Occurrence of Clinically Diagnosed Hypertrophic Cardiomyopathy in the United States.

Hypertrophic cardiomyopathy (HC) is the most common genetic heart disease and an important cause of sudden death and heart failure symptoms. The current prevalence for HC (1:500) is based on echocardiographic population studies in which a substantial proportion of affected subjects have not come to clinical recognition. Therefore, we sought to define the subset of patients with HC who are diagnosed in the US. A proprietary integrated claims database including medical condition International Classification of Diseases, Ninth Revision diagnostic codes for over 160 million individual patients in the US was interrogated for 2013 to identify the prevalence of clinically recognized HC. Patients with ≥1 claim for any of the HC International Classification of Diseases, Ninth Revision diagnosis codes from January to December 2013 were identified. The combined occurrence rate of HC was stratified by age and gender and multiplied by the 2013 United States population in the same age/gender categories to produce the final projected prevalence. The analysis was performed on 169,089,614 patients, of whom 59,009 unique patients were identified with ≥1 claim for HC. The projected estimated occurrence of diagnosed HC in the US in 2013 was 1:3,195 for a total of 98,958 subjects. Average age at HC diagnosis was in the fifth decade of life, with 43% of the cohort composed of women. In conclusion, leveraging a claims-based data analytic technique, about 100,000 patients are diagnosed clinically with HC in the US, an occurrence which is less than the prevalence reported in systematic population studies based on echocardiographic diagnosis. This observation supports the view that many patients with HC are undiagnosed throughout life and enhances our understanding of the burden of this genetic heart disease on the health care system.

Workers' perceptions about worksite policies and environments and their association with leisure-time physical activity.

PURPOSE: To estimate the employed population's exposure to perceived worksite policies and environments hypothesized to promote physical activity and to determine their relationship to leisure-time physical activity. DESIGN: Cross-sectional, random-digit-dial telephone survey. SETTING: Community. SUBJECTS: Employed adults (n = 987) in six North Carolina counties. MEASURES: Outcomes included any leisure-time physical activity, recommended physical activity, and work-break physical activity. Perceived worksite policies and environments included on-site fitness facility at work, safe place to walk outside work, paid time for activity, subsidized health-club membership, and flexible work schedule. ANALYSIS: Descriptive statistics were used to describe the study population and exposure to perceived worksite policies and environments. Multivariable logistic regression was used to evaluate relationships between perceived worksite policies and environments and physical activity, controlling for age, race, sex, educational status, disability, and general health status. RESULTS: Various supportive worksite policies and environments were reported by 15% to 56% of employed participants. Associations between perceived worksite policies and environments and physical activity were strongest for having paid time for non-work-related physical activity, an on-site fitness facility at work, and subsidies for health clubs. Recommended activity was not associated with perceived worksite policies and environments. CONCLUSION: Worksite policies and environments are promising factors for future study in physical activity promotion. Studies should evaluate these relationships in other populations and explore measurement error in self-reported worksite policies and environments.

Association between adult and childhood socioeconomic status and prevalence of the metabolic syndrome in African Americans: the Pitt County Study.

We evaluated the association between socioeconomic status (SES) during childhood and adulthood and prevalence of the metabolic syndrome in African Americans. Higher adult educational status and adult skilled occupation were protective against the metabolic syndrome, but no associations were found between the metabolic syndrome and other SES variables. Differences by gender were observed. Improving access to education among African Americans could reduce risk for the metabolic syndrome, but more research is needed in minority populations.

Patient activism and the struggle for diagnosis: Gulf War illnesses and other medically unexplained physical symptoms in the US.

We examine Gulf War illnesses--which include the fatigue, joint pain, dermatitis, headaches, memory loss, blurred vision, diarrhea, and other symptoms reported by Gulf War veterans--in relation to other medically unexplained physical symptoms such as multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia. Our intent is to examine the diagnosis negotiations involved in these mysterious diseases, by showing the different forms of legitimacy involved in such interactions. Factors involved in diagnostic legitimacy are: diagnostic legitimacy in the medical community, lay acceptance of the diagnosis, uncertainty in looking for causes, and social mobilization. We conclude by noting that research may not be able to find any cause for these diseases/conditions; hence, it may be necessary to embrace medical uncertainty, and also to accept patient experience in order to facilitate diagnosis, treatment, and recovery process. Such a change can alter patients' expectations and taken-for-granted assumptions about medicine, and perhaps in turn reduce the frequency with which dissatisfied individuals form illness groups that mobilize to challenge what they see as an unresponsive medical system.