Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total ...knee replacement is currently unknown. Our objective was to estimate the prevalence of total hip and total knee replacement in the United States.
Prevalence was estimated using the counting method by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010 with general population census and mortality counts. We accounted for relative differences in mortality rates between those who have had total hip or knee replacement and the general population.
The 2010 prevalence of total hip and total knee replacement in the total U.S. population was 0.83% and 1.52%, respectively. Prevalence was higher among women than among men and increased with age, reaching 5.26% for total hip replacement and 10.38% for total knee replacement at eighty years. These estimates corresponded to 2.5 million individuals (1.4 million women and 1.1 million men) with total hip replacement and 4.7 million individuals (3.0 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages.
Around 7 million Americans are living with a hip or knee replacement, and consequently, in most cases, are mobile, despite advanced arthritis. These numbers underscore the substantial public health impact of total hip and knee arthroplasties.
Background Incidence studies of psoriasis are rare, mainly due to lack of established epidemiological criteria and the variable disease course. The objective of this study is to determine time trends ...in incidence and survival of psoriasis patients over three decades. Methods We identified a population-based incidence cohort of 1633 subjects aged ≥18 years first diagnosed with psoriasis between January 1, 1970 and January 1, 2000. The complete medical records for each potential psoriasis subject were reviewed and diagnosis was validated by either a confirmatory diagnosis in the medical record by a dermatologist or medical record review by a dermatologist. Age- and sex-specific incidence rates were calculated and were age- and sex-adjusted to the 2000 US white population. Results The overall age- and sex-adjusted annual incidence of psoriasis was 78.9 per 100,000 (95% confidence interval CI: 75.0-82.9). When psoriasis diagnosis was restricted to dermatologist-confirmed subjects, the incidence was 62.3 per 100,000 (95% CI: 58.8-65.8). Incidence of psoriasis increased significantly over time from 50.8 in the period 1970-1974 to reach 100.5 per 100,000 in the 1995-1999 time period ( P = .001). Although the overall incidence was higher in males than in females ( P = .003), incidence in females was highest in the sixth decade of life (90.7 per 100,000). Survival was similar to that found in the general population ( P = .36). Limitations The study population was mostly white and limited to adult psoriasis patients. Conclusion The annual incidence of psoriasis almost doubled between the 1970s and 2000. The reasons for this increase in incidence are currently unknown, but could include a variety of factors, including a true change in incidence or changes in the diagnosing patterns over time.
Abstract Background The utilization of hip arthroscopy continues to increase in the United States. The purpose of this study was to examine trends in hip arthroscopy procedures and outcomes. Methods ...We performed a retrospective cohort study using Optum Labs Data Warehouse administrative claims data. The cohort comprised 10,042 privately insured enrollees aged 18-64 years who underwent a hip arthroscopy procedure between 2005 and 2013. Utilization trends were examined using age-, sex- and calendar-year specific hip arthroscopy rates. Outcomes were examined using the survival analysis methods and included subsequent hip arthroscopy and total hip arthroplasty. Results Hip arthroscopy rates increased significantly over time from 3.6 per 100,000 in 2005 to 16.7 per 100,000 in 2013. The overall 2-year cumulative incidence of subsequent hip arthroscopy and total hip arthroplasty were 11% and 10%, respectively. In the subset of patients in whom laterality of the subsequent procedure could be determined, about half of the subsequent hip arthroscopy procedures (46%) and almost all of the THA procedures (94%) were on the same side. Decreasing age was significantly associated with the risk of subsequent arthroscopy (p<0.01), whereas increasing age was significantly associated with the subsequent risk of total hip arthroplasty (p<0.01). The 5-year cumulative incidence of total hip arthroplasty reached as high as 35% among individuals aged 55-64 years. Conclusion The utilization of hip arthroscopy procedures increased dramatically over the last decade in the 18-64 year old privately insured population, with the largest increase in younger age groups. Future studies are warranted to understand the determinants of the large increase in utilization of hip arthroscopy and outcomes.
Background Although psoriasis is considered to have a dual peak in age of onset, currently no studies exist regarding the incidence of psoriasis in children. Objective The objective of this study was ...to determine the incidence of psoriasis in childhood. Methods A population-based incidence cohort of patients aged younger than 18 years first given the diagnosis of psoriasis between January 1, 1970, and December 31, 1999, was assembled. The complete medical record of each child was reviewed and psoriasis diagnosis was validated by a confirmatory diagnosis in the medical record by a dermatologist or medical record review by a dermatologist. Age- and sex-specific incidence rates were calculated and were age and sex adjusted to 2000 US white population. Results The overall age- and sex-adjusted annual incidence of pediatric psoriasis was 40.8 per 100,000 (95% confidence interval: 36.6-45.1). When psoriasis diagnosis was restricted to dermatologist-confirmed subjects in the medical record, the incidence was 33.2 per 100,000 (95% confidence interval: 29.3-37.0). Incidence of psoriasis in children increased significantly over time from 29.6 per 100,000 in 1970 through 1974 to 62.7 per 100,000 in 1995 through 1999 ( P < .001). Chronic plaque psoriasis was the most common type (73.7%), and the most commonly involved sites were the extremities (59.9%) and the scalp (46.8%). Limitations The population studied was a mostly white population in the upper Midwest. Conclusion The incidence of pediatric psoriasis increases with increasing age. There is no apparent dual peak in incidence. The incidence of pediatric psoriasis increased in recent years in both boys and girls.
Abstract Objective To describe the age and sex patterns of drug prescribing in Olmsted County, Minnesota. Patients and Methods Population-based drug prescription records for the Olmsted County ...population in 2009 were obtained using the Rochester Epidemiology Project medical records linkage system (n=142,377). Drug prescriptions were classified using RxNorm codes and were grouped using the National Drug File–Reference Terminology. Results Overall, 68.1% of the population (n=96,953) received a prescription from at least 1 drug group, 51.6% (n=73,501) received prescriptions from 2 or more groups, and 21.2% (n=30,218) received prescriptions from 5 or more groups. The most commonly prescribed drug groups in the entire population were penicillins and β-lactam antimicrobials (17%; n=23,734), antidepressants (13%; n=18,028), opioid analgesics (12%; n=16,954), antilipemic agents (11%; n=16,082), and vaccines/toxoids (11%; n=15,918). However, prescribing patterns differed by age and sex. Vaccines/toxoids, penicillins and β-lactam antimicrobials, and antiasthmatic drugs were most commonly prescribed in persons younger than 19 years. Antidepressants and opioid analgesics were most commonly prescribed in young and middle-aged adults. Cardiovascular drugs were most commonly prescribed in older adults. Women received more prescriptions than men for several drug groups, in particular for antidepressants. For several drug groups, use increased with advancing age. Conclusion This study provides valuable baseline information for future studies of drug utilization and drug-related outcomes in this population.
Abstract Tranexamic acid (TA) has been shown to reduce perioperative blood loss and blood transfusion. While concern remains about the cost of antifibrinolytic medication, we hypothesized that ...routine use of tranexamic acid would result in lower direct hospital total cost by decreasing costs associated with blood transfusion, laboratory testing, and room & board. Patients with an American Society of Anesthesiologists (ASA) class II or less undergoing primary total hip or knee arthroplasty at a single institution during 2007–2008 were retrospectively reviewed. The estimated mean direct hospital total cost, operating room, blood/lab, room & board, and pharmacy costs were compared between patients who did and did not receive TA. The study population included 1018 patients, and 580 patients received TA. The mean direct total cost of hospitalization with and without TA was $15,099 and $15,978 ( P < .0002) respectively, a difference of $879. The only increased cost associated with TA was the pharmacy cost which was $921 versus $781 ( P < .0001). The routine use of tranexamic acid TA was associated with lower mean direct hospital total costs after primary total hip and knee arthroplasty as the increase in pharmacy costs was more than offset by cost savings in other categories.
Heart disease in psoriasis Kremers, Hilal Maradit, MD, MSc; McEvoy, Marian T., MD; Dann, Frank J., MD ...
Journal of the American Academy of Dermatology,
08/2007, Letnik:
57, Številka:
2
Journal Article
Recenzirano
Psoriasis has been traditionally viewed as an inflammatory skin disorder of unknown origin. Recent advances in the immunopathogenesis and genetics of psoriasis have broadened our understanding of ...psoriasis. Psoriasis is now considered a systemic inflammatory condition analogous to other inflammatory immune disorders. Patients with other immune disorders, such as systemic lupus erythematosus or rheumatoid arthritis, are known to be at increased risk of heart disease. Similarly, patients with psoriasis may carry an excess risk of heart disease, which would represent an important previously unrecognized cause of morbidity and mortality. This review summarizes the current evidence for an increased cardiovascular risk in patients with psoriasis and outlines deficits in our knowledge in this area.
Abstract Social and behavioral factors are important determinants of health outcomes in a number of medical conditions but their role in joint arthroplasty is poorly understood. In a cohort of 20,124 ...hip and knee arthroplasty procedures, smoking was associated with a significantly higher risk of surgical site infections (hazard ratio 1.7, 95% CI: 1.1–2.6), whereas alcohol use was associated with a lower risk of reoperations and revisions (hazard ratio 0.7, 95% CI: 0.5–0.8). There was no association between marital status and educational attainment with the risk of complications or reoperations in total hip and knee arthroplasty.
Background Electronic claims and medical record databases are increasingly used for observational studies of psoriasis. The purpose of this study was to assess the validity of psoriasis diagnostic ...codes in an electronic database. Methods This study was performed in a population-based setting in Olmsted County, Minnesota, where all diagnoses and procedures from all health care providers in a large community are indexed and recorded in an electronic database. The database was searched for patients aged 18 years or older with diagnostic codes consistent with psoriasis for the time period January 1, 1976, to January 1, 2000. The complete medical records of all patients were reviewed manually for validation of psoriasis diagnoses. Results We reviewed the complete medical records of 2556 patients with at least one diagnostic code consistent with psoriasis. Based on medical record review, 1458 (57.0%) patients were confirmed to have psoriasis, of which the majority (81%) received confirmation by a dermatologist. The most commonly used diagnostic codes for psoriasis were International Classification of Diseases, Ninth Revision 696.1 (psoriasis, not otherwise specified) with a positive predictive value of 68.7% (95% confidence interval: 66.5%, 70.9%). Increasing frequency of codes in a given time window was associated with positive predictive values. However, positive predictive value for only one code in a 5-year time window was still as high as 60% (95% confidence interval: 57%, 63%). Limitations Differences between individual electronic medical record databases may limit the ability to form a general conclusion from these findings. The remitting, relapsing course of psoriasis and the heterogeneity in clinical presentation create challenges in case ascertainment. Conclusion Electronic identification of patients with psoriasis by diagnostic codes alone may lead to misclassification in database studies.
Abstract Background Mortality after total hip and knee arthroplasty is lower than that in the general population, but it is unknown whether there are differences by surgery type, demographics, and ...calendar year. Our objective was to evaluate trends and determinants of long-term mortality among patients with total hip and knee arthroplasties. Methods Using a historical cohort study design, we passively followed up population-based cohorts of total hip and total knee arthroplasty patients with degenerative arthritis who underwent surgery between January 1, 1969 and December 31, 2008. Patients were followed up until death or August 31, 2014. Observed and expected survival was compared using standardized mortality ratios (SMRs). Poisson regression models were used to examine relative mortality patterns by surgery type, age, sex, calendar year, and time since surgery. Results The overall age- and sex-adjusted mortality was significantly lower than that in the general population after both total hip (SMR: 0.82, 95% CI: 0.76-0.88) and total knee (SMR = 0.80, 95% CI: 0.75-0.86) arthroplasties. Despite the low relative mortality within the first 8 years of surgery, we observed a worsening of relative mortality beyond 15 years after total knee arthroplasty surgery. Both short- and long-term mortality improved over calendar time, and the improvement occurred about a decade earlier in total knee arthroplasty than in total hip arthroplasty. Conclusion Survival after total hip and total knee arthroplasties is better than that in the general population for about 8 years after surgery. Secular trends are encouraging and suggest that survival after both procedures has been improving even further in recent years.
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