Recent Advances in the Use of the Mortality Syndromic Surveillance System-New York City, 2015-2020.

OBJECTIVE: New York City's automated mortality syndromic surveillance system monitors temporal and spatial patterns in mortality. To describe the use of the syndromic surveillance system, we used the system to find mortality patterns for the 15 leading causes of death and for deaths from rare and reportable diseases in New York City from February 2015 through June 2020. We used results to find aberrations that indicate threats to public health. METHODS: We used unobserved components models to analyze time series of mortality counts for leading causes of death, historical limits methods for rare and reportable diseases, and SaTScan for temporal-spatial cluster analysis. We obtained data on the number of deaths from the electronic death registry system maintained by the city's Bureau of Vital Statistics. RESULTS: The mortality syndromic surveillance system detected an increase in the number of deaths from heart disease by April 1, 2020, when 75.0 deaths occurred on March 24, 2020, instead of an expected 45.8 deaths (95% upper prediction limit of 61.0) and an increase in the number of deaths from all causes on March 20, 2020, when 194.0 deaths were observed while 150.1 deaths were expected (95% upper prediction limit of 178.0). The number of deaths from all causes returned to normal the week beginning June 14, 2020, when 990.0 deaths were observed and 998.8 deaths were expected. PRACTICE IMPLICATIONS: When compared with efforts from New York City to provide yearly vital statistics, the automated mortality syndromic surveillance system can provide timely mortality data with fewer resources and raise the capacity to detect anomalous increases in mortality.

A new equation to estimate glomerular filtration rate.

BACKGROUND: Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. OBJECTIVE: To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. DESIGN: Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. SETTING: Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. PARTICIPANTS: 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. MEASUREMENTS: GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. RESULTS: In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). LIMITATION: The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. CONCLUSION: The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases.

CKD surveillance using laboratory data from the population-based National Health and Nutrition Examination Survey (NHANES).

Surveillance for chronic kidney disease (CKD) using nationally representative samples of the US population is central in providing information about the magnitude and trends in CKD burden that will guide disease management and prevention planning for clinicians and public health authorities. We used a cross-sectional study design to estimate the change in prevalence of CKD over time by using National Health and Nutrition Examination Survey (NHANES) data. NHANES III (1988-1994) included 15,488 participants and NHANES rounds 1999-2004 included 13,233 participants older than 20 years with serum creatinine measurements who were examined in a mobile examination center. Early stages of CKD were defined by glomerular filtration rate (GFR) estimated by using the Modification of Diet in Renal Disease (MDRD) Study equation and urinary albumin-creatinine ratio following the classification system established by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative. Moderately decreased GFR increased in prevalence from 5.4% to 7.7% (P < 0.001) and severely decreased GFR increased from 0.21% to 0.35% (P = 0.02) from 1988-1994 to 1999-2004. Within CKD stage 3, 18.6% +/- 1.6% (SE) of individuals should be referred to a nephrologist following a proposed set of criteria for referral; referral rates were highest for individuals with diabetes and lower in whites compared with other race-ethnicity groups. These survey data suggest that the prevalence of CKD has increased between 1988-1994 and 1999-2004. Surveillance for early stages of CKD (stages 1 to 4) should monitor these and other trends.

Human immunodeficiency virus counseling, testing, and referral of close contacts to patients with pulmonary tuberculosis: feasibility and costs.

BACKGROUND: We aimed to increase human immunodeficiency virus (HIV) counseling, testing, referral (CTR), and knowledge of HIV serostatus of close contacts of tuberculosis patients and improve tuberculosis screening and treatment of HIV-infected contacts. METHODS: Of close contacts to infectious tuberculosis patients reported from December 2002 to November 2003, investigators (1) offered HIV CTR, (2) identified factors associated with HIV testing, and (3) assessed study costs. RESULTS: Of 614 contacts, 569 (93%) were provided HIV information and offered HIV CTR. Of the 569, 58 (10%) were previously HIV tested; 165 (29%) were newly HIV tested; and 346 (61%) were not tested. None of the 165 newly HIV tested contacts were HIV infected. Contacts more likely to be newly HIV tested (vs not tested) included those aged 18-24, Hispanic, or non-Hispanic Black. Of 24 HIV-infected contacts, 71 percent received chest-radiograph screening for tuberculosis disease; 56 percent of 18 eligible for latent-tuberculosis-infection treatment started and half completed. It cost $1 per patient to provide HIV information and $5-$8 to offer HIV CTR. CONCLUSION: The project increased HIV CTR of close contacts of infectious tuberculosis patients. The important factor for success in knowing contacts' HIV serostatus was simply for TB program staff to ask about it and offer the test to those who did not know their status.

A dynamic switch in Rb+/- mediated neuroendocrine tumorigenesis.

Rb+/- mice develop a complex spectrum of neuroendocrine tumors on a mixed genetic (129Sv x C57BL/6) background. To understand how the 129Sv and C57BL/6 contributions affect Rb+/- tumorigenesis, we serially backcrossed Rb+/- animals to the 129Sv or C57BL/6 strain, and analysed their pathological profiles. Strikingly, the length of survival and the penetrance, severity and multiplicity of neuroendocrine tumors switch dramatically between Rb+/- animals from the two genetic backgrounds. In fact, the 129Sv background significantly enhances both the initiation and progression of tumorigenesis in the intermediate lobe of the pituitary (ILP) in Rb+/- animals. This is due to the surprising fact that ILPs from wild-type 129Sv animals are inherently abnormal, and thus greatly predisposed to neoplasia. This is likely to explain the high incidence of ILP tumors, an otherwise rare tumor type in wild-type mice, in numerous knockout studies performed on the 129Sv strain, and raises the intriguing possibility that the classic Rb+/- neuroendocrine tumors may fade away in another as of yet unidentified inbred strain. Finally, we have increased the utility of the Rb+/- tumor model, since Rb+/- animals on the C57BL/6 background develop high-penetrance tumors of the anterior lobe of the pituitary, a class of tumors estimated to occur in 20-25% of humans.