Diabetes and its related complications and comorbidities (C&Cs) represent a significant and increasing healthcare burden. Absence of a systematic manner to evaluate value propositions of technologies from various stakeholders' perspectives impedes the best uses of current and emerging technologies.
A system dynamics methodology was used to develop a comprehensive causal simulator of the U.S. population and give proof of principle that entire portfolios of present and future technologies can be evaluated for direct and indirect impacts. An explicit semiquantitative methodology was used for surveying, prioritizing, and grouping C&Cs, patient subgroups, and technologies, utilizing diverse publicly available clinical literature.
The resulting model simulates the incidence and prevalence of diabetes and 10 of its most commonly associated C&Cs, reflecting their interrelated upstream and downstream relationships. The simulator enables systematic evaluation of tens of thousands of potential combinations of emerging technologies and technology leverage points that can be used to improve patient outcomes and guide technology investments. Feasibility was demonstrated through single, pair-wise, and targeted analyses of technologies.
This effort demonstrated the feasibility of linking complex, interconnected disease states, impact points, outcomes, and interventions with a variety of outcome metrics, to an extent greater than existing models developed for other purposes. The project demonstrated the ability to identify priority technologies and pipeline therapies and leverage points among diabetes interventions. It demonstrated more effective knowledge management of diverse information essential for formulating strategy that could be applied in a wide range of therapeutic applications and technology innovation uses.
[Show abstract][Hide abstract] ABSTRACT: Temporal trends regarding the epidemiology of atherosclerotic renovascular disease (ARVD) in dialysis populations are poorly defined.
United States Renal Data System data were used to identify patients aged 67 years or older at dialysis inception between 1996 and 2001 (n=146,973). Medicare claims in the preceding 2 years were used to identify ARVD and revascularization procedures. Prior ARVD rose from 7.1% to 11.2% between 1996 and 2001 (adjusted odds ratio [AOR], 1.68). Other associations included hypertensive end-stage renal disease (ESRD; AOR, 2.21), ESRD network (AOR, 0.44 in network 17 versus 1.00 in network 1), peripheral vascular disease (AOR, 1.65), black race (AOR, 0.44), urologic cause of ESRD (AOR, 0.57), age >85 years (AOR, 0.58), substance dependency (AOR, 0.62), and inability to ambulate or transfer (AOR, 0.67). The proportion of ARVD patients undergoing revascularization rose from 14.6% to 16.7% between 1996 and 2001 (AOR, 1.27). Other associations included hypertension (AOR, 2.10), ESRD network (AOR, 2.07 for network 13 versus 1.00 in network 1), age >85 years (AOR, 0.53), and black race (AOR, 0.54). The rise in ARVD was not reflected in the proportion of patients with renovascular disease listed as cause of ESRD on the Medical Evidence Report at dialysis inception (5.5% in 1996, 5.0% in 2001).
ARVD diagnoses have become more common in older patients beginning dialysis therapy. The association of demographic factors including age, race, and geographic residence with utilization patterns suggests possible barriers to care.
[Show abstract][Hide abstract] ABSTRACT: This report presents final 2003 data on U.S. deaths; death rates; life expectancy; infant and maternal mortality; and trends by selected characteristics such as age, sex, Hispanic origin, race, marital status, educational attainment, injury at work, State of residence, and cause of death. A previous report presented preliminary mortality data for 2003 and summarized key findings in the final data for 2003.
This report presents descriptive tabulations of information reported on death certificates, which are completed by funeral directors, attending physicians, medical examiners, and coroners. The original records are filed in the State registration offices. Statistical information is compiled into a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's, National Center for Health Statistics (NCHS). Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision (ICD-10).
In 2003, a total of 2,448,288 deaths were reported in the United States. The age-adjusted death rate was 832.7 deaths per 100,000 standard population, representing a decrease of 1.5 percent from the 2002 rate and a record low historical figure. Life expectancy at birth rose by 0.2 years to a record high of 77.5 years. Considering all deaths, age-specific death rates rose only for those 45-54 years and declined for the age groups 55-64 years, 65-74 years, 75-84 years, and 85 years and over. For the most part, the 15 leading causes of death in 2003 remained the same as in 2002. Heart disease and cancer continued to be the leading and second leading causes of death, together accounting for over half of all deaths. Homicide became the 15th leading cause in 2003, dropping from the 14th leading cause in 2002. Pneumonitis dropped out of the top 15 altogether, and Parkinson's disease entered the list as the 14th leading cause of death. The infant mortality rate in 2003 was 6.85 per 1,000 births.
Generally, mortality patterns in 2003 were consistent with long-term trends. Life expectancy in 2003 increased again to a new record level. The age-adjusted death rate declined to a record low historical figure. The infant mortality rate decreased significantly in 2003; except for 2002, it either decreased or remained level each successive year from 1958 to 2003.
National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 05/2006; 54(13):1-120.
[Show abstract][Hide abstract] ABSTRACT: We utilized coronary artery calcium scores (CACS) to assess differences in atherosclerosis burden between asymptomatic White populations living in continents with different cardiovascular disease rates. The similarities in the genetic pool between Brazilian and Portuguese Caucasian subjects offered an opportunity to assess the influence of environmental factors on the development of atherosclerosis. We reviewed CACS data from 17,563 individuals (12,378 men and 5169 women) collected in the USA (74% of the subjects), Brazil (15% of the subjects) and Portugal (11% of the subjects). CACS was absent in 80 and 88% of Portuguese men and women, compared with 46 and 62% and 33 and 59% of Brazilian and US counterparts (p<0.0001). Although the US subjects showed the lowest prevalence of risk factors they had a higher median (interquartile range) CACS than the Brazilian and the Portuguese cohorts: 4 (0;87), 1 (0;68) and 0 (0;0), respectively (p<0.0001). After adjusting for differences in age and cardiovascular risk factors, US men showed higher relative risk ratios of having any CACS than either Brazilian or Portuguese men. Brazilian and US women did not differ as far as risk of CACS although they demonstrated a greater risk than Portuguese women. In this study, significant differences in CACS were detected among three nations in different continents. The CACS differences paralleled the respective cardiovascular mortality rates.
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