[show abstract][hide abstract] ABSTRACT: Importance Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy.
Objectives To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries.
Design We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages.
Results US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th.
Conclusions and Relevance From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.
The United States spends the most per capita on health care across all countries,1- 2 lacks universal health coverage, and lags behind other high-income countries for life expectancy3 and many other health outcome measures.4 High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups.5- 6 Although overall life expectancy has slowly risen, the increase has been slower than for many other high-income countries.3 In addition, in some US counties, life expectancy has decreased in the past 2 decades, particularly for women.7- 8 Decades of health policy and legislative initiatives have been directed at these challenges; a recent example is the Patient Protection and Affordable Care Act, which is intended to address issues of access, efficiency, and quality of care and to bring greater emphasis to population health outcomes.9 There have also been calls for initiatives to address determinants of poor health outside the health sector including enhanced tobacco control initiatives,10- 12 the food supply,13- 15 physical environment,16- 17 and socioeconomic inequalities.18
With increasing focus on population health outcomes that can be achieved through better public health, multisectoral action, and medical care, it is critical to determine which diseases, injuries, and risk factors are related to the greatest losses of health and how these risk factors and health outcomes are changing over time. The Global Burden of Disease (GBD) framework19 provides a coherent set of concepts, definitions, and methods to do this. The GBD uses multiple metrics to quantify the relationship of diseases, injuries, and risk factors with health outcomes, each providing different perspectives. Burden of disease studies using earlier variants of this approach have been published for the United States for 199620- 22 and for Los Angeles County, California.23 In addition, 12 major risk factors have also been compared for 2005.24
In this report, we use the GBD Study 2010 to identify the leading diseases, injuries, and risk factors associated with the burden of disease in the United States, to determine how these health burdens have changed over the last 2 decades, and to compare the United States with other Organisation for Economic Co-operation and Development (OECD) countries.
JAMA The Journal of the American Medical Association 07/2013; · 29.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: Wide-spread adoption of electronic medical records (EMRs) containing rich amounts of longitudinal clinical data and the formation of EMR-linked biobanks represent an opportunity to rapidly expand sample sizes and efficiently phenotype subjects for genomic studies. The Electronic Medical Records & Genomics (eMERGE) Network consists of five leading institutions involved in EMR phenotyping with linked DNA biobanks. The goal of eMERGE is to conduct genome-wide association studies (GWAS) in approximately 19,000 individuals using EMR-derived phenotypes and biorepository-derived genome-wide genotypes. These institutions include Group Health Research Institute, Marshfield Clinic, Mayo Clinic, Northwestern University and Vanderbilt University. Each site has used electronic algorithms to identify both site-specific phenotypes and network-wide phenotypes (applied at all five sites) for genomic analysis. The panel will present data from site-specific and network-wide studies illustrating the strengths and limitations of EMRs for genomic studies. Panelists will discuss and compare approaches to developing phenotypic electronic algorithms, challenges in implementing algorithms at each site, and approaches to validation of the algorithms and genomic results. Panelists will also present results from initial studies into performing phenome-wide analyses for genetic associations. Finally, the panel will present lessons learned from these efforts.
[show abstract][hide abstract] ABSTRACT: BACKGROUND: The association of Helicobacter Pylori with gastritis, peptic ulcer diseases and gastric cancer is established now days. Frequency of these diseases is very high in developing countries including Pakistan. PATIENTS AND METHODS: This was a descriptive study expanded over twelve months during which frequency of H. Pylori was noted in 50 patients suffering from dyspepsia manifestation suspecting case of acid peptic disease. The patients were collected from surgical and medical in/out patients department of civil hospital Karachi. RESULTS: Out of 50 (n=50) patients, 30 (60 %) were male and 20 (40 %) were female with a male: female ratio of 3:2. Age range was 20-50 years with a mean of + / -SD of 37.74 ± 7.31. All patients were of low and middle socio-economic class living in congested overcrowded areas. All patients reported with epigastric pain while 43 (86%) patients were having heartburn. Upper gastrointestinal endoscopy revealed 16 % gastric ulcer, 25 % duodenal ulcer, 40 % gastritis, 6 % Oesophagitis and 12 % normal results. Frequency of H. Pylori as per upper gastrointestinal endoscopy and ELISA Test result was 78 % . CONCLUSION: H. Pylori plays a definite role in causing acid peptic disease. The patient presented with symptoms of peptic ulcer and therefore majority showed positive, endoscopy and ELISA test result. Various epidemiological factors like gender variations, increasing age and lower socioeconomic status were also positively associated.
MEDICAL CHANNEL PAKISTAN. 04/2010; 16(( 2 )):237 - 239.
[show abstract][hide abstract] ABSTRACT: Background: Nonadherence to asthma medications is associated with increased emergency
department visits and hospitalizations. If adherence is to be improved, first-fill adherence is the
first goal to meet after the physician and patient have decided to begin treatment. Little is known
about first-fill adherence with asthma medications and the factors for no-fill.
Objective: The goal of the study was to examine the proportion of patients who fill a new prescription for an asthma medication and analyze characteristics associated with this first-fill.
Methods: This retrospective cohort study linked electronic health records with pharmacy claims.
The cohort was comprised of 2023 patients aged 18 years or older who sought care from the
Geisinger Clinic, had Geisinger Health Plan pharmacy benefits, and were prescribed an asthma
medication for the first time between 2002 and 2006. The primary outcome of interest was first-time prescription
filled by the patient within 30 days of the prescription order date. Covariates examined included factors related to the
patient (ie, age, sex, and ethnicity), comorbidities and utilization (ie, Charlson comorbidity index, number of office visits, number of additional medications), asthma treatment (ie, delivery route, pharmacologic class), and pharmacy copay amount. A logistic-regression model was used to determine covariates associated with first-fill.
Results: The overall first-fill rate for new asthma medications was 78%. First-fill rate was lower for patients with a
copay above the mean of $12 (odds ratio = 0.76; 95% confidence interval, 0.58-0.99) and higher for patients prescribed oral plus inhaled medications (versus inhaled only, odds ratio = 3.91; 95% confidence interval, 2.15-7.11).
Conclusions: Several factors associated with failing to fill an initial prescription for asthma can be addressed through
simple interventions: screening for difficulties a patient may have in filling prescriptions, avoiding nonformulary medications, and recognizing the barrier that high copays present. In addition, for employers and policymakers, decreasing copay may improve adherence and, therefore, asthma control. [AHDB. 2009;2(4):174-180.
American Health and Drug Benefits. 01/2009; 2:174-180.
[show abstract][hide abstract] ABSTRACT: The first 2 issues of Prescriptions for Excellence in Health Care addressed quality improvement in general terms ("Doing Things Right and Doing the Right Things - Quality and Safety in Health Care," Fall 2007) and from the hospital's perspective ("Hospitals Take Ownership for Quality Improvement and Patient Safety," Winter 2007). In this issue, we feature innovative strategies for improving quality of care in 4 different clinical settings.
Prescriptions for Excellence in Health Care Newsletter Supplement. 01/2008;
[show abstract][hide abstract] ABSTRACT: Randomized clinical trials and observational studies have demonstrated the positive effects of multidisciplinary teams on heart failure (HF) readmissions. Many believe that such teams require the presence of an advanced practice nurse specializing in HF. Catholic Healthcare Partners (CHP) demonstrated that the deployment of Heart Failure Advocates (HFA), non-advanced practice nurses specially trained to promote guideline-based care, can result in significant reductions in both HF hospitalizations and associated costs.
Prescriptions for Excellence in Health Care Newsletter Supplement. 01/2008;
[show abstract][hide abstract] ABSTRACT: Welcome to the premiere issue of Prescriptions for Excellence in Health Care, a series of supplements to our Health Policy Newsletter devoted to the quality improvement agenda. Change - in regulations, technology, and quality measurement, to name a few - is accelerating exponentially. Amid this constant change, it is challenging for health care professionals to remain current on the programs and initiatives being implemented. To help address this issue, the Department of Health Policy has partnered with Eli Lilly and Company to provide you with essential information from the quality improvement and patient safety arenas.
Prescriptions for Excellence in Health Care Newsletter Supplement. 01/2007;
[show abstract][hide abstract] ABSTRACT: Introduction: Pediatric cardiac surgery (PCS) is an ideal model to study the coordinated efforts of team members in a complex organizational structure. We explored the impact of human factors on intraoperative events and outcomes in Pediatric Cardiac Surgery.
�Methods: Prospective observations of PCS procedures were conducted by two researchers from the patient pick-up for surgery to the patient hand-off in the intensive care unit. Complexity scores were calculated using the AristotleR scoring system and outcomes were coded as: 1) uncomplicated hospital stay, 2) mild morbidity, 3) major morbidity, 4) death. Process of care was divided into seven epochs: 1) pre-op/transport to OR, 2) pre-surgery/anesthesia induction, 3) surgery/pre-bypass, 4) surgery/bypass/repair, 5) surgery/post-bypass, 6) transport to ICU, 7) handoff. Events were extracted and coded into compensated or uncompensated major and minor events. Based on NIH definitions, adverse events were defined as unintended incidents in care that may result in adverse outcomes or may require additional care efforts to prevent adverse outcome. Depending on the outcome, they were described as compensated (no adverse outcome) or uncompensated. Linear regression and analysis of variance (AOV) were used to analyze relationships between epochs, complexity, number of events and outcome. Variables such as age, weight, decompensation, pre-op intubation, complexity, surgery duration, pre-surgery/anesthesia induction duration, number of minor events/case, and cardiopulmonary bypass were tested in a forward stepwise logistic regression as predictors of cases with 1 or more major events.��Results: In the 13-month study period, 102 (29%) of 345 cases were observed. The study group median age was 119 days (range 1-5758), and the median complexity was 12.1 (range 5-24.5). The overall study mortality was 4.8% (N=4), with no intraoperative mortality. An average of 1.2 (range 0-6) major events occurred per case. The most common type of major event was cardiovascular (N=15, 16%), while most events occurred during the surgery/post-bypass epoch (N=41, 45%). Cognitive compensation was the most common defense mechanism (N=38, 41%) for major events. An average of 15.3 minor events (range 2-35) occurred per case. The most common type of minor event was communication and coordination failure (N=315, 26%). Minor events occurred most frequently during the surgery/bypass epoch (N=385, 31%). Surgery duration (mean=201 min; SD=91 min) correlated with case complexity. AOV showed significantly higher case complexity, longer surgery duration and higher number of major events/case with death outcomes compared to other outcome groups (p<0.01). Using a logistic regression model we found that complexity OR=1.29 (1.05-1.57, p=0.0131) and surgery duration OR=1.01 (1.00-1.02, p=0.0475) were both significant predictors of major events. ��Conclusions: We demonstrated that the number of major events that occur during PCS increases with case complexity and impacts outcome. Cognitive and system compensation, rather than primary prevention, were the prevalent team practices. Team training and systems management should be improved. In addition, greater emphasis should be placed on preventive measures.
American Heart Association Annual meeting; 12/2006
[show abstract][hide abstract] ABSTRACT: Background Given the dramatic increase in type 2 diabetes in the United States, the development of effective strategies to prevent and control this potentially devastating illness is more important than ever. In the Southwest, diabetes is a far too common and rapidly growing problem among Mexican Americans living near the U.S.-Mexico border. A project designed to address this problem enabled faculty from the University of Arizona to work with community health centers to evaluate and improve diabetes care in border communities. Context This project was a component of the Border Health Strategic Initiative (Border Health ¡SI!) and Racial and Ethnic Approaches to Community Health 2010 (REACH 2010), both funded by the Centers for Disease Control and Prevention. University of Arizona faculty worked in partnership with five community health centers funded by the Health Resources and Services Administration. The goal of the faculty was to assist the community health centers with 1) development of measures of diabetes care based on national clinical practice guidelines, 2) identification of gaps in care based on those measures, and 3) implementation of strategies for closing those gaps. Methods All five centers prioritized their top four or five indicators of diabetes care (e.g., annual dilated eye examination). Different community health centers selected different indicators. Baseline medical record audits were performed using the chosen indicators. Individual results were shared confidentially with providers; overall center results were shared and discussed with providers and staff. Consequences Each clinic chose its own strategies for closing gaps in care. At one-year follow-up, there was evidence of improvement for the majority of indicators in all community health centers. However, some gaps remained. Of the three community health centers having a second-year evaluation, two maintained or increased the improvements made, but one lost ground. Interpretation Our experience with these five border clinics was that translating guidelines into practice is easier said than done. Factors that favored success included an onsite champion, staff buy-in, a willingness to see systems change, and the availability of additional resources, particularly for chart reviews.
[show abstract][hide abstract] ABSTRACT: Introduction Asthma is one of the most common chronic diseases of childhood and is the most common cause of school absenteeism due to chronic conditions. The objective of this study is to estimate direct and indirect costs of asthma in school-age children. Methods Using data from the 1996 Medical Expenditure Panel Survey, we estimated direct medical costs and school absence days among school-age children who had treatment for asthma during 1996. We estimated indirect costs as costs of lost productivity arising from parents loss of time from work and lifetime earnings lost due to premature death of children from asthma. All costs were calculated in 2003 dollars. Results In 1996, an estimated 2.52 million children aged five to 17 years received treatment for asthma. Direct medical expenditure was $1009.8 million ($401 per child with asthma), including payments for prescribed medicine, hospital inpatient stay, hospital outpatient care, emergency room visits, and office-based visits. Children with treated asthma had a total of 14.5 million school absence days; asthma accounts for 6.3 million school absence days (2.48 days per child with asthma). Parents loss of productivity from asthma-related school absence days was $719.1 million ($285 per child with asthma). A total of 211 school-age children died of asthma during 1996, accounting for $264.7 million lifetime earnings lost ($105 per child with asthma). Total economic impact of asthma in school-age children was $1993.6 million ($791 per child with asthma). Conclusion The economic impact of asthma on school-age children, families, and society is immense, and more public health efforts to better control asthma in children are needed.
[show abstract][hide abstract] ABSTRACT: Introduction This study examined differences between men and women in the ability to perform basic activities of daily living, instrumental activities of daily living, and higher physical functioning after stroke. The objective of the study was to determine whether sex differences in stroke recovery can be explained by depressive status beyond older age, stroke severity, prestroke physical functioning, and other medical comorbidities. Methods A total of 459 stroke patients were recruited from acute and subacute facilities in an urban midwestern community. These patients were followed prospectively from stroke onset until 6 months poststroke. All study participants were assessed using standardized stroke outcome measures, including the National Institutes of Health Stroke Scale, the Barthel Activities of Daily Living Index, the Lawton Instrumental Activities of Daily Living scale, and the SF-36 Health Survey physical functioning scale. The Geriatric Depression Scale was used to assess depressive status. Each outcome was measured at baseline (within 2 weeks of stroke onset), as well as 1, 3, and 6 months poststroke. Prestroke physical functioning, stroke characteristics, and comorbidities were also assessed at baseline. Results Female patients in the study were older than male patients, with a mean age of 71 years for women vs 69 years for men. Female patients reported lower prestroke physical functioning than their male counterparts. Six months after stroke, women in the study were less likely than the men to achieve a score of ≥95 on the Barthel Activities of Daily Living Index (hazards ratio [HR] = 0.68; 95% confidence interval [CI], 0.52–0.90), carry out eight of nine instrumental activities of daily living without assistance (HR = 0.46; 95% CI, 0.30–0.68), and score ≥90 on the SF-36 Health Survey physical functioning scale (HR = 0.54; 95% CI, 0.28–1.01). When age, prestroke physical functioning, stroke severity, and depressive status at baseline were controlled in the analysis, women in the study continued to be less likely (HR = 0.51; 95% CI, 0.32–0.79) than men in the study to be able to carry out eight of nine instrumental activities of daily living completely without assistance, but there were no observed sex differences in achievement of independence in basic activities of daily living or higher physical functioning. Conclusion Prestroke physical functioning and depressive symptoms are important factors in the investigation of sex differences in stroke recovery. Lower recovery of activities of daily living and physical functioning in women after stroke may be due to multifactorial effects of older age, poor physical function prior to stroke onset, and depressive status after stroke.
[show abstract][hide abstract] ABSTRACT: Introduction Rapid identification and treatment of ischemic stroke can lead to improved patient outcomes. Public education campaigns in selected communities have helped to increase knowledge about stroke, but most data represent large metropolitan centers working with academic institutions. Much less is known about knowledge of stroke among residents in rural communities. Methods In 2004, 800 adults aged 45 years and older from two Montana counties participated in a telephone survey using unaided questions to assess awareness of stroke warning signs and risk factors. The survey also asked respondents if they had a history of atrial fibrillation, diabetes, high blood pressure, high cholesterol, smoking, heart disease, or stroke. Results More than 70% of survey participants were able to correctly report two or more warning signs for stroke: numbness on any side of the face/body (45%) and speech difficulties (38%) were reported most frequently. More than 45% were able to correctly report two or more stroke risk factors: smoking (50%) and high blood pressure (44%) were reported most frequently. Respondents aged 45 to 64 years (odds ratio [OR] 2.44; 95% confidence interval [CI], 1.783.46), women (OR 2.02; 95% CI, 1.462.80), those with 12 or more years of education (OR 1.96; 95% CI, 1.083.56), and those with high cholesterol (OR 1.68; 95% CI, 1.172.42) were more likely to correctly identify two or more warning signs compared with respondents without these characteristics. Women (OR 1.48; 95% CI, 1.072.05) and respondents aged 45 to 64 years (OR 1.35; 95% CI, 1.011.81) were also more likely to correctly identify two or more stroke risk factors compared with men and older respondents. Conclusion Residents of two rural counties were generally aware of stroke warning signs, but their knowledge of stroke risk factors was limited.