Operationalizing Surveillance of Chronic Disease Self-Management and Self-Management Support.

Sixty percent of US adults have at least one chronic condition, and more than 40% have multiple conditions. Self-management (SM) by the individual, along with self-management support (SMS) by others, are nonpharmacological interventions with few side effects that are critical to optimal chronic disease control. Ruiz and colleagues laid the conceptual groundwork for surveillance of SM/SMS at 5 socio-ecological levels (individual, health system, community, policy, and media). We extend that work by proposing operationalized indicators at each socio-ecologic level and suggest that the indicators be embedded in existing surveillance systems at national, state, and local levels. Without a robust measurement system at the population level, we will not know how far we have to go or how far we have come in making SM and SMS a reality. The data can also be used to facilitate planning and service delivery strategies, monitor temporal changes, and stimulate SM/SMS-related research.

2010 National and State Costs of Excessive Alcohol Consumption.

INTRODUCTION: Excessive alcohol use cost the U.S. $223.5 billion in 2006. Given economic shifts in the U.S. since 2006, more-current estimates are needed to help inform the planning of prevention strategies. METHODS: From March 2012 to March 2014, the 26 cost components used to assess the cost of excessive drinking in 2006 were projected to 2010 based on incidence (e.g., change in number of alcohol-attributable deaths) and price (e.g., inflation rate in cost of medical care). The total cost, cost to government, and costs for binge drinking, underage drinking, and drinking while pregnant were estimated for the U.S. for 2010 and allocated to states. RESULTS: Excessive drinking cost the U.S. $249.0 billion in 2010, or about $2.05 per drink. Government paid for $100.7 billion (40.4%) of these costs. Binge drinking accounted for $191.1 billion (76.7%) of costs; underage drinking $24.3 billion (9.7%) of costs; and drinking while pregnant $5.5 billion (2.2%) of costs. The median cost per state was $3.5 billion. Binge drinking was responsible for >70% of these costs in all states, and >40% of the binge drinking-related costs were paid by government. CONCLUSIONS: Excessive drinking cost the nation almost $250 billion in 2010. Two of every $5 of the total cost was paid by government, and three quarters of the costs were due to binge drinking. Several evidence-based strategies can help reduce excessive drinking and related costs, including increasing alcohol excise taxes, limiting alcohol outlet density, and commercial host liability.

State costs of excessive alcohol consumption, 2006.

BACKGROUND: Excessive alcohol consumption is responsible for an average of 80,000 deaths in the U.S. each year and cost $223.5 billion ($1.90/drink) in 2006. Comparable state estimates of this cost are needed to help inform prevention strategies. PURPOSE: The goal of the study was to estimate the economic cost of excessive drinking by state for 2006. METHODS: From December 2011 to November 2012, an expert panel developed methods to allocate component costs from the 2006 national estimate to states for (1) total; (2) government; (3) binge drinking; and (4) underage drinking costs. Differences in average state wages were used to adjust productivity losses. RESULTS: In 2006, the median state cost of excessive drinking was $2.9 billion (range: $31.9 billion [California] to $419.6 million [North Dakota]); the median cost per drink, $1.91 (range: $2.74 [Utah] to $0.88 [New Hampshire]); and the median per capita cost, $703 (range: $1662 [District of Columbia] to $578 [Utah]). A median of 42% of state costs were paid by government (range: 45.0% [Utah] to 37.0% [Mississippi]). Binge drinking was responsible for a median of 76.6% of state costs (range: 83.1% [Louisiana] to 71.6% [Massachusetts]); underage drinking, a median of 11.2% of state costs (range: 20.0% [Wyoming] to 5.5% [District of Columbia]). CONCLUSIONS: Excessive drinking cost states a median of $2.9 billion in 2006. Most of the costs were due to binge drinking and about $2 of every $5 were paid by government. The Guide to Community Preventive Services has recommended several evidence-based strategies-including increasing alcohol excise taxes, limiting alcohol outlet density, and commercial host liability-that can help reduce excessive alcohol use and the associated economic costs.

Economic costs of excessive alcohol consumption in the U.S., 2006.

BACKGROUND: Excessive alcohol consumption causes premature death (average of 79,000 deaths annually); increased disease and injury; property damage from fire and motor vehicle crashes; alcohol-related crime; and lost productivity. However, its economic cost has not been assessed for the U.S. since 1998. PURPOSE: To update prior national estimates of the economic costs of excessive drinking. METHODS: This study (conducted 2009-2010) followed U.S. Public Health Service Guidelines to assess the economic cost of excessive alcohol consumption in 2006. Costs for health care, productivity losses, and other effects (e.g., property damage) in 2006 were obtained from national databases. Alcohol-attributable fractions were obtained from multiple sources and used to assess the proportion of costs that could be attributed to excessive alcohol consumption. RESULTS: The estimated economic cost of excessive drinking was $223.5 billion in 2006 (72.2% from lost productivity, 11.0% from healthcare costs, 9.4% from criminal justice costs, and 7.5% from other effects) or approximately $1.90 per alcoholic drink. Binge drinking resulted in costs of $170.7 billion (76.4% of the total); underage drinking $24.6 [corrected] billion; and drinking during pregnancy $5.2 billion. The cost of alcohol-attributable crime was $73.3 billion. The cost to government was $94.2 billion (42.1% of the total cost), which corresponds to about $0.80 per alcoholic drink consumed in 2006 (categories are not mutually exclusive and may overlap). CONCLUSIONS: On a per capita basis, the economic impact of excessive alcohol consumption in the U.S. is approximately $746 per person, most of which is attributable to binge drinking. Evidence-based strategies for reducing excessive drinking should be widely implemented.

Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001-2004.

OBJECTIVE: To estimate the prevalence of and the annual number of ambulatory health care visits for pediatric arthritis and other rheumatologic conditions. METHODS: We used physician office visit, outpatient department visit, and emergency department visit data from the 2001-2004 National Ambulatory Medical Care Survey and 2001-2004 National Hospital Ambulatory Medical Care Survey to estimate annual visits for the International Classification of Diseases, Ninth Revision, Clinical Modification codes thought to represent significant pediatric arthritis and other rheumatologic conditions (SPARC). We converted visit estimates into prevalence estimates using data on the number of prior annual visits per patient. Synthetic estimates for states were produced using national rates. RESULTS: The average annualized estimate of the number of children with SPARC was 294,000 (95% confidence interval [95% CI] 188,000-400,000). The annualized number of ambulatory health care visits for SPARC was 827,000 (95% CI 609,000-1,044,000). CONCLUSION: Pediatric arthritis estimates have varied widely because it is an umbrella term for which there are many definitions and because it is a relatively uncommon condition from a population surveillance perspective. Our estimates suggest that arthritis-related health care visits impose a substantial burden on the pediatric health care system. One advantage of this surveillance paradigm is that it has established a starting point for tracking the national prevalence of arthritis and rheumatologic conditions in children on an ongoing basis using existing infrastructure rather than expensive new surveys. This surveillance system will help us monitor and predict the health care needs of patients with these conditions.