What do binge drinkers drink? Implications for alcohol control policy.

BACKGROUND: Although binge drinking (drinking five or more drinks on an occasion) is an important public health problem, little is known about which beverage types are consumed by binge drinkers. This knowledge could guide prevention efforts because beer, wine, and liquor are taxed, marketed, and distributed differently. METHODS: Data from 14,150 adult binge drinkers who responded to the Behavioral Risk Factor Surveillance System binge-drinking module in 2003 and 2004 were analyzed. Information pertained to the amount of alcohol consumed during a binge drinker's most recent binge episode, including beverage-specific consumption. RESULTS: Overall, 74.4% of binge drinkers consumed beer exclusively or predominantly, and those who consumed at least some beer accounted for 80.5% of all binge alcohol consumption. By beverage type, beer accounted for 67.1%, liquor for 21.9%, and wine accounted for 10.9% of binge drinks consumed. Beer also accounted for most of the alcohol consumed by those at highest risk of causing or incurring alcohol-related harm, including people aged 18-20 years (67.0% of drinks were beer); those with three or more binge episodes per month (70.7%); those drinking eight or more drinks per binge episode (69.9%); those binging in public places (64.4%); and those who drove during or within 2 hours of binge drinking (67.1%). CONCLUSIONS: Beer accounted for two thirds of all alcohol consumed by binge drinkers and accounted for most alcohol consumed by those at greatest risk of causing or incurring alcohol-related harm. Lower excise taxes and relatively permissive sales and marketing practices for beer as compared with other beverage types may account for some of these findings. These findings suggest that equalizing alcohol control policies at more stringent levels would be an effective way to prevent excessive drinking.

Trends in total knee replacement surgeries and implications for public health, 1990-2000.

OBJECTIVES: Total joint replacements are important surgical interventions for treating severe arthritis of weight-bearing joints. The most common indication for total knee replacement (TKR) is osteoarthritis of the knee joint. The goals of this study were to assess the trend in rate of TKR in Wisconsin and to describe the economic impact of these surgical procedures on the health care system. METHOD: A population-based cross-sectional study of TKR surgeries was conducted among Wisconsin residents aged > or = 45 years. The Wisconsin inpatient hospital discharge data from 1990 through 2000 were used. Rates were age-adjusted to the 2000 U.S. population, and charges for TKR were adjusted for inflation. RESULTS: From 1990 through 2000, the age-adjusted rate for TKR increased by 81.5% (from 162 to 294 per 100,000; p<0.001). The rate increased the most among the youngest age group (45-49 years), rate ratio 5.1 for men, 4.2 for women. The total charges for TKR increased from 69.4 million dollars to 148 million dollars (109.2% inflation-adjusted increase). Medicare received the highest proportion of charges for TKR procedures, but throughout the study period, the proportion of charges covered by private insurance increased by 39%. CONCLUSIONS: The rate and costs of TKR procedures among Wisconsin residents increased substantially from 1990 through 2000, especially among younger age groups. Changes in medical practices probably accounted for some of this increase, but these trends also may reflect an increased prevalence of osteoarthritis, which in turn may be related to dramatic increases in the number of individuals who are overweight.

Arthritis, body mass index, and professional advice to lose weight: implications for clinical medicine and public health.

BACKGROUND: Arthritis is the leading cause of disability in the United States. Obesity is a risk factor for arthritis, but the relationship between arthritis and weight has not been well characterized at the population level in the United States. Previous research shows that physicians often fail to advise their obese patients to lose weight. OBJECTIVES: To describe the relationship between body weight and arthritis in the United States, and to assess predictors of efforts to lose weight among obese adults with arthritis, including the impact of professional advice to lose weight. METHODS: Data from the 2000 Behavioral Risk Factor Surveillance System (a population-based survey of U.S. adults) from the 35 states that collected information on weight and height, arthritis, and efforts to lose weight. Arthritis was based on self-report of doctor diagnosis or chronic joint symptoms. Main outcome measures were arthritis and efforts to lose weight among adults with arthritis. RESULTS: Overall, 31.7% of respondents had self-reported arthritis. There was a strong relationship between body weight and arthritis. Specifically, the prevalence of arthritis was 25.9% among normal weight (18.5 to 24.9 body mass index [BMI]) adults; 32.1% among overweight (25 to 29.9 BMI) adults; and 43.5% among obese (>30 BMI) adults. This association persisted after adjusting for other factors (adjusted odds ratio [AOR] for having arthritis among obese individuals compared with healthy weight individuals, 3.6; 95% confidence interval [CI]=3.2-3.8). Among obese adults with arthritis who had a routine checkup within the past 12 months, only 43% were advised to lose weight by a health professional. However, recipients of such advice were more likely to try to lose weight than nonrecipients, and professional advice was the strongest independent predictor of weight loss efforts (AOR=2.8; 95% CI=2.5-3.1). CONCLUSIONS: Body mass index (BMI) is an important independent risk factor for self-reported arthritis. Although physicians often fail to advise obese adults with arthritis to lose weight, adults who report receiving such advice were more likely to report weight-loss efforts. Improved awareness of the relationship between arthritis and weight might help motivate patients to lose weight, and physician advice to lose weight could contribute to the prevention and treatment of arthritis.

The state of arthritis in Wisconsin.

Arthritis is the leading cause of disability and functional limitation in Wisconsin and trails only heart disease as the leading cause of work disability. In 2001, the estimated prevalence of arthritis/chronic joint symptoms (CJS) among US adults was 33%, representing approximately 69.9 million adults. Wisconsin has established a statewide program to address this chronic condition. Prior to its inception, no state-based arthritis surveillance was available. The Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) first included questions on chronic joint symptoms and doctor-diagnosed arthritis in 2000. That data provides a baseline to describe the burden of arthritis in Wisconsin. This report summarizes the prevalence of arthritis and its distribution among Wisconsin adults. Proven public health interventions should be applied and new interventions developed to improve function, decrease pain, and delay disability among persons with arthritis, particularly those at highest risk for functional impairment and disability.

Obesity and physical inactivity among Wisconsin adults with arthritis.

INTRODUCTION: Arthritis is the leading cause of disability in Wisconsin, and affects approximately 34% of Wisconsin adults. Obesity is an established risk factor for arthritis; however, the relationship between arthritis and obesity has not been well characterized at the population level in Wisconsin. OBJECTIVES: Describe the relationship between arthritis, obesity, physical inactivity, and efforts to lose weight among Wisconsin adults. METHODS: Wisconsin Behavioral Risk Factor Surveillance System 2000-2001. Arthritis was defined by either doctor diagnosis or self-reported chronic joint symptoms. RESULTS: Overall, 36% of respondents had arthritis. Among adults with arthritis, 28% were obese (BMI>30) compared to 16% without arthritis. The prevalence of leisure time physical inactivity was substantially higher among those with arthritis compared to those without arthritis (27.8% vs. 19.2%). Although prevalence of obesity was higher among those with arthritis, only 46% of adults with arthritis made an effort to lose weight. CONCLUSIONS: A high proportion of adults with arthritis are obese and are physically inactive, even though studies have shown that weight loss and regular physical activity relieve arthritis symptoms. Efforts should be made to promote weight loss and physical activities among adults with arthritis.

The Wisconsin Arthritis Program--a new partnership to reduce the leading cause of disability.

There are known and effective strategies to prevent arthritis, reduce symptoms, decrease disability, and improve quality of life. For example: Weight management and physical activity may lower risk. Early diagnosis and appropriate self-management may decrease pain. Arthritis Self-help Course, an evidence-based education program, may reduce pain and enhance self-management. The new Wisconsin Arthritis Program will engage citizens, health professionals, and organizations together as partners to reach more people in order to utilize effective strategies to prevent arthritis, reduce symptoms, decrease disability, and improve quality of life.

Population-based study of trends, costs, and complications of weight loss surgeries from 1990 to 2002.

OBJECTIVE: To describe the trends, costs, and complications associated with weight loss surgery (WLS). RESEARCH METHODS AND PROCEDURES: Wisconsin inpatient hospital discharge data from 1990 to 2003 were used for analysis. A WLS case was defined as anyone with a WLS-related procedure code and a primary diagnosis of morbid obesity. Charges were inflation-adjusted to 2001 constant dollars; complications were defined on the basis of readmission, extended length of stay, repeat surgical procedures, or death. RESULTS: The number of WLSs increased from 269 in 1990 to 1992 to 1,884 in 2000 to 2002 (rate ratio = 4.6). Increases in WLSs were greatest among those 50 to 59 years of age (rate ratio = 6.4), women (rate ratio = 6.8), and blacks (rate ratio = 20.0). Between the two periods, inflation-adjusted WLS charges increased 12-fold, and the inflation-adjusted charge per procedure doubled, despite a decreased length of stay. For 2000 to 2002, 23.3% of WLS patients had either an extended length of stay or readmission within 30 days, 7.4% required a repeat surgical procedure, and 0.7% died. DISCUSSION: In Wisconsin, the rate and costs of WLSs have increased dramatically, and the incidence of postoperative complications was high. The epidemic of obesity in the United States makes it imperative to better assess the cost-effectiveness of WLS and to improve its safety.