Undiagnosed Prevalence Research Articles

Polycystic Ovary Syndrome in Active Duty Service Women: A Retrospective Analysis.

Women make up 16.3% of the Department of Defense (DoD) active duty military population. January 2016, the Secretary of the Defense opened all military positions to women, including combat positions. Identifying conditions that may impact health and military readiness are essential to maintaining a fit and ready force. Polycystic ovary syndrome (PCOS) is a condition that has significant health and military readiness implications for active duty service women (ADSW). Some of the common manifestations of PCOS, overweight, obesity, and abnormal menstrual cycles, have a direct impact on the deployment readiness of ADSW, which effects military operations. The prevalence of PCOS in ADSW must be identified to ascertain true numbers in the DoD to appropriately support, treat, and manage this population; therefore, the purpose of this study was to explore the prevalence of PCOS diagnosis, in ADSW. A retrospective analysis of electronic health record data from the Department of Defense Military Health Systems DataMart was conducted for calendar years January 2011 - December 2016, using ICD 9 and 10 codes. ADSW with symptoms and conditions that were present with PCOS but did not have the ICD 9 or 10 code for PCOS were also identified to explore the potential undiagnosed prevalence of PCOS. The diagnosed symptoms and conditions included for analysis were weight gain, obesity, dyslipidemia, glucose intolerance, hypertension, acne, acanthosis nigricans, infertility, and menstrual irregularity. There are 11,190 (0.2%) ADSW diagnosed with PCOS, and 9,112 (0.17%) diagnosed with symptoms that meet the profile and characteristics present in PCOS, but have no diagnosis. All branches of service and ranks were represented in these numbers. PCOS is present in ADSW. Obtaining an accurate prevalence rate of this condition helps reveal the extent of its presence, helps increase awareness, and identify that there is a population in need of targeted support and interventions to maintain a fit and ready force.

2210. An Online Survey of Hepatitis C Testing Attitudes and Practice Habits Among Residents at an Urban Medical Center

BackgroundThe hepatitis C virus (HCV) is the most common blood-borne infection; treatments are well tolerated, highly effective, and improve health outcomes. A recent blinded seroprevalence study of ED patients identified an undiagnosed HCV prevalence 0.8%. New York State recently highlighted a strategic plan to reduce the incidence and prevalence of HCV through aggressive testing, linkage, and treatment. To evaluate HCV screening practices, we conducted a survey of resident attitudes and practice habits surrounding HCV screening.MethodsFrom August 1, 2017 to April 30, 2018 we conducted an anonymous online survey to examine attitudes about sexual health screening among residents at an upper Manhattan academic medical center. Response rates were 22% (33) for internal medicine (IM), 45% (35) for pediatrics (Peds), and 21% (10) for emergency medicine (EM).ResultsA majority of IM residents (61%) agreed that HCV screening was one of their responsibilities as compared with Peds (23%, P = 0.002) and EM residents (20%). This differed from HIV testing where the majority of residents across disciplines (73, 71, 60%) considered HIV screening to be their responsibility. IM residents were more likely to agree that it is important to screen for HCV in all care settings. However, less than half of them considered HCV screening (42%) or successfully screened (45%) the majority of their eligible patients. Barriers to HCV screening were diverse across specialty groups with the majority of EM residents concerned about inadequate resources (90%) and issues surrounding minors (90%). IM residents were concerned about higher priority issues (85%) and time constraints (58%). Peds residents were concerned that HCV testing was outside their scope of practice (69%) and that the prevalence was too low (63%). When informed that one-third of individuals diagnosed with HCV were outside of the birth cohort both Peds and EM providers were more likely to consider screening their patients for HCV. ConclusionIM residents acknowledged the importance of HCV screening and felt it was appropriate to screen in all settings but identified challenges to screening. Barriers to HCV screening differed between IM, Peds, and EM residents highlighting opportunities for individualized targeted interventions.Disclosures All authors: No reported disclosures.

Universal screening at age 1–2 years as an adjunct to cascade testing for familial hypercholesterolaemia in the UK: A cost-utility analysis

Background and aimsFamilial hypercholesterolaemia (FH) is widely underdiagnosed. Cascade testing (CT) of relatives has been shown to be feasible, acceptable and cost-effective in the UK, but requires a supply of index cases. Feasibility of universal screening (US) at age 1–2 years was recently demonstrated. We examined whether this would be a cost-effective adjunct to CT in the UK, given the current and plausible future undiagnosed FH prevalence. MethodsSeven cholesterol and/or mutation-based US ± reverse cascade testing (RCT) alternatives were compared with no US in an incremental analysis with a healthcare perspective. A decision model was used to estimate costs and outcomes for cohorts exposed to the US component of each strategy. RCT case ascertainment was modelled using recent UK CT data, and probabilistic Markov models estimated lifetime costs and health outcomes for the cohorts screened under each alternative. 1000 Monte Carlo simulations were run for each model, and average outcomes reported. Further uncertainty was explored deterministically. Threshold analysis investigated the association between undiagnosed FH prevalence and cost-effectiveness. ResultsA strategy involving cholesterol screening followed by diagnostic genetic testing and RCT was the most cost-effective modelled (incremental cost-effectiveness ratio (ICER) versus no US £12,480/quality adjusted life year (QALY); probability of cost-effectiveness 96·8% at £20,000/QALY threshold). Cost-effectiveness was robust to both deterministic sensitivity analyses and threshold analyses that modelled ongoing case ascertainment at theoretical maximum levels. ConclusionsThese findings support implementation of universal cholesterol screening followed by diagnostic genetic testing and RCT for FH, under a UK conventional willingness-to-pay threshold.

People living with undiagnosed HIV infection and a low CD4 count: estimates from surveillance data, Italy, 2012 to 2014.

Background and aimsLate HIV diagnosis is associated with onward HIV transmission, higher morbidity, mortality and healthcare costs. In Italy, more than half of people living with HIV were diagnosed late during the last decade, with a CD4 count < 350 cells/mm3 at diagnosis. We aimed to determine the number and characteristics of people living with undiagnosed HIV infection and low CD4 counts in Italy.MethodsData on newly reported HIV diagnoses from 2012 –2014 were obtained from the national HIV surveillance system. We used the European Centre for Disease Prevention and Control HIV modelling tool to calculate the undiagnosed prevalence and yearly diagnosed fraction (YDF) in people with low CD4 count.ResultsThe estimated annual number undiagnosed HIV infections with low CD4 count was on average 6,028 (95% confidence interval (CI): 4,954–8,043) from 2012–2014. In 2014, most of the undiagnosed people with low CD4 count were men (82.8%), a third acquired HIV through sex between men (MSM) (35.0%), and heterosexual transmission (33.4%), respectively. The prevalence of undiagnosed HIV infection was 11.3 (95% CI: 9.3–14.9) per 100,000 residents ranging from 0.7 to 20.8 between Italian regions. Nationally the prevalence rate was 280.4 (95% CI: 173.3–450.2) per 100,000 MSM, 8.3 (95% CI: 4.9–13.6) per 100,000 heterosexual men, and 3.0 (95% CI: 1.4–5.6) per 100,000 women. The YDF was highest among heterosexual women (27.1%; 95% CI: 16.9–45.2%).ConclusionsThese findings highlight the importance of improving efforts to identify undiagnosed HIV infections primarily among men, both MSM and heterosexual men.

Revealing geographical and population heterogeneity in HIV incidence, undiagnosed HIV prevalence and time to diagnosis to improve prevention and care: estimates for France.

IntroductionTo close gaps in HIV prevention and care, knowledge about locations and populations most affected by HIV is essential. Here, we provide subnational and sub‐population estimates of three key HIV epidemiological indicators, which have been unavailable for most settings.MethodsWe used surveillance data on newly diagnosed HIV cases from 2004 to 2014 and back‐calculation modelling to estimate in France, at national and subnational levels, by exposure group and country of birth: the numbers of new HIV infections, the times to diagnosis, the numbers of undiagnosed HIV infections. The denominators used for rate calculations at national and subnational levels were based on population size (aged 18 to 64) estimates produced by the French National Institute of Statistics and Economic Studies and the latest national surveys on sexual behaviour and drug use.ResultsWe estimated that, in 2014, national HIV incidence was 0.17‰ (95% confidence intervals (CI): 0.16 to 0.18) or 6607 (95% CI: 6057 to 7196) adults, undiagnosed HIV prevalence was 0.64‰ (95% CI: 0.57 to 0.70) or 24,197 (95% CI: 22,296 to 25,944) adults and median time to diagnosis over the 2011 to 2014 period was 3.3 years (interquartile range: 1.2 to 5.7). Three mainland regions, including the Paris region, out of the 27 French regions accounted for 56% of the total number of new and undiagnosed infections. Incidence and undiagnosed prevalence rates were 2‐ to 10‐fold higher than the national rates in three overseas regions and in the Paris region (p‐values < 0.001). Rates of incidence and undiagnosed prevalence were higher than the national rates for the following populations (p‐values < 0.001): born‐abroad men who have sex with men (MSM) (respectively, 108‐ and 78‐fold), French‐born MSM (62‐ and 44‐fold), born‐abroad persons who inject drugs (14‐ and 18‐fold), sub‐Saharan African‐born heterosexuals (women 15‐ and 15‐fold, men 11‐ and 13‐fold). Importantly, affected populations varied from one region to another, and in regions apparently less impacted by HIV, some populations could be as impacted as those living in most impacted regions.ConclusionsIn France, some regions and populations have been most impacted by HIV. Subnational and sub‐population estimates of key indicators are not only essential to adapt, design implement and evaluate tailored HIV interventions in France, but also elsewhere where similar heterogeneity is likely to exist.

Declining prevalence of undiagnosed HIV in Melbourne: results from community‐based bio‐behavioural studies of gay and bisexual men

Objective:To measure changes in undiagnosed HIV among gay and bisexual men (GBM) in Melbourne. Methods:Undiagnosed HIV was compared between GBM recruited anonymously in 2008 in gay venues only and GBM anonymously or confidentially (results delivery) recruited in 2014 at gay venues and a community festival. Surveys were completed and oral fluid specimens collected for HIV testing; positive tests among GBM reporting being HIV‐negative or unknown/untested were classified as undiagnosed. Tests of proportions compared serological prevalence, undiagnosed prevalence and participant characteristics. Results:HIV prevalence was 9.5% and 7.1% among 639 and 993 GBM recruited in 2008 and 2014, respectively; undiagnosed prevalence declined significantly from 31.1% to 7.1% (p<0.001). Sexual risk and undiagnosed HIV was highest among venue‐recruited participants in 2014 (17.6%). Fewer diagnosed GBM participated confidentially in 2014, but this did not meaningfully influence comparative undiagnosed HIV prevalence. Conclusion:We provide the first estimates of changes in undiagnosed HIV in Australia, demonstrating a marked decline in undiagnosed HIV among GBM. Implications for public health:Our findings are consistent with reports of increases in HIV testing among GBM. Given sustained high HIV diagnosis rates, new testing models that encourage high frequency testing are needed to control the local HIV epidemic.

Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE).

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

Rationale and methodology for a population-based study of diabetes and common eye diseases in a rural area in Bangladesh: Bangladesh Population based Diabetes and Eye Study (BPDES)

Objectives: The purpose of this study were (i) to assess the knowledge, attitudes and practice (KAP) and impact of socioeconomic factors upon the prevalence of pre-diabetes and diabetes (ii) compute a diabetes risk score and (iii) estimate the undiagnosed prevalence of hypertension amongst a large adult population in rural Bangladesh. Methods/design: A sample of 3104 adults aged ?30 years were interviewed from a cluster sample of 18 villages in the Banshgram Union of the Narail District, Bangladesh. Each participant was interviewed using a semi-structured questionnaire that assessed participant knowledge, attitudes and practice (KAP) regarding diabetes, its risk factors, complications and management. Data on demographic details, education, socioeconomic status, medical history, dietary and lifestyle behavior was obtained. Fasting capillary glucose, blood pressure, presenting vision and anthropometric parameters were measured. Participants were stratified into those without diabetes, pre-diabetes, and diagnosed diabetes (known and newly diagnosed). The association of KAP components and other risk factors with diabetes status was assessed. Logistic regression analysis allowed for the development of a non-invasive risk-stratification tool to be developed and implemented for the rural Bangladeshi community. Multinomial logistic regression was applied to report the associations of risk factors with the severity of hypertension. Results and discussion: In Banshgram, over 95% people had not undergone any previous diabetes screening. Baseline demographics estimated the prevalence of diabetes in the sample was 3.2% (n=99). 47% of participants had no formal education. Whilst there is literature on the prevalence of diabetes in urban and semi-urban Bangladesh there is a paucity of evidence examining the impact of KAP of diabetes amongst the general community. We believe that the BPDES has developed a methodology to provide new evidence to guide health policy and targeted population-based interventions in these rural areas.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.367-375

Identification of immunodominant antigens for the laboratory diagnosis of toxocariasis

To identify immunodominant antigens of Toxocara canis recognised by Toxocara-infected sera as recombinant reagents for immunodiagnosis of toxocariasis. Pooled sera from human cases of toxocariasis were used to identify immunodominant antigens by immunoscreening a T. canis larval expression cDNA library. The positive clones were sequenced to reveal the identity of the antigens. The recombinant proteins were expressed in E. coli and then used to confirm their immunoreaction with sera of humans with toxocariasis. Two chosen antigens were also used to differentiate Toxocara infection from other helminth infections in mice. Eleven antigens with immunodiagnostic potential were identified, including two C-type lectins (CTLs) that reacted strongly with the Toxocara-positive serum pool. The first CTL (Tc-CTL-1) is the same as TES-32, previously identified as a major immunodominant component of TES; the second CTL (Tc-CTL-2) is a novel C-type lectin sharing 83% amino acid sequence identity within the functional domain of Tc-CTL-1. The E. coli-expressed recombinant Tc-CTL-1 was strongly recognised by the Toxocara-positive serum pool or sera from animals experimentally infected with T. canis. Reactivity with recombinant Tc-CTL-1 was higher when the unreduced protein was used in an enzyme-linked immunosorbent assay (ELISA), dot-blot assay or Western blot test compared to the protein under reduced condition. Both recombinant Tc-CTL-1- and Tc-CTL-2-based ELISAs were able to differentiate T. canis infection from other helminth infections in experimentally infected mice. Both Tc-CTL-1 and Tc-CTL-2 were able to differentiate Toxocara infection from other helminth infections and could potentially be used as sensitive and specific immunodiagnostic antigens.

Is chlamydia screening and testing in Britain reaching young adults at risk of infection? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

BackgroundIn the context of widespread opportunistic chlamydia screening among young adults, we aimed to quantify chlamydia testing and diagnosis among 16–24 year olds in Britain in relation to risk factors...

Hypertension Prevalence, Awareness and Control Levels among Ghawarna: An African-Descendant Ethnic Minority in the Jordan Valley.

Treatment and control of hypertension (HTN) is a challenging issue as undiagnosed HTN prevalence seems to be high among certain ethnic groups, such as African-descendant populations. The current study attempted to measure HTN prevalence, awareness and control levels among Ghawarna, an African-descendant ethnic group living in the Jordan Valley (Al-Ghawr). A cross-sectional study was conducted in a community of Ghawarna between March and June 2013 in Ghawr Al-Mazraa Village in the southern part of the Jordan Valley. A total of 517 participants, aged >25 years, were randomly selected using cluster random sampling technique. Data were collected using an interviewer-administrated questionnaire and on-location measurement of blood pressure (BP), height, and weight. Prevalence rates were compared by sex and age groups using chi-square test while backward selection logistic regression analysis was used to identify predictors of HTN. We found 229 (44.3%) of the 517 participants had HTN. Of those 229 hypertensives, 146 (28.2%) participants were discovered to have HTN for the "first time." Only 23 of the 83 who were aware of their hypertension had their BP controlled. When we added the undiagnosed HTN (n=146) to the uncontrolled HTN (n=60), the prevalence of uncontrolled HTN became 90% (206/229). Older age, higher BMI, diabetes mellitus, and dyslipidemia were associated with having HTN. HTN prevalence, awareness and control levels are alarming among Ghawarna.

Economic Burden of Undiagnosed Nonvalvular Atrial Fibrillation in the United States

Atrial fibrillation (AF) may be clinically silent and therefore undiagnosed. To date, no estimates of the direct medical cost of undiagnosed AF exist. We estimated the United States (US) incremental cost burden of undiagnosed nonvalvular AF nationally using administrative claims data. To calculate the incremental costs of undiagnosed AF, we compared annual medical costs (in 2014 US Dollars) for patients with AF compared to propensity-matched controls and multiplied this by estimates of undiagnosed AF prevalence derived from the same data sources. The study population included US residents aged ≥18years with 24months of continuous enrollment drawn from 2 large administrative claims databases. Mean per capita medical spending for patients with AF aged from 18 to 64year was $38,861 (95% confidence interval [CI] $35,781 to $41,950) compared to $28,506 (95% CI $28,409 to $28,603) for similar patients without AF (incremental cost difference $10,355, p <0.001); total spending for patients aged ≥65years with AF was $25,322 (95% CI $25,049 to $25,595) compared to $21,706 (95% CI $21,563 to $21,849) for similar patients without AF (incremental cost difference $3,616, p <0.001). Using estimates of the US prevalence of undiagnosed AF (596,000) drawn from the same data, we estimated that the US incremental cost burden of undiagnosed nonvalvular AF is $3.1 billion (95% CI $2.7 to $3.7 billion). In conclusion, the direct medical costs for patients with undiagnosed AF are greater than patients with similar observable characteristics without AF and strategies to identify and treat patients with undiagnosed AF could lead to sizable reductions in stroke sequelae and associated costs.

Prevalence of Prediabetes and Undiagnosed Diabetes in Canada (2007-2011) According to Fasting Plasma Glucose and HbA1c Screening Criteria.

To provide the first population-based estimates of prediabetes and undiagnosed type 2 diabetes prevalence in Canada. We combined two fasting subsamples of the Canadian Health Measures Survey, which were restricted to nonpregnant adults ≥20 years of age (N = 3,494). Undiagnosed diabetes was defined as not having self-reported type 2 diabetes but having blood glucose measures that met Canadian guidelines (i.e., fasting plasma glucose [FPG] level of ≥7.0 mmol/L or hemoglobin A1c [HbA1c] level of ≥6.5% [≥48 mmol/mol]). Prediabetes was defined as an FPG level of ≥6.1 and <7.0 mmol/L or an HbA1c level of ≥6.0% and <6.5% (≥42 and <48 mmol/mol). All estimates were weighted using survey sampling weights. CIs were calculated with the bootstrap method. According to FPG levels, the prevalence of undiagnosed type 2 diabetes in Canadian adults was 1.13% (95% CI 0.79, 1.62), contributing to ∼20% of total type 2 diabetes prevalence (5.62 [95% CI 4.52, 6.95]). Compared with FPG levels, the undiagnosed prevalence was greater using HbA1c level as a criterion (3.09% [95% CI 1.97, 4.81]), ∼41% of the total number of cases of diabetes (7.55 [95% CI 5.98, 9.49]). The HbA1c-only criterion resulted in a threefold increase in prediabetes prevalence overall and a sixfold increase among females (FPG 2.22%, HbA1c 13.31%). Screening based on FPG only identified older undiagnosed case patients, with a mean age of 58.7 years (95% CI 59.9, 63.4). Similarly, using HbA1c identified younger individuals with prediabetes, with reduced BMI and waist circumference compared with FPG levels. In this first study of a nationally representative sample with biospecimen measures, we found that the prevalence of undiagnosed type 2 diabetes and prediabetes was significantly higher using HbA1c levels compared with FPG levels. Further evaluation is needed to fully assess the impact of using the HbA1c criterion.

Gender-based screening for chlamydial infection and divergent infection trends in men and women.

ObjectivesTo assess the potential impact of chlamydial screening policy that recommends routine screening of women but not men.MethodsPopulation surveys of probability samples of Baltimore adults aged 18 to 35 years in 1997–1998 and 2006–2009 collected biospecimens to estimate trends in undiagnosed chlamydial infection. Survey estimates are compared to surveillance data on diagnosed chlamydial infections reported to the Health Department.ResultsPrevalence of undiagnosed chlamydial infection among men increased from 1.6% to 4.0%, but it declined from 4.3% to 3.1% among women (p = 0.028 for test of interaction). The annual (average) number of diagnosed infections was substantially higher among women than men in both time periods and increased among both men and women. Undiagnosed infection prevalence was substantially higher among black than non-black adults (4.0% vs 1.2%, p = 0.042 in 1997–98 and 5.5% vs 0.7%, p<0.001 in 2006–09).ConclusionDivergent trends in undiagnosed chlamydial infection by gender parallel divergent screening recommendations that encourage chlamydial testing for women but not for men.

Trends in the prevalence of diabetes and impaired fasting glucose in association with obesity in Iran: 2005–2011

To estimate the prevalence and trends of diabetes mellitus (DM) and impaired fasting glucose (IFG), 2005-2011, and to determine the contribution of obesity to DM prevalence. Data from Surveillance of Risk Factors of Non-communicable Diseases (SuRFNCD) conducted in 2005, 2007, and 2011 were gathered. DM was defined as presence of self-reported previous diagnosis or a fasting plasma glucose (FPG)≥7 mmol/L. IFG was diagnosed with FPG levels between 5.6 and 6.9 mmol/L. Prevalence rates for 2011 and trends for 2005-2011 were determined by extrapolating survey results to Iran's adult population. Population attributable fraction (PAF) of obesity was also calculated. In 2011, IFG and total DM prevalence rates were 14.60% (95%CI: 12.41-16.78) and 11.37% (95%CI: 9.86-12.89) among 25-70 years, respectively. DM was more common in older age (p < 0.0001), in women (p = 0.0216), and in urban-dwellers (p = 0.0001). In 2005-2011, trend analysis revealed a 35.1% increase in DM prevalence (OR: 1.04, 95%CI: 1.01-1.07, p = 0.011); albeit, IFG prevalence remained relatively unchanged (OR: 0.98, 95%CI: 0.95-1.00, p = 0.167). In this period, DM awareness improved; undiagnosed DM prevalence decreased from 45.7% to 24.7% (p < 0.001). PAF analysis demonstrated that 33.78%, 10.25%, and 30.56% of the prevalent DM can be attributed to overweight (BMI≥25kg/m(2)), general obesity (BMI≥30 kg/m(2)), and central obesity (waist circumference≥90 cm), respectively. Additionally, the DM increase rate in 2005-2011, was 20 times higher in morbidly obese compared with lean individuals. More than four million Iranian adults have DM which has increased by 35% over the past seven years, owing in large part, to expanding obesity epidemic.

Prevalence of Diagnosed and Undiagnosed Type 2 Diabetes Mellitus Among US Adolescents: Results From the Continuous NHANES, 1999–2010

Although prevalence and incidence of type 2 diabetes mellitus (T2DM) are reportedly increasing among adolescents, national data are lacking, particularly in regard to undiagnosed T2DM. To estimate the prevalence of diagnosed and undiagnosed T2DM among US adolescents, we analyzed a nationally representative cross-section of 11,888 adolescents aged 12-19 years who received a diabetes interview in the Continuous National Health and Nutrition Examination Survey during 1999-2010. Among them, a random subsample of 4,661 adolescents also had fasting blood samples collected. Persons who reported a previous diabetes diagnosis and were either taking no medication or taking an oral hypoglycemic agent (with or without insulin) were classified as having T2DM; persons who reported using insulin alone were classified as having type 1 diabetes. Undiagnosed diabetes was defined as a fasting plasma glucose concentration of ≥126 mg/dL and was assumed to be type 2. In the fasting subsample, 31 diabetes cases (types 1 and 2) were identified, representing a prevalence of 0.84% (weighted 95% confidence interval (CI): 0.51, 1.40) (276,638 cases; 95% CI: 134,255, 419,020). Estimates of the prevalences of type 1 and type 2 diabetes were 0.48% (95% CI: 0.23, 1.02) and 0.36% (95% CI: 0.20, 0.67), respectively, indicating that T2DM accounted for 43% of all cases. Further, undiagnosed T2DM prevalence was 0.12% (95% CI: 0.05, 0.31), representing 34% of T2DM cases (40,611 cases; 95% CI: 2,850, 78,373). T2DM accounts for approximately half of adolescent diabetes in the United States, and one-third of these cases are undiagnosed.

Undiagnosed Disease, Especially Diabetes, Casts Doubt On Some Of Reported Health ‘Advantage’ Of Recent Mexican Immigrants

Newly arrived Mexican immigrants in the United States generally report better health than do native-born Americans, but this health advantage erodes over time. At issue is whether the advantage is illusory-a product of disease that goes undiagnosed in Mexico but is discovered after immigration. Using results from the National Health and Nutrition Examination Survey, we compared clinical to self-reported diagnosed disease prevalence and found that Mexican immigrants are not as healthy as previously thought when undiagnosed disease is taken into account, particularly with respect to diabetes. About half of recent immigrants with diabetes were unaware that they had the disease-an undiagnosed prevalence that was 2.3 times higher than that among Mexican Americans with similar characteristics. Diagnosed prevalence was 47 percent lower among recent Mexican immigrants than among native-born Americans for both diabetes and hypertension, but undiagnosed disease explained one-third of this recent immigrant advantage for diabetes and one-fifth for hypertension. The remaining health advantage might be explained in part by immigrant selectivity-the notion that healthier people might be more likely to come to the United States. Lack of disease awareness is clearly a serious problem among recent Mexican immigrants. Since undiagnosed disease can have adverse health consequences, medical practice should emphasize disease detection among new arrivals as part of routine visits. Although we found little evidence that health insurance plays much of a role in preventing these diseases, we did find that having health insurance was an important factor in promoting awareness of both hypertension and diabetes.

Obesity and overweight prevalence and its association with undiagnosed hypertension in Shanghai population, China: a cross-sectional population-based survey

The aim of this study was to determine the prevalence of overweight and obese subjects in the Shanghai population of China and its association with undiagnosed hypertension, by taking age, gender and place of residence (urban or suburban) into account. A cross-sectional population-based survey was conducted in 2007. The sample included 13,359 participants aged 15-69 years.Weight, height, and blood pressure were recorded, and information about gender, age and place of residence was obtained. Overweight and obesity prevalence were calculated by the body mass index (BMI) definition recommended by Working Group on Obesity in China (normal weight, 18.5-23.9 kg/m(2); overweight, 24-27.9 kg/m(2); obesity, ≥ 28 kg/m(2)). Undiagnosed hypertension was defined by China criteria in accord with that of WHO-ISH (subjects with systolic pressure ≥ 140 mmHg, and/or diastolic pressure ≥ 90 mmHg). Multiple logistic regression analyses were used to assess the association of overweight or obesity with undiagnosed hypertension by adjusting for age, gender and place of residence. The overall overweight, obesity, and undiagnosed hypertension prevalence were 27.6% (95% CI: 26.8-28.4), 6.6% (95% CI: 6.2-7.0), and 15.5% (95% CI: 14.9-16.1), respectively. Compared to normal weight subjects, the odds ratios (OR) for subjects who were overweight and had hypertension was 2.33 (95% CI: 2.10-2.59); that for obesity and hypertension was 4.27 (95% CI: 3.66-4.99). These data suggest that overweight and obesity prevalence and their association with undiagnosed hypertension are high in our study population.

Estimating Trends in Incidence, Time-to-Diagnosis and Undiagnosed Prevalence using a CD4-based Bayesian Back-calculation

Abstract There has been much recent speculation regarding the potential for HIV test-and-treat strategies to provide control of the HIV endemic. In the UK, despite advanced HIV surveillance and the implementation of a number of testing initiatives and attempts to widen access to antiretroviral drugs, the number of new diagnoses persists at a high level having risen considerably over the course of the last ten years. The extent to which this high level of diagnosis is attributable to levels of HIV transmission or improved rates of testing and diagnosis is unclear. To disentangle these competing factors, we use a Bayesian back-calculation based on HIV and AIDS diagnosis data augmented by observed CD4 count levels at diagnosis. The CD4 count acts as a prognostic marker indicative of the time-since-infection for any new diagnosis. In addition to estimating time-dependent rates of infection and diagnosis, we exploit the model structure to estimate posterior distributions for a number of key epidemiological quantities such as trends in the time-to-diagnosis and the time-since infection distributions as well as the prevalence of undiagnosed infection. These quantities are stratified by CD4 count where possible. The proposed methodology is applied to HIV/AIDS surveillance data from England &amp; Wales uncovering a decreasing trend in the time to diagnosis and stable levels of incidence in recent years.

P223a Increasing the quality of COPD case finding, diagnosis and management through a primary care financial incentive scheme in inner London

Introduction and ObjectivesCOPD is a major cause of mortality/morbidity in high smoking prevalence Primary Care Trusts (PCTs). Our PCT expected COPD prevalence (3.7%) is therefore high but recorded prevalence (2009/2010)...