weight women, the associations with diet were stronger than among women of African-American or Hispanic/Latino origin and among overweight and obese women. Findings demonstrate the successful replication of an empirical hypothesis-oriented a posteriori dietary pattern score in a multi-ethnic population of postmenopausal women, with subgroup differences by race/ethnicity and body weight. Future research needs to apply the score in non-US populations.

A descriptive study on selected growth parameters and growth hormone receptor gene in healthy young adults from the American Midwest

ContextThe first study of growth hormone receptor (GHR) genotypes in healthy young adults in the United States attending a Midwestern university and impact on selected growth parameters. ObjectiveTo describe the frequency of GHR genotypes in a sample of healthy young adults from the United States attending a university in the Midwest and analyze the relationship between GHR genotypes and selected growth parameters. DesignSaliva was collected from 459 healthy young adults (237 females, 222 males; age range = 18–25 y) and DNA isolated for genotyping of GHR alleles (fl/fl, fl/d3, or d3/d3). Selected growth parameters were collected and GHR genotype data examined for previously reported associations (e.g., height, weight or bone mass density) or novel findings (e.g., % body water and index finger length). ResultsWe found 219 participants (48%) homozygous for fl/fl, 203 (44%), heterozygous fl/d3 and 37 (8%) homozygous d3/d3. The distribution of GHR genotypes in our participants was consistent with previous reports of non-US populations. Several anthropometric measures differed by sex. The distribution of GHR genotypes did not significantly differ by sex, weight, or other anthropometric measures. However, the fl/d3 genotype was more common among African-Americans. ConclusionsOur study of growth and anthropometric parameters in relationship to GHR genotypes found no association with height, weight, right index finger length, BMI, bone mass density, % body fat or % body water in healthy young adults. We did identify sex differences with increased body fat, decreased bone density, body water and index finger length in females.

Profile differences of purchasers, non-purchasers, and users and non-users of Personal Emergency Response Systems: Results of a prospective cohort study

Background‘Personal Emergency Response Systems’ (PERS) can provide a solution for raising the alert after a fall but no criteria are available to enable us to estimate whether a population which is set to benefit from a PERS will be able to use the device. ObjectiveTo describe the profile differences of purchasers and non-purchasers of a PERS and to explore the population of users and non-users of these devices. MethodsThe study was part of an observational cohort survey of elderly fallers which took place in the emergency department of our University urban hospital. Results413 patients were included. 115 of them were purchasers of a PERS, presented a lower index of independence in daily activities, greater fall history and a tendency to live alone. Only 18 purchasers used their PERS to alert and they were significantly more likely to live alone, showed a trend to be younger and less demented. This subgroup spent less time on the ground and with a lower 6-months mortality. ConclusionsThe subjects who had and had not purchased a PERS presented no significant differences in terms of time on the ground or consequences. However it was more relevant to focus on the users and non-users of those PERS to isolate a frailer population. Indeed the consequences of falls were more devastating in the group of purchasers who had not used their device to alert. This group may benefit the most from new generations of PERS which do not require control by the subject.

Malignancy rates in patients with rheumatoid arthritis treated with tocilizumab

ObjectiveTo analyse malignancy rates in patients with rheumatoid arthritis (RA) treated with tocilizumab.MethodsPatients who received tocilizumab or placebo+methotrexate/disease-modifying antirheumatic drugs in the double-blind phases of 5-phase three trials or who...

Timeline of History of Hypertension Treatment.

It is surprising that only about 50 years ago hypertension was considered an essential malady and not a treatable condition. Introduction of thiazide diuretics in late 50s made some headway in successful treatment of hypertension and ambitious multicenter VA co-operative study (phase 1 and 2) started in 1964 for diastolic hypertension ranging between 90 and 129 mmHg and completed by 1971 established for the first time that treating diastolic hypertension reduced CV events such as stroke and heart failure and improved mortality. In the following decade, these results were confirmed for the wider US and non-US population, including women and goal-oriented BP treatment to diastolic 90 became the standard therapy recommendation. But isolated systolic hypertension (accounting for two-thirds of the 70 million hypertensive population in USA alone) was not considered treatable until 1991 when SHEP study (systolic hypertension in elderly program) was completed and showed tremendous benefits of treating systolic BP over 160 mmHg using only a simple regimen using small dose chlorthalidone with addition of atenolol if needed. In the next two decades, ALLHAT and other studies examined the comparability of outcomes with use of different classes and combinations of antihypertensive drugs. Although diastolic BP goal was established as 90 in the late 70s and later confirmed by HOT study, the goal BP for systolic hypertension was not settled until very recently with completion of SPRINT study. ACCORD study showed no significant difference in outcome with sys 140 vs. 120 in diabetics. But recently completed SPRINT study with somewhat similar protocol as in ACCORD but in non-diabetic showed almost one-quarter reduction in all-cause mortality and one-third reduction of CV events with systolic BP goal 120.

Prevalence of statin-drug interactions in older people: a systematic review.

Statins are among the most frequently prescribed medications internationally. Older people are commonly prescribed multiple medications and are at an increased risk of drug-drug interactions, including statin-drug interactions. The aim of this study was to conduct a systematic review of current evidence on the prevalence of statin-drug interactions in older people. A systematic search of observational studies in Embase, Medline, and PubMed was conducted. Articles were included if they were published in English during the period July 2000-July 2014 and reported on the prevalence of statin-drug interactions in people over 65 years of age. Two reviewers independently assessed the articles for eligibility and extracted the data. The search returned 1556 eligible articles. A total of 19 articles met the inclusion criteria. In studies (n = 7) that focused on statin users only, the prevalence of potential statin-drug interactions assessed using different measures ranged from 0.19 to 33.0 %. In studies that examined drug interactions across a population of both statin users and non-users (n = 12), the prevalence of potential statin-drug interactions ranged from 0.1 to 7.1 % (n = 8), and the prevalence of clinically relevant statin-drug interactions ranged from 1.5 to 4 % (n = 4). Current published evidence suggests substantial variations in the prevalence of statin-drug interactions and their clinical relevance. Further studies are necessary to provide a better understanding of the prevalence of clinically significant statin-drug interactions, the medications most frequently contributing to statin-drug interactions, and impact on relevant clinical outcomes in older people.

A Nationwide Analysis of Pelvic Ring Fractures: Incidence and Trends in Treatment, Length of Stay, and Mortality.

Background:Previous studies evaluating the epidemiology of pelvic ring fractures and predictors of mortality are largely based upon non-US populations, potentially limiting their generalizability. This study sought to analyze trends of pelvic ring fractures and associated complications in the United States using the largest and most recent national data set available. The specific aims of this study were to determine whether the incidence of pelvic ring fractures changed over time, whether in-hospital mortality following pelvic ring fracture changed over time, whether hospital length of stay following pelvic ring fracture changed over time, and whether there are independent predictors of in-hospital mortality, adverse events, or nonroutine discharge following pelvic fracture.Methods:The National Hospital Discharge Survey was queried to identify all patients admitted to US hospitals with pelvic ring fractures between 1990 and 2007. A cohort representative of 1 464 458 patients was identified, and multivariable logistic regression was used to find independent predictors of mortality, adverse events, and nonroutine discharge to another inpatient facility.Results:Between 1990 and 2007, the population-adjusted incidence of pelvic ring fractures increased from 27.24 to 34.30 per 100 000 capita (P < .001). Mortality declined from 4.2% to 2.8% (P < .001) paralleling an increase in the proportion of patients treated with surgical fixation (7.22%-10.36%). All forms of internal fixation were associated with decreased odds of mortality, while external fixation was associated with increased odds of mortality. Internal fixation was also associated with lower odds of adverse events and nonroutine discharge to inpatient facilities. The average in-hospital length of stay decreased from 11.2 days to 6.5 days (P < .001).Conclusion:This study provides the largest and most comprehensive epidemiologic analysis of pelvic ring fractures in the United States. Knowledge of the increasing incidence of pelvic fractures and prognostic factors associated with poor outcomes may improve outcomes.

A marginalized two-part model for longitudinal semicontinuous data.

In health services research, it is common to encounter semicontinuous data, characterized by a point mass at zero followed by a right-skewed continuous distribution with positive support. Examples include health expenditures, in which the zeros represent a subpopulation of patients who do not use health services, while the continuous distribution describes the level of expenditures among health services users. Longitudinal semicontinuous data are typically analyzed using two-part random-effect mixtures with one component that models the probability of health services use, and a second component that models the distribution of log-scale positive expenditures among users. However, because the second part conditions on a non-zero response, obtaining interpretable effects of covariates on the combined population of health services users and non-users is not straightforward, even though this is often of greatest interest to investigators. Here, we propose a marginalized two-part model for longitudinal data that allows investigators to obtain the effect of covariates on the overall population mean. The model additionally provides estimates of the overall population mean on the original, untransformed scale, and many covariates take a dual population average and subject-specific interpretation. Using a Bayesian estimation approach, this model maintains the flexibility to include complex random-effect structures and easily estimate functions of the overall mean. We illustrate this approach by evaluating the effect of a copayment increase on health care expenditures in the Veterans Affairs health care system over a four-year period.

Abstract P003: Distribution of Ideal Cardiovascular Health Metrics in US and Non-US populations: A Meta-Analysis of Proportions

Introduction: With the development of new health metrics to define ideal cardiovascular health (CVH), several studies have examined the distribution of the American Heart Association (AHA) 2020 ideal CVH metrics both within and outside the United States (US). In this meta-analysis of proportions, we synthesized available data on ideal CVH metrics distribution in US cohorts and compared them with non-US populations. Methods: A MEDLINE database search was conducted using relevant free text terms such as “life’s simple 7”, “AHA 2020”, “American Heart Association 2020” and “ideal cardiovascular health” between January 2000 and October 2014. Studies were included in the meta-analysis if the proportions achieving ideal for 0, 1, 2, 3, 4, 5 or ≥6 ideal CVH metrics were known or could be estimated. A meta-analysis of proportions was conducted for US and non-US studies using a random effect model (REM). REM models were chosen because of the significant heterogeneity among studies. Results: Overall the pooled data consisted of 10 US cohorts with a total population of 94,761 participants and 6 non-US cohorts with a total of 130,242 participants. The table shows the pooled prevalence of ideal CVH factors in this population. Overall the pooled estimates of US cohorts showed 15% had 0-1 ideal CVH metrics (inter-study range: 7-22%), while 3% (inter-study range: 1-10%) had 6-7 ideal CVH metrics. This is comparable to 12% (inter-study range 1-17%) and 2% (inter-study range: 1-12%) for 0-1 and 6-7 ideal CVH metrics in the non-US studies. Conclusion: The proportion of persons achieving 6 or more ideal CVH metrics in both US and non-US cohorts is very low and the distribution of CVH metrics is similar in both US and non-US populations. Considering the strong association with worse outcomes, a coordinated global effort at improving CVH should be considered a priority.

Review of Proton Pump Inhibitor Overuse in the US Veteran Population.

Objective: A growing body of evidence provides proof that proton pump inhibitors (PPIs) are overused in the general population and that such use is associated with adverse risks and unnecessary costs. Our objective was to systematically evaluate PPI overuse in the veteran population. Data Sources: A literature search using MEDLINE and CINHAL databases (1946-December 2014) was performed using the search term proton pump inhibitors coupled with each of the following key words: inappropriate use, misuse, and overuse. Searches were limited to studies and reviews in English language and human subjects. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: All articles that centrally addressed the issue of PPI overuse were evaluated, following the PRISMA guidelines for systematic reviews. Data were extracted into Microsoft Excel 2013. Articles that focused on the pediatric or non-US veteran populations were excluded. Data Synthesis: Among 30 articles included, 5 evaluated PPI overuse in veterans. The reported prevalence rate of PPI overuse in veterans ranged from 33% to 67%. Several cases reported PPI-associated Clostridium difficile-associated diarrhea and pneumonia. One Veterans Affairs center reported the total cost of PPI overuse to be more than $200 000 based on over-the-counter costs and more than $1.5 million based on average wholesale price cost. Conclusions: PPI overuse is common among veterans and exposes them to adverse risks and costs the system enormous dollars. Based on the findings of this review, we provide recommendations to curb PPI overuse among veterans and in the Veterans Affairs system.