Understanding recent increases in chronic disease treatment rates: more disease or more detection?
ABSTRACT The proportion of the population treated for major medical conditions, including diabetes, cancer and mental illness, increased rapidly during the 1990s. We document the magnitude of these increases and use a model of prevalence to identify three potential causes: increased clinical incidence of disease, longer survival times among persons with chronic illnesses and increased detection. We present a series of analyses to evaluate the contribution of each factor. We find that increases in obesity explain a large proportion of the increase in treatment rates for conditions closely linked to obesity (e.g. diabetes). We provide some evidence that increases in treated prevalence unexplained by changes in the underlying clinical incidence of disease are driven by increased detection and treatment of patients with 'subclinical' illness.
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ABSTRACT: The prevalences of major modifiable risk factors for cardiovascular disease (CVD) are disproportionately high in the 18-county Mississippi Delta region, and many of these risk factors disproportionately affect blacks. Temporal trends in the prevalence of CVD risk factors in the Mississippi Delta have not been determined. We examined trends in CVD risk factors from 2001 to 2010 in the region. Longitudinal trends in prevalence of high blood pressure, high cholesterol, diabetes, obesity, physical inactivity, and current smoking were investigated using self-reported data from the Behavioral Risk Factor Surveillance System. Joinpoint regression models were used to examine annual percentage change (APC) in the prevalence of these risk factors. Overall, from 2001 to 2010, we observed significant increases in the prevalence of high cholesterol (APC, 4.22%), obesity (APC, 3.65%), and diabetes (APC, 3.54%). Among blacks, we found significant increases in the prevalence of high cholesterol (APC, 3.41%), obesity (APC, 3.48%), and diabetes (APC, 4.96%). Among whites, we found significant increases in high blood pressure (APC, 2.18%), high cholesterol (APC, 4.78%), obesity (APC, 4.18%), and physical inactivity (APC, 3.06%). We also observed a significant decrease in smoking among whites (APC, -1.99%). From 2001 to 2010, we found a significant increase in the prevalence of high cholesterol, diabetes, and obesity in the Mississippi Delta. We also observed racial differences in those prevalences.Preventing chronic disease 01/2015; 12:E21. DOI:10.5888/pcd12.140481 · 1.96 Impact Factor
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ABSTRACT: Registered Dietitian (RD) services as part of insurance wellness programs offer a promising venue for improving public health. This study was conducted to evaluate the effectiveness of RD nutrition counseling services provided as part of an insurance benefit on body weight and associated health parameters. Eligible members could enroll to receive 6 RDs visits a year for assistance with weight management. The study RDs were randomized into either Usual Care (UC) or Lifestyle Case Management (LCM) groups. Body weight, waist circumference, and systolic and diastolic blood pressure measurements of program enrollees were evaluated for between group as well as start and end program comparisons. There was a statistically significant difference in the number of RD follow-up visits between the two groups as LCM patients had more RD contact than UC patients. Weight and waist circum-ference changes from baseline to end of study show statistically significant changes with a trend for improvement in systolic blood pressure. Additionally, a clinically significant reduction in weight was achieved in a quarter of program enrollees. In conclusion this study shows that through a coordinated health promotion program RDs' services are of value to an insured population.
Obstetrical and Gynecological Survey 01/2012; 67(1):55-63. DOI:10.1097/OGX.0b013e318242ee82 · 2.36 Impact Factor