ObjectiveTo examine the value of percent body fat (%BF) with body mass index (BMI) to assess the risk of abnormal blood glucose (ABG) among US adults who are normal weight or overweight. We ...hypothesised that normal-weight population with higher %BF is more likely to have ABG.DesignA cross-sectional study.SettingNational Health and Nutrition Examination Survey, 1999–2006, conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.ParticipantsParticipants were US adults aged 40 and older who have never been diagnosed with type 2 diabetes by a doctor (unweighted n=6335, weighted n=65 705 694). The study population was classified into four groups: (1) normal weight with normal %BF, (2) normal weight with high %BF, (3) overweight with normal %BF and (4) overweight with high %BF.Main outcome measuresORs for ABG including pre-diabetes and undiagnosed diabetes (HbA1c ≥5.7%, ≥39 mmol/mol).Results64% of population with normal BMI classification had a high %BF. Prevalence of ABG in normal-weight group with high %BF (13.5%) is significantly higher than the overweight group with low %BF (10.5%, P<0.001). In an unadjusted model, the OR of ABG was significantly greater in adults at normal BMI with high %BF compared with individuals at normal weight with low %BF. In an adjusted model controlling for age, sex, race/ethnicity, first-degree-relative diabetes, vigorous-intensity activities and muscle strengthening activities, risks of ABG were greater in population with normal weight and high %BF (OR 1.55, 95% CI 1.01 to 2.38) and with overweight and low %BF (OR 1.17, 95% CI 0.69 to 1.98, P<0.05).ConclusionsIntegrating BMI with %BF can improve in classification to direct screening and prevention efforts to a group currently considered healthy and avoid penalties and stigmatisation of other groups that are classified as high risk of ABG.
Demand for geriatric care is increasing due to aging population. Trends in maintaining certification in geriatrics are unreported. Our objective was to describe the historic trend of family ...physicians who certified in geriatric medicine (FPs-GM) since 1988 and to assess differences in practice patterns between FPs-GM and family physicians (FPs).
We performed a retrospective descriptive study using administrative data collected by the American Board of Family Medicine (ABFM). The study population was family physicians registering to continue their ABFM certification from 2017 to 2019. Medicare public use billing data was linked to ABFM administrative data on certification history. We used univariate analysis for descriptive analysis and logistic regression to identify contributors of recertification in geriatrics.
We identified a total of 3,207 FPs-GM between 1988 and 2019. More than half maintained GM certification since 2009 (57%), with male gender, White race, and urban practice associated with maintaining GM certification; 61% of their patients were older adults. FPs-GM were more likely to be in an academic practice setting with nearly half (53%) also practicing in hospitals or nursing homes. In the adjusted regression model, younger FPs or FPs who treat more older patients were significantly more likely to be recertified in geriatrics whereas other demographics and practice characteristics were not significant.
Most FPs who recently earned GM certification tended to retain certification since the required accredited fellowship started in 1995.
Postacute sequelae of coronavirus (PASC) disease of 2019 (COVID-19) include morbidity and mortality, but little is known of the impact on medical expenditures. This study measures patients' health ...care costs after COVID hospitalization before vaccinations.
The Merative MarketScan database is used to track trends in medical expenditures for commercially insured patients hospitalized for COVID-19 (case subjects) compared with COVID-19 patients not hospitalized (control subjects) using a propensity score matching model. Medical expenditures were estimated from 30-, 60-, and 120-day clean periods after an initial COVID-19 encounter through the end of 2020.
Average total medical expenditures were 96% higher for individuals hospitalized for COVID-19 starting 30 days after initial COVID-19 encounter and almost 70% higher 120 days after based on the propensity score matching. The average spending differential was $11,242 30 days after and $4959 120 days after. This effect is highest for inpatient admissions and services 60 days after at $56,862 and lowest among pharmaceuticals 120 days after at $329. The magnitude of the difference is greater for those with hypertension or diabetes where total expenditures is $14,958 30 days after, and $5962 120 days after compared with those without these chronic conditions.
The results suggest both health and economic implications for COVID-19 hospitalization and supports the use of vaccinations to help mitigate these implications. PASC includes increased health care costs for hospitalized patients, particularly for those with chronic conditions. Preventing COVID-19 hospitalization has economic value in terms of reduced medical spending in addition to health benefits associated with reduced morbidity and mortality.
Social determinants of health (SDoH) have been linked to a variety of health conditions, but there are no multivariate measures of these determinants to estimate the risk of morbidity or mortality in ...a community. We developed a score derived from multivariate measures of SDoH that predicts county-level cardiovascular disease (CVD) mortality.
Using county-level data from 3,026 US counties, we developed a score considering variables of neighborhood socioeconomic status, food/lifestyle environment, and health care resource availability and accessibility to predict the 3-year average (2015-2017) age-adjusted county-level mortality rate for all CVD. We used one 50% random sample to develop the score and the other to validate the score. A Poisson regression model was developed to estimate parameters of variables while accounting for intrastate correlation.
The index score was based on 7 SDoH factors: percentage of the population of minority (nonwhite) race, poverty rate, percentage of the population without a high school diploma, grocery store ratio, fast-food restaurant ratio, after-tax soda price, and primary care physician supply. The area under the curve for the development and validation groups was similar, 0.851 (95% CI, 0.829-0.872) and 0.840 (95% CI, 0.817-0.863), respectively, indicating excellent discriminative ability. The index had better predictive performance for CVD burden than other area-level indexes: poverty only (area under the curve= 0.808,
<.001); the Centers for Disease Control and Prevention's Social Vulnerability Index (CDC-SVI) (area under the curve =0.786,
<.001); and the Agency for Healthcare Research and Quality's Socioeconomic Status (AHRQ-SES) index (area under the curve =0.835,
= .03).
Our validated multivariate SDoH index score accurately classifies counties with high CVD burden and therefore has the potential to improve CVD risk prediction for vulnerable populations and interventions for CVD at the county level.
BACKGROUND:The utilization of preventive care services has been less than optimal. As part of an effort to address this, the Affordable Care Act (ACA) mandated that private health insurance plans ...cover evidence-based preventive services.
OBJECTIVES:To evaluate whether the provisions of ACA have increased being up-to-date on recommended preventive care services among privately insured individuals aged 18–64.
RESEARCH DESIGN:Multivariate linear regression models were used to examine trends in prevalence of being up-to-date on selected preventive services, diagnosis of health conditions, and health expenditures between pre-ACA (2007–2010) and post-ACA (2011–2014). Adjusted difference-in-difference analyses were used to estimate changes in those outcomes in the privately insured that differed from changes in the uninsured (control group).
RESULTS:After the passage of ACA, up-to-date rates of routine checkup (2.7%; 95% confidence interval, 0.8%–4.7%; P=0.007) and flu vaccination (5.9%; 95% confidence interval, 4.2%–7.6%; P<0.001) increased among those with private insurance, as compared with the control group. Changes in blood pressure check, cholesterol check and cancer screening (pap smear test, mammography, and colorectal cancer screening) were not associated with the ACA. Prevalence in diagnosis of health conditions remained constant. Slower uptrends in adjusted total health care expenditures and downtrends in adjusted out-of-pocket costs were observed during the study period.
CONCLUSIONS:The provisions of the ACA have resulted in trivial increases in being up-to-date on selected preventive care services. Additional efforts may be required to take full advantage of the elimination of cost-sharing under the ACA.
OBJECTIVE:--Determining modifiable risks factors for cognitive decline and dementia are a public health priority as we seek to prevent dementia. Type 2 diabetes and related disorders such as ...hyperinsulinemia increase with aging and are increasing in the U.S. population. Our objective was to determine whether hyperinsulinemia is associated with cognitive decline among middle-aged adults without type 2 diabetes, dementia, or stroke in the Atherosclerosis Risk in Communities (ARIC) cohort. RESEARCH DESIGN AND METHODS--Middle-aged adults (aged 45-64 years at baseline) in the ARIC cohort had fasting insulin and glucose assessed between 1987 and 1989. Subjects with dementia, type 2 diabetes, or stroke at baseline were excluded from analysis. Three tests of cognitive function available at baseline and 6 years later were delayed word recall (DWR), digit symbol subtest (DSS), and first letter word fluency (WF). Cross-sectional comparisons and linear regression models were computed for cognitive tests at baseline and change in cognitive test scores to determine whether cognitive function was associated with two measures of insulin resistance, fasting insulin and homeostasis model assessment (HOMA). Linear regression models controlled for age, sex, race, marital status, education level, smoking status, alcohol use, depression, hypertension, and hyperlipidemia. RESULTS:--In unadjusted and adjusted analyses, hyperinsulinemia based on fasting insulin and HOMA at baseline was associated with significantly lower baseline DWR, DSS, and WF scores and a greater decline over 6 years in DWR and WF. CONCLUSIONS:--Insulin resistance is a potentially modifiable midlife risk factor for cognitive decline and dementia.
Implementing a structured activity to encourage exercise in children may be a strategy with benefits. We evaluated pulmonary function in elementary school children participating in a school-based ...exercise program called The Daily Mile.
During the fall semester, we implemented The Daily Mile program in one elementary school and compared pulmonary function in children in the intervention school pre- and postintervention to children in a control school in the same community. The primary outcomes were forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1% (the FEV1/FVC ratio).
The children in the control school showed no significant change in FEV1% during the semester (P=.06). On the other hand, children in the intervention school showed a significant improvement in FEV1% during the same semester (P=.001). This effect was consistent even when stratifying by asthma and sports participation.
The Daily Mile has benefits for pulmonary function in children. Although family physicians should continue to encourage their patients to have a healthy lifestyle, a more effective approach may be to encourage schools to adopt a program that teachers oversee and administer in a structured way.
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