Dietary behavior and nutrient intake patterns among U.S. men and women with inflammatory bowel disease (IBD) are unclear at the population level.
This cross-sectional study compared dietary intake ...patterns among U.S. adults (aged ≥18 years) with and without IBD in the 2015 National Health Interview Survey (N = 33,626). Age-standardized weighted prevalences for intake of fruits, vegetables, dairy, whole grain bread, dietary fiber, calcium, total added sugars, sugar-sweetened beverages (SSBs), processed meat, and supplement use were compared between adults with and without IBD by sex.
In 2015, an estimated 3 million adults (1.3%) reported IBD. Compared with adults without IBD, adults with IBD were more likely to be older, non-Hispanic white, not currently working, former smokers, and former alcohol drinkers. Overall, dietary behaviors were similar among adults with and without IBD. However, adults with IBD were more likely to take vitamin D supplements (31.5% vs 18.8%) and consume dietary fiber <16.7 grams(g)/day, the amount that 50% of U.S. adults consumed (51.8% vs 44.1%), than those without IBD. Compared with their counterparts, men with IBD were more likely to consume vegetables ≥1 time/day (84.9% vs 76.0%) and take any supplement (59.6% vs 46.0%); women with IBD were more likely to have SSBs ≥2 times/day (26.8% vs 17.8%) and total added sugars ≥14.6 teaspoons(tsp)/day, the amount that 50% of U.S. adults consumed (55.3% vs 46.7%).
Adopting a healthy diet, especially limiting added sugars intake among women with IBD, might be important for the overall health.
The aim of this study was to measure hypertension prevalence, awareness, treatment and control by depressive symptoms among USA adults.
Using the National Health and Nutrition Examination Survey data ...from 2007 to 2018 ( n = 28 532), depressive symptoms were categorized as 'none or minimum', 'mild', 'moderate' and 'moderately severe or severe' by the Patient Health Questionnaire. Hypertension was assessed by history, blood pressure measures and antihypertensive medication use. Adjusted prevalence rates and adjusted prevalence ratios (APRs) of hypertension prevalence, awareness, treatment and control were measured.
By depressive, the adjusted prevalence of hypertension (32.0, 34.2, 37.3 and 36.6%), awareness (80.6, 83.9, 85.7 and 89.8%) and treatment (73.1, 75.2, 78.6 and 83.9%) increased with advanced depressive symptoms, respectively (all P < 0.001). However, no difference in hypertension control was noted after full adjustment. Compared with those with no or minimum depressive symptoms, APRs of hypertension prevalence for mild, moderate and moderately severe or severe depressive symptom were 1.07 (1.02-1.12), 1.16 (1.107-1.262) and 1.15 (1.05-1.26), respectively. The corresponding APRs were 1.04 (1.003-1.08), 1.06 (1.01-1.11) and 1.11 (1.06-1.17) for hypertension awareness, and 1.03 (0.98-1.07), 1.08 (1.02-1.14) and 1.15 (1.08-1.22) for hypertension treatment, respectively.
Among USA adults, depressive symptoms were significantly associated with hypertension prevalence, awareness and treatment, but not with hypertension control. When managing hypertension, healthcare providers should be aware of the mental health status.
•About 1.5 million US adults with active epilepsy have suboptimal seizure control.•Seizure control among those with active epilepsy varied by annual family income.•Interventions are warranted for ...those with seizures at all family income levels.
Uncontrolled seizures among people with epilepsy increase risk of adverse health and social outcomes including increased risk of death. Previous population-based studies have reported suboptimal seizure control and disparities in seizure control among U.S. adults with active epilepsy (self-reported doctor-diagnosed epilepsy and taking anti-seizure medicine or with ≥ 1 seizures in the past 12 months) by annual family income. This brief is based upon data from the 2021 and 2022 National Health Interview Survey (NHIS) to provide updated national estimates of the percentages of adults with active epilepsy with and without seizure control (0 seizures in past 12 months) vs. ≥ 1) by anti-seizure medication use and by annual family income. Annual family income was operationalized with NHIS poverty-income ratio (PIR) categories (i.e., total family income divided by the US Census Bureau poverty threshold given the family’s size and number of children): PIR < 1.0, 1.0 ≤ PIR < 2.0; PIR ≥ 2.0. Among the 1.1 % of US adults with active epilepsy in 2021/2022 (estimated population about 2.9 million), 49.2 % (∼1.4 million) were taking antiseizure medication and reported no seizures (seizure control), 36.2 % (∼1.1 million) were taking antiseizure medication and reported ≥ 1 seizures (uncontrolled seizures), and 14.7 % (∼400,000) were not taking antiseizure medication and had ≥ 1 seizures (uncontrolled seizures). The prevalence of seizure control among those with active epilepsy varied substantially by annual family income, with a larger percentage of adults with PIR ≥ 2.0 reporting seizure control compared with those with PIR < 1.0. Opportunities for intervention include improving provider awareness of epilepsy treatment guidelines, enhancing access and referral to specialty care, providing epilepsy self-management supports, and addressing unmet social needs of people with epilepsy with uncontrolled seizures, especially those at lowest family income levels.
Preventive care is important for managing inflammatory bowel disease (IBD), yet primary care providers (PCPs) often face challenges in delivering such care due to discomfort and unfamiliarity with ...IBD-specific guidelines. This study aims to assess PCPs' attitudes towards, and practices in, providing preventive screenings for IBD patients, highlighting areas for improvement in guideline dissemination and education.
Using a web-based opt-in panel of PCPs (DocStyles survey, spring 2022), we assessed PCPs' comfort level with providing/recommending screenings and the reasons PCPs felt uncomfortable (n = 1,503). Being likely to provide/recommend screenings for depression/anxiety, skin cancer, osteoporosis, and cervical cancer were compared by PCPs' comfort level and frequency of seeing patients with IBD. We estimated adjusted odd ratios (AORs) of being likely to recommend screenings and selecting responses aligned with IBD-specific guidelines by use of clinical practice methods.
About 72% of PCPs reported being comfortable recommending screenings to patients with IBD. The top reason identified for not feeling comfortable was unfamiliarity with IBD-specific screening guidelines (55%). Being comfortable was significantly associated with being likely to provide/recommend depression/anxiety (AOR = 3.99) and skin cancer screenings (AOR = 3.19) compared to being uncomfortable or unsure. Percentages of responses aligned with IBD-specific guidelines were lower than those aligned with general population guidelines for osteoporosis (21.7% vs. 27.8%) and cervical cancer screenings (34.9% vs. 43.9%), and responses aligned with IBD-specific guidelines did not differ by comfort level for both screenings. Timely review of guidelines specific to immunosuppressed patients was associated with being likely to provide/recommend screenings and selecting responses aligned with IBD-specific guidelines.
Despite a general comfort among PCPs in recommending preventive screenings for IBD patients, gaps in knowledge regarding IBD-specific screening guidelines persist. Enhancing awareness and understanding of these guidelines through targeted education and resource provision may bridge this gap.
Recently, the American Heart Association developed a set of 7 ideal health metrics that will be used to measure progress toward their 2020 goals for cardiovascular health. The objective of the ...present study was to examine how well these metrics predicted mortality from all causes and diseases of the circulatory system in a national sample of adults in the United States.
We used data from 7622 adults ≥20 years of age who participated in the National Health and Nutrition Examination Survey from 1999 to 2002 and whose mortality through 2006 was determined via linkage to the National Death Index. For the dietary and glycemic metrics, we used alternative measures. During a median follow-up of 5.8 years, 532 deaths (186 deaths resulting from diseases of the circulatory system) occurred. About 1.5% of participants met none of the 7 ideal cardiovascular health metrics, and 1.1% of participants met all 7 metrics. The number of ideal metrics was significantly and inversely related to mortality from all causes and diseases of the circulatory system. Compared with participants who met none of the ideal metrics, those meeting ≥5 metrics had a reduction of 78% (adjusted hazard ratio, 0.22; 95% confidence interval, 0.10-0.50) in the risk for all-cause mortality and 88% (adjusted hazard ratio, 0.12; 95% confidence interval, 0.03-0.57) in the risk for mortality from diseases of the circulatory system.
The number of ideal cardiovascular health metrics is a strong predictor of mortality from all causes and diseases of the circulatory system.
The Behavioral Risk Factor Surveillance System (BRFSS) is a network of health-related telephone surveys--conducted by all 50 states, the District of Columbia, and participating US territories-that ...receive technical assistance from CDC. Data users often aggregate BRFSS state samples for national estimates without accounting for state-level sampling, a practice that could introduce bias because the weighted distributions of the state samples do not always adhere to national demographic distributions.
This article examines six methods of reweighting, which are then compared with key health indicator estimates from the National Health Interview Survey (NHIS) based on 2013 data.
Compared to the usual stacking approach, all of the six new methods reduce the variance of weights and design effect at the national level, and some also reduce the estimated bias. This article also provides a comparison of the methods based on the variances induced by unequal weighting as well as the bias reduction induced by raking at the national level, and recommends a preferred method.
The new method leads to weighted distributions that more accurately reproduce national demographic characteristics. While the empirical results for key estimates were limited to a few health indicators, they also suggest reduction in potential bias and mean squared error. To the extent that survey outcomes are associated with these demographic characteristics, matching the national distributions will reduce bias in estimates of these outcomes at the national level.
Patients with inflammatory bowel disease (IBD) have higher health services use than those without IBD. We investigated patient and hospital characteristics of major ambulatory surgery encounters for ...Crohn's disease (CD) or ulcerative colitis (UC) vs non-IBD patients.
We conducted a cross-sectional study using 2017 Nationwide Ambulatory Surgery Sample. Major ambulatory surgery encounters among patients aged ≥18 years with CD (n = 20,635) or UC (n = 9,894) were compared to 9.4 million encounters among non-IBD patients. Weighted percentages of patient characteristics (age, sex, median household income, primary payers, patient location, selected comorbidities, discharge destination, type of surgeries) and hospital-related characteristics (hospital size, ownership, location and teaching status, region) were compared by IBD status (CD, UC, and no IBD). Linear regression was used to estimate mean total charges, controlling for these characteristics.
Compared with non-IBD patients, IBD patients were more likely to have private insurance, reside in urban areas and higher income zip codes, and undergo surgeries in hospitals that were private not-for-profit, urban teaching, and in the Northeast. Gastrointestinal surgeries were more common among IBD patients. Some comorbidities associated with increased risk of surgical complications were more prevalent among IBD patients. Total charges were 9% lower for CD patients aged <65 years (Median: $16,462 vs $18,106) and 6% higher for UC patients aged ≥65 years (Median: $16,909 vs $15,218) compared to their non-IBD patient counterparts.
Differences in characteristics of major ambulatory surgery encounters by IBD status may identify opportunities for efficient resource allocation and positive surgical outcomes among IBD patients.
Objective
Studies have suggested a potential link between traumatic experiences, psychological stress, and autoimmunity, but the impact of stress on disease activity and symptom severity in systemic ...lupus erythematosus (SLE) remains unclear. The present study was undertaken to examine whether increases in perceived stress independently associate with worse SLE disease outcomes over 3 years of follow‐up.
Methods
Participants were drawn from the California Lupus Epidemiology Study (CLUES). Stress was measured annually using the 4‐item Perceived Stress Scale (PSS). Participants with increases of ≥0.5 SD in PSS score were defined as having an increase in stress. Four outcomes were measured at the year 3 follow‐up visit: physician‐assessed disease activity (Systemic Lupus Erythematosus Disease Activity Index); patient‐reported disease activity (Systemic Lupus Activity Questionnaire); pain (Patient‐Reported Outcomes Measurement Information System PROMIS pain interference scale); and fatigue (PROMIS fatigue scale). Multivariable linear regression evaluated longitudinal associations of increase in stress with all 4 outcomes while controlling for potential confounders.
Results
The sample (n = 260) was 91% female, 36% Asian, 30% White, 22% Hispanic, and 11% African American; the mean ± SD age was 46 ± 14 years. In adjusted longitudinal analyses, increase in stress was independently associated with greater physician‐assessed disease activity (P = 0.015), greater self‐reported disease activity (P < 0.001), more pain (P = 0.019), and more fatigue (P < 0.001).
Conclusion
In a racially diverse sample of individuals with SLE, those who experienced an increase in stress had significantly worse disease activity and greater symptom burden at follow‐up compared to those with stress levels that remained stable or declined. Findings underscore the need for interventions to bolster stress resilience and support effective coping strategies among individuals living with lupus.
Small area estimation is a statistical technique used to produce reliable estimates for smaller geographic areas than those for which the original surveys were designed. Such small area estimates ...(SAEs) often lack rigorous external validation. In this study, we validated our multilevel regression and poststratification SAEs from 2011 Behavioral Risk Factor Surveillance System data using direct estimates from 2011 Missouri County-Level Study and American Community Survey data at both the state and county levels. Coefficients for correlation between model-based SAEs and Missouri County-Level Study direct estimates for 115 counties in Missouri were all significantly positive (0.28 for obesity and no health-care coverage, 0.40 for current smoking, 0.51 for diabetes, and 0.69 for chronic obstructive pulmonary disease). Coefficients for correlation between model-based SAEs and American Community Survey direct estimates of no health-care coverage were 0.85 at the county level (811 counties) and 0.95 at the state level. Unweighted and weighted model-based SAEs were compared with direct estimates; unweighted models performed better. External validation results suggest that multilevel regression and poststratification model-based SAEs using single-year Behavioral Risk Factor Surveillance System data are valid and could be used to characterize geographic variations in health indictors at local levels (such as counties) when high-quality local survey data are not available.
Background
Urban–rural differences in IBD-specific health care utilization at the national level have not been examined in the USA.
Aims
We compared urban and rural rates of IBD-related office visits ...and IBD-specific (Crohn’s disease (CD) or ulcerative colitis (UC)) hospitalizations and emergency department (ED) visits.
Methods
From multiple national data sources, we compared national rates using Z test and compared estimates of patient and hospital characteristics and hospitalization outcomes between urban and rural areas using Chi-square and t tests.
Results
In 2015 and 2016, digestive disease-related office visit rates, per 100 adults, were 3.1 times higher in urban than in rural areas (8.7 vs 2.8,
P
< 0.001). In 2017, age-adjusted rates per 100,000 adults were significantly higher in rural than urban areas for CD-specific hospitalizations (26.3 vs 23.6,
P
= 0.03) and ED visits (49.3 vs 39.5,
P
= 0.002). Compared with their urban counterparts, rural adults hospitalized for CD or UC in 2017 were more likely to be older and non-Hispanic white, have lower household income, Medicare coverage, and an elective admission, and were discharged from hospitals that were large, non-federal government owned, and in the Midwest or South. There were no significant urban–rural differences in length of stay and 30-day readmission rate.
Conclusions
While IBD or digestive disease-related office visit rates were lower in rural compared to urban areas, CD-specific hospitalization and ED visit rates were higher. Strategies that improve office-based care among rural patients with IBD may help to avoid more costly forms of health care use.
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