Numbers and rates of hospitalizations and ED visits by patients with COPD are important metrics for surveillance purposes. The objective of this study was to examine trends in these rates from 2001 ...to 2012 among adults aged ≥ 18 years in the United States.
Data from the Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) were examined for temporal trends in the numbers and rates of hospitalizations by patients with COPD or bronchiectasis, mean length of stay, in-hospital case-fatality rate, 30-day readmission rate, and numbers and rates of ED visits.
The national number of discharges with COPD or bronchiectasis as the principal diagnosis was about 88,000 higher in 2012 than in 2001, but the age-adjusted rate of discharges did not change significantly (range, 242.7-286.0 per 100,000 population, P trend = .554). In contrast, hospitalization rates for common cardiovascular disorders, pneumonia, and lung cancer decreased significantly by 27% to 68%, whereas the mean charge doubled and mean cost increased by 40%. From 2006 to 2011, the numbers of ED visits increased from 1,480,363 to 1,787,612. The age-adjusted rate increased nonsignificantly from 654 to 725 per 100,000 population (P trend = .072).
Despite many local and national efforts to reduce the burden of COPD, total hospitalizations and ED visits over the past decade have increased for COPD, and the age-adjusted rates of hospitalizations and ED visits for COPD or bronchiectasis have not changed significantly in the United States.
OBJECTIVE:--The International Diabetes Federation (IDF) has proposed a new definition of the metabolic syndrome that emphasizes central adiposity as determined by ethnic group-specific thresholds of ...waist circumference. The objective of this study was to estimate the prevalence of this syndrome using the IDF definition among U.S. adults and to compare it with the prevalence estimated using the definition of the National Cholesterol Education Program (NCEP). RESEARCH DESIGN AND METHODS--A total of 3,601 men and women aged >/=20 years from the National Health and Nutrition Examination Survey 1999-2002 were included in the analyses. RESULTS:--Based on the NCEP definition, the unadjusted prevalence of the metabolic syndrome was 34.5 ± 0.9% (percent ± SE) among all participants, 33.7 ± 1.6% among men, and 35.4 ± 1.2% among women. Based on the IDF definition, the unadjusted prevalence of the metabolic syndrome was 39.0 ± 1.1% among all participants, 39.9 ± 1.7% among men, and 38.1 ± 1.2% among women. The IDF definition led to higher estimates of prevalence in all of the demographic groups, especially among Mexican-American men. The two definitions similarly classified approximately93% of the participants as having or not having the metabolic syndrome. CONCLUSIONS:--In the U.S., the use of the IDF definition of the metabolic syndrome leads to a higher prevalence estimate of the metabolic syndrome than the estimate based on the NCEP definition.
Mortality rates from coronary heart disease (CHD), which had risen during the twentieth century in many countries, started declining in some countries during the 1960s. Once initial skepticism about ...the validity of the observed trends dissipated, researchers attempted to generate explanations about the events that had transpired using a variety of techniques, including ecological examinations of the trends in risk factors for CHD and changes in management of CHD, multivariate risk equations, and increasingly sophisticated modeling techniques. Improvements in risk factors as well as changes in cardiac treatments have both contributed to the reductions in CHD mortality, although estimates of their contributions have varied among countries. Models suggest that additional large reductions in CHD mortality are feasible by either improving the distribution of risk factors in the population or raising the percentage of patients receiving evidence-based treatments.
BACKGROUND COPD remains a leading cause of morbidity and mortality. The objectives of this study were to estimate (1) national US COPD-attributable annual medical costs by payer (direct) and ...absenteeism (indirect) in 2010 and projected medical costs through 2020 and (2) state-specific COPD-attributable medical and absenteeism costs in 2010. METHODS We used the 2006-2010 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, and 2010 Centers for Medicare and Medicaid Services data to generate cost estimates and 2010 census data to project medical costs through 2020. RESULTS In 2010, total national medical costs attributable to COPD and its sequelae were estimated at $32.1 billion, and total absenteeism costs were $3.9 billion, for a total burden of COPD-attributable costs of $36 billion. An estimated 16.4 million days of work were lost because of COPD. Of the medical costs, 18% was paid for by private insurance, 51% by Medicare, and 25% by Medicaid. National medical costs are projected to increase from $32.1 billion in 2010 to $49.0 billion in 2020. Total state-specific costs in 2010 ranged from $49.1 million in Wyoming to $2.8 billion in California: medical costs ranged from $42.5 million in Alaska to $2.5 billion in Florida and absenteeism costs ranged from $8.4 million in Wyoming to $434.0 million in California. CONCLUSIONS Costs attributable to COPD and its sequelae are substantial and are projected to increase through 2020. Evidence-based interventions that prevent tobacco use and reduce the clinical complications of COPD may result in potential decreased COPD-attributable costs.
Current estimates from objective accelerometer data suggest that American adults are sedentary for ∼7.7 h/day. Historically, sedentary behaviour was conceptualized as one end of the physical activity ...spectrum but is increasingly being viewed as a behaviour distinct from physical activity.
Prospective studies examining the associations between screen time (watching television, watching videos and using a computer) and sitting time and fatal and non-fatal cardiovascular disease (CVD) were identified. These prospective studies relied on self-reported sedentary behaviour.
The majority of prospective studies of screen time and sitting time has shown that greater sedentary time is associated with an increased risk of fatal and non-fatal CVD. Compared with the lowest levels of sedentary time, risk estimates ranged up to 1.68 for the highest level of sitting time and 2.25 for the highest level of screen time after adjustment for a series of covariates, including measures of physical activity. For six studies of screen time and CVD, the summary hazard ratio per 2-h increase was 1.17 (95% CI: 1.13-1.20). For two studies of sitting time, the summary hazard ratio per 2-h increase was 1.05 (95% CI: 1.01-1.09).
Future prospective studies using more objective measures of sedentary behaviour might prove helpful in quantifying better the risk between sedentary behaviour and CVD morbidity and mortality. This budding science may better shape future guideline development as well as clinical and public health interventions to reduce the amount of sedentary behaviour in modern societies.
Coronary heart disease (CHD) mortality rates have fallen dramatically over the past 4 decades in the Western world. However, recent data from the United States and elsewhere suggest a plateauing of ...CHD incidence and mortality among young women. We therefore examined recent trends in CHD mortality rates in the United States according to age and sex.
We analyzed mortality data between 1979 and 2011 for US adults ≥25 years of age. We calculated age-specific CHD mortality rates and compared estimated annual percentage changes during 3 approximate decades of data (1979-1989, 1990-1999, and 2000-2011). We then used Joinpoint regression modeling to assess changes in trends over time on the basis of inflection points of the mortality rates. Adults ≥65 years of age showed consistent mortality declines, which became even steeper after 2000 (women, -5.0%; men, -4.4%). In contrast, young men and women (<55 years of age) initially showed a clear decline in CHD mortality from 1979 until 1989 (estimated annual percentage change, -5.5% in men and -4.6% in women). However, the 2 subsequent decades saw stagnation with minimal improvement. Notably, young women demonstrated no improvements between 1990 and 1999 (estimated annual percentage change, 0.1%) and only -1% estimated annual percentage change since 2000. Joinpoint analyses provided consistent results.
The dramatic decline in CHD mortality since 1979 conceals major heterogeneities. CHD death rates in older groups are now falling steeply. However, young adults have experienced frustratingly small decreases in CHD mortality rates since 1990. The drivers of these major differences in CHD mortality trends by age and sex merit urgent study.
Objectives The objective of this study was to examine trends in predicted 10-year risk for coronary heart disease (CHD) and cardiovascular disease (CVD) from 1999 to 2000 and from 2009 to 2010 among ...adults in the United States. Background Examining trends in predicted risk for CHD and CVD may offer insights into the direction of cardiovascular health. Methods Data from 7,751 fasting participants, ages 30 to 74 years, of 6 consecutive 2-year cycles of the National Health and Nutrition Examination Survey were used. Predicted 10-year risk for CHD and CVD was calculated using risk equations derived from data from the Framingham Heart Study. Results Mean predicted 10-year risk for CHD was 7.2% during 1999 to 2000 and 6.5% during 2009 to 2010 (p for linear trend = 0.005), and for CVD it was 9.2% during 1999 to 2000 and 8.7% during 2009 to 2010 (p for linear trend = 0.152). Mean predicted risk for CHD and CVD declined significantly among participants ages 40 to 49 years, 50 to 59 years, 60 to 74 years, and among women. Mean predicted risk for CHD declined significantly among men and whites but nonsignificantly among Mexican Americans (p for linear trend = 0.067). Mean predicted risk increased nonsignificantly among African Americans for both CHD (p for linear trend = 0.063) and CVD (p for linear trend = 0.059). Of the modifiable cardiovascular risk factors included in the risk equations, favorable trends were noted for mean systolic and diastolic blood pressure, mean concentrations of total cholesterol and high-density lipoprotein cholesterol, and smoking status. The prevalence of diabetes mellitus worsened. Conclusions Predicted 10-year risk for CHD improved modestly. Reversing the seemingly rising trend in risk among African-American adults should be a high priority.
Our objective was to estimate the magnitude of the relative risk (RR) for cardiovascular disease associated with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) from published ...prospective observational studies.
Hyperglycemia is a known risk factor for cardiovascular disease. However, the magnitude of the RR for cardiovascular disease associated with IFG and IGT is unclear.
We searched PubMed from 1997 through 2008 for relevant publications and performed a meta-analysis.
In 18 publications with information about IFG (110 to 125 mg/dl) (IFG 110), estimates of RR ranged from 0.65 to 2.50. The fixed-effects summary estimate of RR was 1.20 (95% confidence interval CI: 1.12 to 1.28). In 8 publications with information about IFG (100 to 125 mg/dl) (IFG 100), estimates of RR ranged from 0.87 to 1.40. The fixed-effects summary estimate of RR was 1.18 (95% CI: 1.09 to 1.28). In 8 publications with information about IGT, estimates of RR ranged from 0.83 to 1.34. The fixed-effects summary estimate of RR was 1.20 (95% CI: 1.07 to 1.34). Five studies combined IFG and IGT, yielding a fixed-effects summary estimate of RR of 1.10 (95% CI: 0.99 to 1.23). No significant difference between the summary estimates for men and women were detected (IFG 110: men: 1.17 95% CI: 1.05 to 1.31, women: 1.30 95% CI: 1.10 to 1.54; IFG 100: men: 1.23 95% CI: 1.06 to 1.42, women: 1.16 95% CI: 0.99 to 1.36).
Impaired fasting glucose and IGT are associated with modest increases in the risk for cardiovascular disease.
We examined the relationship between 4 low-risk behaviors-never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption-and mortality in a representative sample of people ...in the United States.
We used data from 16958 participants aged 17 years and older in the National Health and Nutrition Examination Survey III Mortality Study from 1988 to 2006.
The number of low-risk behaviors was inversely related to the risk for mortality. Compared with participants who had no low-risk behaviors, those who had all 4 experienced reduced all-cause mortality (adjusted hazard ratio AHR=0.37; 95% confidence interval CI=0.28, 0.49), mortality from malignant neoplasms (AHR=0.34; 95% CI=0.20, 0.56), major cardiovascular disease (AHR=0.35; 95% CI=0.24, 0.50), and other causes (AHR=0.43; 95% CI=0.25, 0.74). The rate advancement periods, representing the equivalent risk from a certain number of years of chronological age, for participants who had all 4 high-risk behaviors compared with those who had none were 11.1 years for all-cause mortality, 14.4 years for malignant neoplasms, 9.9 years for major cardiovascular disease, and 10.6 years for other causes.
Low-risk lifestyle factors exert a powerful and beneficial effect on mortality.
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