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1.
Circ Cardiovasc Qual Outcomes ; 13(1): e005902, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31931615

RESUMEN

BACKGROUND: Despite cardiac rehabilitation (CR) being shown to improve health outcomes among patients with heart disease, its use has been suboptimal. In response, the Million Hearts Cardiac Rehabilitation Collaborative developed a road map to improve CR use, including increasing participation rates to ≥70% by 2022. This observational study provides current estimates to measure progress and identifies the populations and regions most at risk for CR service underutilization. METHODS AND RESULTS: We identified Medicare fee-for-service beneficiaries who were CR eligible in 2016, and assessed CR participation (≥1 CR session attended), timely initiation (participation within 21 days of event), and completion (≥36 sessions attended) through 2017. Measures were assessed overall, by beneficiary characteristics and geography, and by primary CR-qualifying event type (acute myocardial infarction hospitalization; coronary artery bypass surgery; heart valve repair/replacement; percutaneous coronary intervention; or heart/heart-lung transplant). Among 366 103 CR-eligible beneficiaries, 89 327 (24.4%) participated in CR, of whom 24.3% initiated within 21 days and 26.9% completed CR. Eligibility was highest in the East South Central Census Division (14.8 per 1000). Participation decreased with increasing age, was lower among women (18.9%) compared with men (28.6%; adjusted prevalence ratio: 0.91 [95% CI, 0.90-0.93]) was lower among Hispanics (13.2%) and non-Hispanic blacks (13.6%) compared with non-Hispanic whites (25.8%; adjusted prevalence ratio: 0.63 [0.61-0.66] and 0.70 [0.67-0.72], respectively), and varied by hospital referral region and Census Division (range: 18.6% [East South Central] to 39.1% [West North Central]) and by qualifying event type (range: 7.1% [acute myocardial infarction without procedure] to 55.3% [coronary artery bypass surgery only]). Timely initiation varied by geography and qualifying event type; completion varied by geography. CONCLUSIONS: Only 1 in 4 CR-eligible Medicare beneficiaries participated in CR and marked disparities were observed. Reinforcement of current effective strategies and development of new strategies will be critical to address the noted disparities and achieve the 70% participation goal.

2.
Hypertension ; 74(6): 1324-1332, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31679429

RESUMEN

Despite the importance of antihypertensive medication therapy for blood pressure control, no single data system provides estimates of medication nonadherence rates across age groups and health insurance plans types. Using multiple administrative datasets and national survey data, we determined health insurance plan-specific and overall weighted national rates of nonadherence to antihypertensive medications among insured hypertensive US adults in 2015. We used 2015 prescription claims data from Medicare Part D and 3 IBM MarketScan databases (Commercial, Medicaid, Medicare Supplemental) to calculate medication nonadherence rates among hypertensive adults aged ≥18 years with public or private health insurance using the proportion of days covered algorithm. These findings, in combination with National Health Interview Survey findings, were used to project national weighted estimates of nonadherence. We included 23.8 million hypertensive adults who filled 265.8 million prescriptions for antihypertensive medications. Nonadherence differed by health insurance plan type (highest for Medicaid members, 55.4%; lowest for Medicare Part D members, 25.2%). The overall weighted national nonadherence rate was 31.0%, with greater nonadherence among women versus men, younger versus older adults (aged 18-34 years, 58.1%; aged 65-74 years, 24.4%), fixed-dose combination medication nonusers (31.2%) versus users (29.4%), and by pharmacy outlet type (retail only, 30.7%; any mail order, 19.8%). In 2015, almost one-third (≈16.3 million) of insured US adults with diagnosed hypertension were considered nonadherent to their antihypertensive medication regimen, and considerable disparities were evident. Public health and healthcare professionals can use available evidence-based interventions to address nonadherence and improve blood pressure control.

3.
Am J Clin Nutr ; 109(6): 1672-1682, 2019 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-31136657

RESUMEN

BACKGROUND: Understanding measurement error in sodium and potassium intake is essential for assessing population intake and studying associations with health outcomes. OBJECTIVE: The aim of this study was to compare sodium and potassium intake derived from 24-h dietary recall (24HDR) with intake derived from 24-h urinary excretion (24HUE). DESIGN: Data were analyzed from 776 nonpregnant, noninstitutionalized US adults aged 20-69 y who completed 1-to-2 24HUE and 24HDR measures in the 2014 NHANES. A total of 1190 urine specimens and 1414 dietary recalls were analyzed. Mean bias was estimated as mean of the differences between individual mean 24HDR and 24HUE measurements. Correlations and attenuation factors were estimated using the Kipnis joint-mixed effects model accounting for within-person day-to-day variability in sodium excretion. The attenuation factor reflects the degree to which true associations between long-term intake (estimated using 24HUEs) and a hypothetical health outcome would be approximated using a single 24HDR: values near 1 indicate close approximation and near 0 indicate bias toward null. Estimates are reported for sodium, potassium, and the sodium: potassium (Na/K) ratio. Model parameters can be used to estimate correlations/attenuation factors when multiple 24HDRs are available. RESULTS: Overall, mean bias for sodium was -452 mg (95% CI: -646, -259), for potassium -315 mg (CI: -450, -179), and for the Na/K ratio -0.04 (CI: -0.15, 0.07, NS). Using 1 24HDR, the attenuation factor for sodium was 0.16 (CI: 0.09, 0.21), for potassium 0.25 (CI:0.16, 0.36), and for the Na/K ratio 0.20 (CI: 0.10, 0.25). The correlation for sodium was 0.27 (CI: 0.16, 0.37), for potassium 0.35 (CI: 0.26, 0.55), and for the Na/K ratio 0.27 (CI: 0.13, 0.32). CONCLUSIONS: Compared with 24HUE, using 24HDR underestimates mean sodium and potassium intake but is unbiased for the Na/K ratio. Additionally, using 24HDR as a measure of exposure in observational studies attenuates the true associations of sodium and potassium intake with health outcomes.


Asunto(s)
Encuestas Nutricionales/normas , Potasio en la Dieta/metabolismo , Sodio en la Dieta/metabolismo , Adulto , Anciano , Sesgo , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales/métodos , Potasio en la Dieta/orina , Sodio en la Dieta/orina , Estados Unidos , Adulto Joven
4.
Prev Chronic Dis ; 16: E52, 2019 04 25.
Artículo en Inglés | MEDLINE | ID: mdl-31022369

RESUMEN

INTRODUCTION: Little is known about trends in the overall combined burden of fatal and nonfatal cerebrovascular disease events in the United States. Our objective was to describe the combined burden by age, sex, and region from 2006 through 2014. METHODS: We used data on adults aged 35 and older from 2006 through 2014 Nationwide Emergency Department Sample, National Inpatient Sample of the Healthcare Cost and Utilization Project, and the National Vital Statistics System. We calculated age-standardized cerebrovascular disease event rates by using the 2010 US Census population. Trends in rates were assessed by calculating the relative percentage change (RPC) between 2006 and 2014, and by using Joinpoint to obtain P values for overall trends. RESULTS: The age-standardized rate increased significantly for total cerebrovascular disease events (primary plus comorbid events) from 1,050 per 100,000 in 2006 to 1,147 per 100,000 in 2014 (P < .05 for trend). Treat-and-release emergency department visits with comorbid cerebrovascular disease events increased significantly, from 114 per 100,000 in 2006 to 213 per 100,000 in 2014 (RPC of 87%, P < .05 for trend). Significant rate increases were identified among adults aged 35 to 64 with an RPC of 19% in primary cerebrovascular disease events, 48% in comorbid cerebrovascular disease events, and 36% in total events. CONCLUSION: Our findings have important implications for the increasing cerebrovascular disease burden among adults aged 35 to 64. Focused prevention strategies should be implemented, especially among young adults who may be unaware of existing modifiable risk factors.


Asunto(s)
Factores de Edad , Trastornos Cerebrovasculares/economía , Trastornos Cerebrovasculares/epidemiología , Costo de Enfermedad , Geografía , Factores Sexuales , Adulto , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estados Unidos/epidemiología
5.
Am J Clin Nutr ; 109(1): 139-147, 2019 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-30624582

RESUMEN

Background: Both excessive sodium intake and obesity are risk factors for hypertension and cardiovascular disease. The association between sodium intake and obesity is unclear, with few studies assessing sodium intake using 24-h urine collection. Objectives: Our objective was to assess the association between usual 24-h sodium excretion and measures of adiposity among US adults. Methods: Cross-sectional data were analyzed from a sample of 730 nonpregnant participants aged 20-69 y who provided up to 2 complete 24-h urine specimens in the NHANES 2014 and had data on overweight or obesity [body mass index (kg/m2) ≥25] and central adiposity [waist circumference (WC): >88 cm for women, >102 cm for men]. Measurement error models were used to estimate usual sodium excretion, and multiple linear and logistic regression models were used to assess its associations with measures of adiposity, adjusting for sociodemographic, health, and dietary variables [i.e., energy intake or sugar-sweetened beverage (SSB) intake]. All analyses accounted for the complex survey sample design. Results: Unadjusted mean ± SE usual sodium excretion was 3727 ± 43.5 mg/d and 3145 ± 55.0 mg/d among participants with and without overweight/obesity and 3653 ± 58.1 mg/d and 3443 ± 35.3 mg/d among participants with or without central adiposity, respectively. A 1000-mg/d higher sodium excretion was significantly associated with 3.8-units higher BMI (95% CI: 2.8, 4.8) and a 9.2-cm greater WC (95% CI: 6.9, 11.5 cm) adjusted for covariates. Compared with participants in the lowest quartile of sodium excretion, the adjusted prevalence ratios in the highest quartile were 1.93 (95% CI: 1.69, 2.20) for overweight/obesity and 2.07 (95% CI: 1.74, 2.46) for central adiposity. The associations also were significant when adjusting for SSBs, instead of energy, in models. Conclusions: Higher usual sodium excretion is associated with overweight/obesity and central adiposity among US adults.


Asunto(s)
Adiposidad/fisiología , Encuestas Nutricionales , Sodio/orina , Adulto , Anciano , Bebidas , Índice de Masa Corporal , Estudios Transversales , Ingestión de Energía , Grupos Étnicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad Abdominal/epidemiología , Sobrepeso/epidemiología , Sodio en la Dieta/administración & dosificación , Edulcorantes/administración & dosificación , Estados Unidos/epidemiología , Circunferencia de la Cintura
6.
Am J Prev Med ; 56(1): e13-e21, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30337237

RESUMEN

INTRODUCTION: Self-measured blood pressure monitoring (SMBP) plus additional clinical support is an evidence-based strategy that improves blood pressure control. Despite national recommendations for SMBP use and potential cost savings, insurance coverage for implementation is limited in the U.S. and little is known regarding clinical implementation. METHODS: In 2017, using 2015 and 2016 DocStyles survey data from 1,590 primary care physicians and nurse practitioners in U.S. outpatient facilities, SMBP-related clinical practices and provider roles were assessed. RESULTS: Almost all (97%) respondents reported using SMBP. Among 1,539 who used SMBP, more than half (60%) used SMBP for a combination of diagnostic and treatment purposes, whereas 24% used SMBP for diagnosis only and 16% used SMBP for treatment only. The most common methods for patients to share SMBP results with clinical staff were paper log (68%); during appointments (66%); by telephone (37%); by secure website (22%); or by secure e-mail (19%). Nearly all (98%) respondents reported that medication adjustments were provided to patients based on SMBP readings. About 15% did not counsel patients regarding cuff size, and 8% did not validate patient devices. Only 13% of respondents reported having monitor loaner programs, and availability did not vary by the financial status of the patient population (p=0.59). CONCLUSIONS: SMBP is used widely in outpatient facilities as reported in the survey, although provider roles and SMBP-related practices vary, and gaps exist regarding patient counseling, device validation, and loaner program availability. As part of efforts to improve hypertension control, healthcare professionals can promote increased use of best practices for SMBP, whereas insurers can implement standardization and support of SMBP.

7.
Circ Heart Fail ; 11(12): e004873, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30562099

RESUMEN

BACKGROUND: Heart failure (HF)-a serious and costly condition-is increasingly prevalent. We estimated the US burden including emergency department (ED) visits, inpatient hospitalizations and associated costs, and mortality. METHODS AND RESULTS: We analyzed 2006 to 2014 data from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample, the Healthcare Cost and Utilization Project National (nationwide) Inpatient Sample, and the National Vital Statistics System. International Classification of Disease codes identified HF and comorbidities. Burden was estimated separately for ED visits, hospitalizations, and mortality. In addition, criteria were applied to identify total unique acute events. Rates of primary HF (primary diagnosis or underlying cause of death) and comorbid HF (comorbid diagnosis or contributing cause of death) were calculated, age standardized to the 2010 US population. In 2014, there were an estimated 1 068 412 ED visits, 978 135 hospitalizations, and 83 705 deaths with primary HF. There were 4 071 546 ED visits, 3 370 856 hospitalizations, and 230 963 deaths with comorbid HF. Between 2006 and 2014, the total unique acute event rate for primary HF declined from 536 to 449 per 100 000 (relative percent change of -16%; P for trend, <0.001) but increased for comorbid HF from 1467 to 1689 per 100 000 (relative percentage change, 15%; P for trend, <0.001). HF-related mortality decreased significantly from 2006 to 2009 but did not change meaningfully after 2009. For hospitalizations with primary HF, the estimated mean cost was $11 552 in 2014, totaling an estimated $11 billion. CONCLUSIONS: Given substantial healthcare and mortality burden of HF, rising healthcare costs, and the aging US population, continued improvements in HF prevention, management, and surveillance are important.


Asunto(s)
Costo de Enfermedad , Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/terapia , Costos de Hospital , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Comorbilidad , Bases de Datos Factuales , Servicio de Urgencia en Hospital/economía , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Costos de Hospital/tendencias , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente/economía , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
8.
Pediatrics ; 142(5)2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30333131

RESUMEN

BACKGROUND AND OBJECTIVES: Socioeconomic disparities in cardiovascular health among adults have been documented, but disparities during adolescence are less understood. In this study, we examined secular trends in cardiovascular risk factors and disparities among US adolescents. METHODS: We analyzed NHANES data from 1999 to 2014, including 11 557 (4854 fasting) participants aged 12 to 19 years. To examine trends in cardiovascular risk factors, adolescents were stratified into 3 groups on the basis of family poverty-income ratio: low income (poverty-income ratio, <1.3), middle income (≥1.3 and <3.5), and high income (≥3.5). RESULTS: From 1999 to 2014, the prevalence of obesity increased (16.3%-20.9%, P = .001) but only among low- and middle-income adolescents, with significant disparities in prevalence by income (21.6% vs 14.6% among low- versus high-income adolescents, respectively, in 2011-2014). In addition, there were significant and persistent disparities in the prevalence of smoking (20.7% vs 7.3% among low- versus high-income adolescents, respectively, in 2011-2014), low-quality diet (68.9% vs 55.4%), and physical inactivity (25.6% vs 17.0%). No significant disparities were observed in the prevalence of prediabetes and diabetes, hypertension, or hypercholesterolemia, although the prevalence of prediabetes and diabetes nearly doubled (11.9%-23.1%, P < .001) among all adolescents from 1999 to 2014. Overall, the prevalence of adolescents with 2 or more risk factors declined, but this decline was only significant for high-income adolescents (44.1%-29.1%, P = .02). CONCLUSIONS: Recent improvements in cardiovascular health have not been equally shared by US adolescents of varying socioeconomic status.


Asunto(s)
Salud del Adolescente/tendencias , Enfermedades Cardiovasculares/etiología , Disparidades en el Estado de Salud , Renta/tendencias , Adolescente , Enfermedades Cardiovasculares/epidemiología , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Medición de Riesgo/métodos , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiología , Adulto Joven
9.
Sleep Health ; 4(5): 448-455, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30241660

RESUMEN

OBJECTIVES: Insufficient sleep negatively impacts the cardiovascular system. No study has examined the association between sleep duration and heart age (person's predicted vascular age based on cardiovascular disease [CVD] risk profile). This study examines association between sleep duration and excess heart age (EHA; difference between heart age and chronological age) among US adults. DESIGN AND PARTICIPANTS: Cross-sectional 2007-2014 National Health and Nutrition Examination Survey data for respondents aged 30-74 years without CVD or stroke (n = 12,775). MEASUREMENTS: Self-reported sleep duration was classified into 5 categories (≤5, 6, 7, 8, and ≥9 hours). We used sex-specific Framingham heart age algorithm to calculate heart age and multivariable linear regression to examine association between sleep duration and EHA. RESULTS: A total of 13.4% (95% confidence interval 12.5-14.3), 24.2% (23.1-25.2), 31.0% (29.8-32.3), 25.9% (25.0-26.9), and 5.5% (5.0-6.1) reported sleeping ≤5, 6, 7, 8, and ≥9 hours, respectively. We observed a nonlinear relationship between sleep duration and EHA using 7 hours as reference: EHA (adjusted for sociodemographics, body mass index, physical activity, Healthy Eating Index-2010, sleep disorder, and depression status) was 5.1 (4.8-5.8), 4.5 (3.9-5.1), 3.7 (3.3-4.0), 4.5 (4.1-5.0), and 4.1 (3.3-4.9) years for sleep durations of ≤5, 6, 7, 8 and ≥9 hours, respectively (P = .015 for quadratic trend). EHA was significantly higher among participants with lower education, lower income, and obesity. CONCLUSION: Mean adjusted EHA was lowest among adults who reported sleeping 7 hours per night and increased as adults reported sleeping fewer or more hours. Discussing sleep duration in the context of EHA may be helpful for patients and clinicians.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Privación de Sueño/epidemiología , Sueño , Adulto , Anciano , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de Tiempo , Estados Unidos/epidemiología
10.
MMWR Morb Mortal Wkly Rep ; 67(27): 758-762, 2018 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-30001558

RESUMEN

Hypertension is an important modifiable risk factor for cardiovascular morbidity and mortality, and hypertension in adolescents and young adults is associated with long-term negative health effects (1,2).* In 2017, the American Academy of Pediatrics (AAP) released a new Clinical Practice Guideline (3), which updated 2004 pediatric hypertension guidance† with new thresholds and percentile references calculated from a healthy-weight population. To examine trends in youth hypertension and the impact of the new guideline on classification of hypertension status, CDC analyzed data from 12,004 participants aged 12-19 years in the 2001-2016 National Health and Nutrition Examination Survey (NHANES). During this time, prevalence of hypertension declined, using both the new (from 7.7% to 4.2%, p<0.001) and former (from 3.2% to 1.5%, p<0.001) guidelines, and declines were observed across all weight status categories. However, because of the new percentile tables and lower threshold for hypertension (4), application of the new guideline compared with the former guideline resulted in a weighted net estimated increase of 795,000 U.S. youths being reclassified as having hypertension using 2013-2016 data. Youths who were older, male, and those with obesity accounted for a disproportionate share of persons reclassified as having hypertension. Clinicians and public health professionals might expect to see a higher prevalence of hypertension with application of the new guideline and can use these data to inform actions to address hypertension among youths. Strategies to improve cardiovascular health include adoption of healthy eating patterns and increased physical activity (3).


Asunto(s)
Hipertensión/epidemiología , Adolescente , Niño , Femenino , Humanos , Hipertensión/diagnóstico , Masculino , Encuestas Nutricionales , Obesidad Pediátrica/epidemiología , Guías de Práctica Clínica como Asunto , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
11.
Am J Med ; 131(3): 276-283.e2, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-28893514

RESUMEN

BACKGROUND: Increasing use of nurse practitioners and physician assistants is a possible solution to the shortage of primary care providers in the United States, but the quality of care they provide is not well understood. METHODS: Because the scope of practice of the 3 provider types is similar in the Veterans Health Administration, we determined whether patients managed by primary care nurse practitioners, physician assistants, or physicians had similar hemoglobin A1c levels at comparable times in the natural history of diabetes. Our retrospective cohort study examined veterans with newly diagnosed diabetes in 2008, continuous primary care from 2008 to 2012, and more than 75% of primary care visits with nurse practitioner, physician assistant, or physician. RESULTS: Of the 19,238 patients, 95.3% were male, 77.7% were white, and they had a mean age 68.5 years; 14.7%, 7.1%, and 78.2% of patients were managed by nurse practitioners, physician assistants, and physicians, respectively. Median hemoglobin A1c was comparable at diagnosis (6.6%, 6.7%, 6.7%, P > .05) and after 4 years (all 6.5%, P > .5). Hemoglobin A1c levels at initiation of the first (7.5%-7.6%) and second (8.0%-8.2%) oral medications for patients of nurse practitioners and physician assistants compared with that of physicians was also similar after adjusting for patient characteristics (all P > .05). Nurse practitioners started insulin at a lower hemoglobin A1c (9.4%) than physicians (9.7%), which remained significant after adjustment (P < .05). CONCLUSIONS: At diagnosis and during 4 years of follow-up, diabetes management by nurse practitioners and physician assistants was comparable to management by physicians. The Veterans Health Administration model for roles of nurse practitioners and physician assistants may be broadly useful to help meet the demand for primary care providers in the United States.


Asunto(s)
Diabetes Mellitus/terapia , Enfermeras Practicantes , Asistentes Médicos , Atención Primaria de Salud/organización & administración , Anciano , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos , Veteranos
12.
Am J Med ; 131(4): 443.e11-443.e24, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-28993187

RESUMEN

BACKGROUND: Many individuals with diabetes remain undiagnosed, leading to delays in treatment and higher risk for subsequent diabetes complications. Despite recommendations for diabetes screening in high-risk groups, the optimal approach is not known. We evaluated the utility of inpatient glucose levels as an opportunistic screening tool for identifying patients at high risk for diabetes. METHODS: We retrospectively examined 462,421 patients in the US Department of Veterans Affairs healthcare system, hospitalized on medical/surgical services in 2000-2010, for ≥3 days, with ≥2 inpatient random plasma glucose (RPG) measurements. All had continuity of care: ≥1 primary care visit and ≥1 glucose measurement within 2 years before hospitalization and yearly for ≥3 years after discharge. Glucose levels during hospitalization and incidence of diabetes within 3 years after discharge in patients without diabetes were evaluated. RESULTS: Patients had a mean age of 65.0 years, body mass index of 29.9 kg/m2, and were 96% male, 71% white, and 18% black. Pre-existing diabetes was present in 39.4%, 1.3% were diagnosed during hospitalization, 8.1% were diagnosed 5 years after discharge, and 51.3% were never diagnosed (NonDM). The NonDM group had the lowest mean hospital RPG value (112 mg/dL [6.2 mmol/L]). Having at least 2 RPG values >140 mg/dL (>7.8 mmol/L), the 95th percentile of NonDM hospital glucose, provided 81% specificity for identifying incident diabetes within 3 years after discharge. CONCLUSIONS: Screening for diabetes could be considered in patients with at least 2 hospital glucose values at/above the 95th percentile of the nondiabetic range (141 mg/dL [7.8 mmol/L]).


Asunto(s)
Glucemia/análisis , Diabetes Mellitus Tipo 2/sangre , Hospitales de Veteranos , Pacientes Internos , Tamizaje Masivo/métodos , Anciano , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Estados Unidos/epidemiología
13.
Circulation ; 137(3): 237-246, 2018 01 16.
Artículo en Inglés | MEDLINE | ID: mdl-29021321

RESUMEN

BACKGROUND: Higher levels of sodium and lower levels of potassium intake are associated with higher blood pressure. However, the shape and magnitude of these associations can vary by study participant characteristics or intake assessment method. Twenty-four-hour urinary excretion of sodium and potassium are unaffected by recall errors and represent all sources of intake, and were collected for the first time in a nationally representative US survey. Our objective was to assess the associations of blood pressure and hypertension with 24-hour urinary excretion of sodium and potassium among US adults. METHODS: Cross-sectional data were obtained from 766 participants age 20 to 69 years with complete blood pressure and 24-hour urine collections in the 2014 National Health and Nutrition Examination Survey, a nationally representative survey of the US noninstitutionalized population. Usual 24-hour urinary electrolyte excretion (sodium, potassium, and their ratio) was estimated from ≤2 collections on nonconsecutive days, adjusting for day-to-day variability in excretion. Outcomes included systolic and diastolic blood pressure from the average of 3 measures and hypertension status, based on average blood pressure ≥140/90 and antihypertensive medication use. RESULTS: After multivariable adjustment, each 1000-mg difference in usual 24-hour sodium excretion was directly associated with systolic (4.58 mm Hg; 95% confidence interval [CI], 2.64-6.51) and diastolic (2.25 mm Hg; 95% CI, 0.83-3.67) blood pressures. Each 1000-mg difference in potassium excretion was inversely associated with systolic blood pressure (-3.72 mm Hg; 95% CI, -6.01 to -1.42). Each 0.5 U difference in sodium-to-potassium ratio was directly associated with systolic blood pressure (1.72 mm Hg; 95% CI, 0.76-2.68). Hypertension was linearly associated with progressively higher sodium and lower potassium excretion; in comparison with the lowest quartile of excretion, the adjusted odds of hypertension for the highest quartile was 4.22 (95% CI, 1.36-13.15) for sodium, and 0.38 (95% CI, 0.17-0.87) for potassium (P<0.01 for trends). CONCLUSIONS: These cross-sectional results show a strong dose-response association between urinary sodium excretion and blood pressure, and an inverse association between urinary potassium excretion and blood pressure, in a nationally representative sample of US adults.


Asunto(s)
Presión Sanguínea , Hipertensión/fisiopatología , Hipertensión/orina , Natriuresis , Potasio/orina , Sodio/orina , Adulto , Anciano , Biomarcadores/orina , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Prevalencia , Pronóstico , Factores de Riesgo , Factores de Tiempo , Estados Unidos , Adulto Joven
14.
Am J Cardiol ; 120(11): 1966-1973, 2017 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-28964382

RESUMEN

The prevalence of atrial fibrillation (AF) is increasing in the United States as the population ages, but national surveillance is lacking. This cross-sectional study (2006 to 2014) analyzed data from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample, the National (Nationwide) Inpatient Sample, and the National Vital Statistics System. Event totals were estimated independently for emergency department (ED) visits, hospitalizations, and mortality, and then collectively after applying criteria to identify mutually exclusive events. Rates were calculated for AF as primary diagnosis or underlying cause of death (primary AF), as well as secondary diagnosis or contributing cause of death (co-morbid AF), and standardized by age to the 2010 US population. From 2006 to 2014, event rates increased for primary AF (249 to 268 per 100,000) and co-morbid AF (1,473 to 1,835 per 100,000). In 2014, an estimated 599,790 ED visits, 453,060 hospitalizations, and 21,712 deaths listed AF as primary. A total of 684,470 mutually exclusive primary AF and 4,695,997 mutually exclusive co-morbid AF events occurred. Among ED visits and hospitalizations with primary AF, the most common secondary diagnoses were hypertension, heart failure, ischemic heart disease, and diabetes. The mean cost per hospitalization with primary AF was $8,819. Mean costs were higher for those with co-morbid AF versus those without co-morbid AF among hospitalizations with a primary diagnosis of ischemic heart disease, heart failure, stroke, hypertension, or diabetes (all p ≤0.01). In conclusion, with the substantial health and economic impact of AF and an aging US population, improved diagnosis, prevention, management, and surveillance of AF are increasingly important.


Asunto(s)
Fibrilación Atrial/mortalidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Predicción , Costos de Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/economía , Fibrilación Atrial/terapia , Estudios Transversales , Servicio de Urgencia en Hospital/economía , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria/tendencias , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto Joven
15.
Prev Chronic Dis ; 14: E56, 2017 07 13.
Artículo en Inglés | MEDLINE | ID: mdl-28704176

RESUMEN

Chronic disease, which is linked to unhealthy nutrition environments, is highly prevalent in Guam. The nutrition environment was assessed in 114 stores and 63 restaurants in Guam. Stores had limited availability of some healthier foods such as lean ground meat (7.5%) and 100% whole-wheat bread (11.4%), while fruits (81.0%) and vegetables (94.8%) were more commonly available; 43.7% of restaurants offered a healthy entrée or main dish salad, 4.1% provided calorie information, and 15.7% denoted healthier choices on menus. Improving the nutrition environment could help customers make healthier choices.


Asunto(s)
Comercio , Abastecimiento de Alimentos , Promoción de la Salud , Restaurantes , Análisis de los Alimentos , Frutas , Guam , Humanos , Verduras
16.
J Diabetes Complications ; 31(9): 1430-1436, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28673663

RESUMEN

AIMS: Clinical trials show lifestyle change programs are beneficial, yet large-scale, successful translation of these programs is scarce. We investigated the association between participation in the largest U.S. lifestyle change program, MOVE!, and diabetes control outcomes. METHODS: This longitudinal, retrospective cohort study used Veterans Health Administration databases of patients with diabetes who participated in MOVE! between 2005 and 2012, or met eligibility criteria (BMI ≥25kg/m2) but did not participate. Main outcomes were diabetic eye disease, renal disease, and medication intensification. RESULTS: There were 400,170 eligible patients with diabetes, including 87,366 (22%) MOVE! PARTICIPANTS: Included patients were 96% male, 77% white, with mean age 58years and BMI 34kg/m2. Controlling for baseline measurements and age, race, sex, BMI, and antidiabetes medications, MOVE! participants had lower body weight (-0.6kg), random plasma glucose (-2.8mg/dL), and HbA1c (-0.1%) at 12months compared to nonparticipants (each p<0.001). In multivariable Cox models, MOVE! participants had lower incidence of eye disease (hazard ratio 0.80, 95% CI 0.75-0.84) and renal disease (HR 0.89, 95% CI 0.86-0.92) and reduced medication intensification (HR 0.82, 95% CI 0.80-0.84). CONCLUSIONS: If able to overcome participation challenges, lifestyle change programs in U.S. health systems may improve health among the growing patient population with diabetes.


Asunto(s)
Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Participación del Paciente/estadística & datos numéricos , Conducta de Reducción del Riesgo , Veteranos/estadística & datos numéricos , Programas de Reducción de Peso , Anciano , Índice de Masa Corporal , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus/sangre , Femenino , Humanos , Incidencia , Estilo de Vida , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Servicios Preventivos de Salud/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Salud de los Veteranos , Programas de Reducción de Peso/estadística & datos numéricos
17.
Prev Med ; 100: 229-234, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28450122

RESUMEN

Weight-related behaviors such as sedentary activity, physical activity, and diet have been the focus of efforts to prevent and reduce the occurrence of obesity and overweight in children, but few longitudinal studies have examined the effects of weight-related behaviors on changes in weight status over time in children. This study examines the effects of weight-related behaviors on subsequent changes in weight during childhood. We used the Early Childhood Longitudinal Study Kindergarten Cohort (ECLS-K), a nationally representative prospective cohort of children in the United States. Data, including anthropometric measures, were collected six times across 1998-2007 (analytic sample=4938). We employed an autoregressive cross-lagged model in a structural equation model framework to assess the effects of behavioral factors -intake of fruit, vegetables, fast food and sugar-sweetened beverages, television viewing, and physical activity - on weight stability over time. BMI z-scores were highly stable throughout childhood: the standardized parameter estimates of BMI z-scores on subsequent-period BMI z-scores ranged from 0.79 to 0.86. BMI z-scores were least stable between Kindergarten and 1st grade but became highly stable between 3rd and 5th grades. After accounting for prior weight, behavioral factors had little effect on subsequent weight. The most important behavioral factor was TV viewing in the 1st and 3rd grades: an additional hour of daily TV viewing was associated with 0.04 higher BMI z-score. It is important to prevent excessive weight gain early in childhood, as weight patterns are long-lasting; the most important behavioral factor may be limiting children's screen time.


Asunto(s)
Peso Corporal/fisiología , Dieta/estadística & datos numéricos , Ejercicio , Obesidad/prevención & control , Televisión/estadística & datos numéricos , Niño , Preescolar , Femenino , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Masculino , Estados Unidos
18.
Am J Prev Med ; 52(4): 459-468, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27939239

RESUMEN

INTRODUCTION: Lifestyle change programs implemented within healthcare systems could reach many Americans, but their impact on cardiovascular disease (CVD) remains unclear. The MOVE! program is the largest lifestyle change program implemented in a healthcare setting in the U.S. This study aimed to determine whether MOVE! participation was associated with reduced CVD incidence. METHODS: This retrospective cohort study, analyzed in 2013-2015, used national Veterans Health Administration databases to identify MOVE! participants and eligible non-participants for comparison (2005-2012). Patients eligible for MOVE!-obese or overweight with a weight-related health condition, and no baseline CVD-were examined (N=1,463,003). Of these, 169,248 (12%) were MOVE! PARTICIPANTS: Patients were 92% male, 76% white, with mean age 52 years and BMI of 32. The main outcome was incidence of CVD (ICD-9 and procedure codes for coronary artery disease, cerebrovascular disease, peripheral vascular disease, and heart failure). RESULTS: Adjusting for age, race, sex, BMI, statin use, and baseline comorbidities, over a mean 4.9 years of follow-up, MOVE! participation was associated with lower incidence of total CVD (hazard ratio [HR]=0.83, 95% CI=0.80, 0.86); coronary artery disease (HR=0.81, 95% CI=0.77, 0.86); cerebrovascular disease (HR=0.87, 95% CI=0.82, 0.92); peripheral vascular disease (HR=0.89, 95% CI=0.83, 0.94); and heart failure (HR=0.78, 95% CI=0.74, 0.83). The association between MOVE! participation and CVD incidence remained significant when examined across categories of race/ethnicity, BMI, diabetes, hypertension, smoking status, and statin use. CONCLUSIONS: Although participation was limited, MOVE! was associated with reduced CVD incidence in a nationwide healthcare setting.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Estilo de Vida , Programas de Reducción de Peso/estadística & datos numéricos , Adulto , Enfermedades Cardiovasculares/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Salud de los Veteranos
19.
MMWR Morb Mortal Wkly Rep ; 65(20): 510-3, 2016 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-27227418

RESUMEN

Compared with the United States overall, Guam has higher mortality rates from cardiovascular disease and stroke (1). Excess sodium intake can increase blood pressure and risk for cardiovascular disease (2,3). To determine the availability and promotion of lower-sodium options in the nutrition environment, the Guam Department of Public Health and Social Services (DPHSS) conducted an assessment in September 2015 using previously validated tools adapted to include sodium measures. Stores (N = 114) and restaurants (N = 63) were randomly sampled by region (north, central, and south). Data from 100 stores and 62 restaurants were analyzed and weighted to account for the sampling design. Across the nine product types assessed, lower-sodium products were offered less frequently than regular-sodium products (p<0.001) with <50% of stores offering lower-sodium canned vegetables, tuna, salad dressing, soy sauce, and hot dogs. Lower-sodium products were also less frequently offered in small stores than large (two or more cash registers) stores. Reduced-sodium soy sauce cost more than regular soy sauce (p<0.001) in stores offering both options in the same size bottle. Few restaurants engaged in promotion practices such as posting sodium information (3%) or identifying lower-sodium entrées (1%). Improving the availability and promotion of lower-sodium foods in stores and restaurants could help support healthier eating in Guam.


Asunto(s)
Comercio , Análisis de los Alimentos/estadística & datos numéricos , Restaurantes , Sodio en la Dieta/análisis , Guam , Humanos
20.
MMWR Morb Mortal Wkly Rep ; 64(52): 1393-7, 2016 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-26741238

RESUMEN

Hypertension, a major risk factor for cardiovascular diseases, occurs among 29% of U.S. adults, and lowering excess sodium intake can reduce blood pressure (1-3). The 2015-2020 Dietary Guidelines for Americans recommend consuming less than 2,300 mg dietary sodium per day for persons aged ≥14 years and less for persons aged 2-13 years.* To examine the current prevalence of excess sodium intake among Americans overall, and among hypertensive adults, CDC analyzed data from 14,728 participants aged ≥2 years in the 2009-2012 National Health and Nutrition Examination Survey (NHANES). Eighty-nine percent of adults and over 90% of children exceeded recommendations for sodium intake. Among hypertensive adults, 86% exceeded 2,300 mg dietary sodium per day. To address the high prevalence of excess sodium consumption in the U.S. population, the Institute of Medicine (IOM) recommended reducing sodium in the food supply, as excess sodium added to foods during commercial processing and preparation represents the main source of sodium intake in U.S. diets (4).


Asunto(s)
Sodio en la Dieta/administración & dosificación , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Política Nutricional , Encuestas Nutricionales , Estados Unidos , Adulto Joven
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