Costs and healthcare use of patients with chronic kidney disease in the Northern Territory, Australia.

BACKGROUND: The burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective. METHODS: We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model. RESULTS: Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD. CONCLUSION: The total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.

Association between salinity and hospital admission for hypertension: an ecological case-control study in the Mekong Delta Region in Vietnam.

Background: Drinking water in the Mekong Delta Region (MDR) is highly vulnerable to salinity intrusion and this problem is expected to increase with the projected climate change and sea level rise. Despite this, research on health effects of saline contaminated water is scarce in this region. This study examines the risk of hospital admission for hypertension in salinity-affected areas of the MDR. Methods: Cases and controls were obtained from national/provincial hospital admission records for 2013. The cases were adult patients whom hypertension (ICD10-code: I10-I15) was primary diagnosis for admission. Of the 13 provinces in the MDR, we identified seven as 'salinity exposed' and the remaining as 'non-exposed' areas. A multi-level logistic regression model was used to examine the association between salinity exposure and hypertension outcome. Results: Of the total 573 650 hospital admissions, 22 382 (~3.9%) were hypertensive cases. The multi-level logistic model combining both individual and ecological factors showed a 9% increase in risk (95% CI: 3-14%) of hypertension admission among individuals in exposed areas compared to those in non-exposed areas. Conclusion: In order to develop and promote appropriate adaptation strategies, further research is recommended to identify the salt exposure pathways and consumption behaviours in the salinity exposed areas.

A climate-based prediction model in the high-risk clusters of the Mekong Delta region, Vietnam: towards improving dengue prevention and control.

OBJECTIVE: To develop a prediction score scheme useful for prevention practitioners and authorities to implement dengue preparedness and controls in the Mekong Delta region (MDR). METHODS: We applied a spatial scan statistic to identify high-risk dengue clusters in the MDR and used generalised linear-distributed lag models to examine climate-dengue associations using dengue case records and meteorological data from 2003 to 2013. The significant predictors were collapsed into categorical scales, and the ß-coefficients of predictors were converted to prediction scores. The score scheme was validated for predicting dengue outbreaks using ROC analysis. RESULTS: The north-eastern MDR was identified as the high-risk cluster. A 1 °C increase in temperature at lag 1-4 and 5-8 weeks increased the dengue risk 11% (95% CI, 9-13) and 7% (95% CI, 6-8), respectively. A 1% rise in humidity increased dengue risk 0.9% (95% CI, 0.2-1.4) at lag 1-4 and 0.8% (95% CI, 0.2-1.4) at lag 5-8 weeks. Similarly, a 1-mm increase in rainfall increased dengue risk 0.1% (95% CI, 0.05-0.16) at lag 1-4 and 0.11% (95% CI, 0.07-0.16) at lag 5-8 weeks. The predicted scores performed with high accuracy in diagnosing the dengue outbreaks (96.3%). CONCLUSION: This study demonstrates the potential usefulness of a dengue prediction score scheme derived from complex statistical models for high-risk dengue clusters. We recommend a further study to examine the possibility of incorporating such a score scheme into the dengue early warning system in similar climate settings.

Drinking water contributes to high salt consumption in young adults in coastal Bangladesh.

Increasing salinity of freshwater from environmental and anthropogenic influences is threatening the health of 35 million inhabitants in coastal Bangladesh. Yet little is known about the characteristics of their exposure to salt (sodium), a major risk factor for hypertension and related chronic diseases. This research examined sodium consumption levels and associated factors in young adults. We assessed spot urine samples for 282 participants (19-25 years) during May-June 2014 in a rural sub-district in southwestern coastal Bangladesh and measured sodium levels of their potable water sources. The significant factors associated with high sodium consumption were determined from logistic regression analyses. Mean sodium content in tube-well water (885 mg/L) was significantly higher than pond water (738 mg/L) (P = 0.01). Fifty three percent of subjects were consuming sodium at levels above the WHO recommended level (≥2 g/day). The users of tube-well water were more likely to consume sodium above this recommended level than pond water users. Salinity problems are projected to increase with climate change, and with large populations potentially at risk, appropriate public health and behavior-change interventions are an urgent priority for this vulnerable coastal region along with targeted research to better understand sodium exposure pathways and health benefits of alternative water supplies.

Correlates of Climate Variability and Dengue Fever in Two Metropolitan Cities in Bangladesh.

Dengue fever is a major public health concern in Bangladesh with increased incidence during monsoon. We aimed to assess the correlation of temperature, humidity, and rainfall on dengue fever in two dengue endemic cities in Bangladesh. It was a time series analysis of climate factors and dengue occurrence data in Dhaka and Chittagong cities from 1 January 2000 to 31 December 2009. Daily mean temperature, rainfall, and humidity data were obtained from the Bangladesh meteorological department and daily dengue cases data were obtained from the directorate general of health services (DGHS) of Bangladesh. The mean dengue incidence was 31.62 (SD 28.7) per 100,000 in Dhaka whereas it was 5.76 (SD 11.7) per 100,000 population in Chittagong. The incidence of dengue cases was found significantly associated with the monthly mean temperature, total rainfall, and mean humidity in Dhaka, though in Chittagong, the significantly associated factors​ ​​​​​​were monthly total rainfall and mean humidity. The autoregressive integrated moving average (ARIMA) model identified monthly mean humidity and total rainfall as the most significant contributing factors for dengue cases in Dhaka and Chittagong, respectively. Our study reinforces the relationship of climate parameters with dengue fever, which will support policy-makers in developing a climate-based early warning system for dengue in Bangladesh.

Drinking water salinity and risk of hypertension: A systematic review and meta-analysis.

We summarized epidemiological studies assessing sodium in drinking water and changes in blood pressure or hypertension published in English from 1960 to 2015 from PubMed, Scopus, and Web of Science. We extracted data on blood pressure level or prevalence of hypertension and calculated pooled estimates using an inverse variance weighted random-effects model. The pooled standardized mean difference (SMD) in 7 studies (12 data sets) comparing the low and high water sodium exposure groups for systolic blood pressure (SBP) was 0.08 (95% CI, -0.17 to 0.34) and for diastolic blood pressure (DBP) was 0.23 (95% CI, 0.09-0.36). Of the 3 studies that assessed the association between high water sodium and odds of hypertension, 2 recent studies showed consistent findings of higher risk of hypertension. Our systematic review suggests an association between water sodium and human blood pressure (more consistently for DBP) but remain inconclusive because of the small number of studies (largely in young populations) and the cross-sectional design and methodological drawbacks. In the context of climate-change-related sea level rise and increasing saltwater intrusion into drinking water sources, further research is urgently warranted to investigate and guide intervention in this increasingly widespread problem.

The effect of drinking water salinity on blood pressure in young adults of coastal Bangladesh.

More than 35 million people in coastal Bangladesh are vulnerable to increasing freshwater salinization. This will continue to affect more people and to a greater extent as climate change projections are realised in this area in the future. However the evidence for health effects of consuming high salinity water is limited. This research examined the association between drinking water salinity and blood pressure in young adults in coastal Bangladesh. We conducted a cross-sectional study during May-June 2014 in a rural coastal sub-district of Bangladesh. Data on blood pressure (BP) and salinity of potable water sources was collected from 253 participants aged 19-25 years. A linear regression method was used to examine the association between water salinity exposure categories and systolic BP (SBP) and diastolic BP (DBP) level. Sixty five percent of the study population were exposed to highly saline drinking water above the Bangladesh standard (600 mg/L and above). Multivariable linear regression analyses identified that compared to the low water salinity exposure category (<600 mg/L), those in the high water salinity category (>600 mg/L), had statistically significantly higher SBP (B 3.46, 95% CI 0.75, 6.17; p = 0.01) and DBP (B 2.77, 95% CI 0.31, 5.24; p = 0.03). Our research shows that elevated salinity in drinking water is associated with higher BP in young coastal populations. Blood pressure is an important risk factor of hypertension and cardiovascular diseases. Given the extent of salinization of freshwater in many low-lying countries including in Bangladesh, and the likely exacerbation related to climate change-induced sea level rise, implementation of preventative strategies through dietary interventions along with promotion of low saline drinking water must be a priority in these settings.