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1.
Med Care ; 57(10): 773-780, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31415338

RESUMO

INTRODUCTION: Colorectal cancer (CRC) is a common but largely preventable malignancy. Screening is recommended for all adults aged 50-75 years; however, screening rates are low nationally and vary by patient factors and across health care systems. It is currently unknown whether there are inequities in CRC screening rates by patient sociodemographic and/or clinical factors in the Veterans Health Administration (VA) where the majority of patients are CRC screening-eligible age and CRC is the third most commonly diagnosed cancer. METHODS: We performed a retrospective cohort study using VA national clinical performance and quality data to determine the overall CRC screening rate, rates by patient sociodemographic and clinical factors, and predictors of screening adjusting for patient and system factors. We also determined whether disparities in screening exist in VA. RESULTS: The overall CRC screening rate in VA was 81.5%. Screening rates were lowest among American Indians/Alaska Natives [75.3%; adjusted odds ratio (aOR)=0.77, 95% confidence interval (CI)=0.65-0.90], those with serious mental illness (75.8%; aOR=0.65, 95% CI=0.61-0.69), those with substance abuse (76.9%; aOR=0.76, 95% CI=0.72-0.80), and those in the lowest socioeconomic status quintile (79.5%; aOR=1.10-1.31 for quintiles 2-5 vs. lowest quintile 1). Increasing age, Hispanic ethnicity, black race, Asian race, and high comorbidity were significant predictors of screening uptake. CONCLUSIONS: Many racial/ethnic disparities in CRC screening documented in non-VA settings do not exist in VA. Nonetheless, overall high VA CRC screening rates have not reached American Indians/Alaska Natives, low socioeconomic status groups, and those with mental illness and substance abuse. These groups might benefit from additional targeted efforts to increase screening uptake.


Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde dos Veteranos/estatística & dados numéricos , Idoso , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/psicologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Saúde Mental/etnologia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pobreza/etnologia , Pobreza/estatística & dados numéricos , Estudos Retrospectivos , Fatores Socioeconômicos , Estados Unidos , United States Department of Veterans Affairs , Saúde dos Veteranos/etnologia
2.
Cardiovasc Revasc Med ; 19(6S): 31-35, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29980377

RESUMO

BACKGROUND: Contrast-induced nephropathy (CIN) is a complication of diagnostic angiography and percutaneous coronary and endovascular intervention. We investigated the effect of race on the development of CIN. METHODS: We studied 4070 predominantly male patients undergoing peripheral and coronary angiography and percutaneous coronary and endovascular intervention. We analyzed the incidence of CIN at 72 h, of renal dysfunction at 3 months as well as the long-term incidence of hemodialysis and of death. RESULTS: The mean age was 67.2 years. CIN occurred in 92 (7.1%) Caucasian patients and in 42 (6.6%) non-Caucasians at 72 h after the procedure (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.74-1.57; P = 0.69). At 3 months, renal dysfunction was seen in 231 (11.24%) Caucasian patients versus 121 (11.52%) of the non-Caucasian group (OR 0.97, CI 0.77-1.23; P = 0.81). After a follow-up of 5 years, of the 4070 patients, 17 patients (0.64%) of the Caucasian group were placed on dialysis versus 27 (1.88%) of the non-Caucasian group (OR 0.34, 0.18-0.62; P = 0.0004) and 535 (20.28%) of the Caucasian patients had died compared to 293 (20.44%) of the non-Caucasian group (OR = 0.99, 95% CI 0.85-1.17; P = 0.94). CONCLUSIONS: In this cohort of patients, race was not associated with the development of CIN at 72 h, or the development of renal dysfunction at 3 months post angiography or intervention. In the long-term, the rate of initiation of dialysis was significantly lower in the Caucasian patients but mortality was not.


Assuntos
Angiografia/efeitos adversos , Meios de Contraste/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Grupo com Ancestrais do Continente Europeu , Nefropatias/induzido quimicamente , Nefropatias/etnologia , Intervenção Coronária Percutânea/efeitos adversos , Afro-Americanos , Idoso , Angiografia Coronária/efeitos adversos , Feminino , Hispano-Americanos , Humanos , Nefropatias/mortalidade , Nefropatias/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Saúde dos Veteranos/etnologia , Virginia/epidemiologia
3.
J Am Heart Assoc ; 7(2)2018 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-29330260

RESUMO

BACKGROUND: Black race has been shown to be a risk factor for amputation in peripheral artery disease (PAD); however, race has been argued to be a marker for socioeconomic status (SES) rather than true disparity. The aim of this study is to study the impact of race and SES on amputation risk in PAD patients. METHODS AND RESULTS: Patients with incident PAD in the national Veterans Affairs Corporate Data Warehouse were identified from 2003 to 2014 (N=155 647). The exposures were race and SES (measured by median income in residential ZIP codes). The outcome was incident major amputation. Black veterans were significantly more likely to live in low-SES neighborhoods and to present with advanced PAD. Black patients had a higher amputation risk in each SES stratum compared with white patients. In Cox models (adjusting for covariates), black race was associated with a 37% higher amputation risk compared with white race (hazard ratio: 1.37; 95% confidence interval, 1.30-1.45), whereas low SES was independently predictive of increased risk of amputation (hazard ratio: 1.12; 95% confidence interval, 1.06-1.17) and showed no evidence of interaction with race. In predicted amputation risk analysis, black race and low SES continued to be significant risk factors for amputation regardless of PAD presentation. CONCLUSIONS: Black race significantly increases the risk of amputation within the same SES stratum compared with white race and has an independent effect on limb loss after controlling for comorbidities, severity of PAD at presentation, and use of medications.


Assuntos
Afro-Americanos , Amputação , Grupo com Ancestrais do Continente Europeu , Disparidades em Assistência à Saúde , Renda , Doença Arterial Periférica/cirurgia , Classe Social , Saúde dos Veteranos , Idoso , Amputação/economia , Comorbidade , Data Warehousing , Diabetes Mellitus/economia , Diabetes Mellitus/etnologia , Feminino , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/etnologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/economia , Doença Arterial Periférica/etnologia , Prevalência , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/etnologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Saúde dos Veteranos/economia , Saúde dos Veteranos/etnologia
4.
Womens Health Issues ; 27(6): 700-706, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28890128

RESUMO

BACKGROUND: Women veterans are at increased risk for cardiovascular disease (CVD), but little is known about comorbidities and healthcare preferences associated with CVD risk in this population. METHODS: We describe the prevalence of CVD-relevant health behaviors, mental health symptoms, and health care use characteristics and preferences among participants of the National Survey of Women Veterans (conducted 2008-2009). FINDINGS: Fifty-four percent of respondents were at risk for CVD (defined as a diagnosis of hypertension, diabetes, current tobacco use, or obesity without CVD). In unadjusted analysis, ORs for being at risk for CVD were greater among those interested in gender-specific clinical settings (OR, 2.0; 95% CI, 1.2-3.4) and gender-specific weight loss programs (OR, 1.8; 95% CI, 1.1-2.9). ORs were also greater for women who were physically inactive (OR, 1.9; 95% CI, 1.1-3.3), with current symptoms of depression (OR, 2.5; 95% CI, 1.1-6.1), anxiety (OR, 2.1; 95% CI, 1.2-3.6), and posttraumatic stress disorder (OR, 2.4; 95% CI, 1.2-4.8). Adjusting for age, race/ethnicity, marital status, education level, employment, and source of health care use, the ORs for CVD risk were higher for women with current posttraumatic stress disorder symptoms (2.5; 95% CI, 1.1-5.3) and gender-specific health care preferences (2.0; 95% CI, 1.1-3.4), and gender-specific weight loss programs (1.9; 95% CI, 1.1-3.2). CONCLUSIONS: Risk for CVD was common and preferences for gender-specific care and posttraumatic stress disorder were associated with being at risk for CVD. Women's health clinics may be a good location for targeted CVD prevention interventions for women veterans both in and outside the Veterans Health Administration.


Assuntos
Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Saúde dos Veteranos/etnologia , Veteranos/psicologia , Saúde da Mulher/etnologia , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Comportamento de Escolha , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia
5.
Drug Alcohol Depend ; 178: 527-533, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28728114

RESUMO

OBJECTIVE: Pharmacologic treatment is recommended for alcohol use disorders (AUD), but most patients do not receive it. Although racial/ethnic minorities have greater AUD consequences than whites, whether AUD medication receipt varies across race/ethnicity is unknown. We evaluate this in a national sample. METHODS: Electronic health records data were extracted for all black, Hispanic, and/or white patients who received care at the U.S. Veterans Health Administration (VA) during Fiscal Year 2012 and had a documented AUD diagnosis. Mixed effects regression models, with a random effect for facility, determined the likelihood of receiving AUD pharmacotherapy (acamprosate, disulfiram, topirimate or oral or injectable naltrexone ≤180days after AUD diagnosis) for black and Hispanic patients relative to white patients. Models were unadjusted and then adjusted for patient- and facility-level factors. RESULTS: 297,506 patients had AUD; 26.4% were black patients, 7.1% were Hispanic patients and 66.5% were white patients; 5.1% received AUD medications. Before adjustment, black patients were less likely than white [Odds Ratio (OR) 0.77; 95% Confidence Interval (CI) 0.75 -0.82; (p<0.001)], while Hispanic patients were more likely than white (OR 1.09; 95% CI 1.01-1.16) to receive AUD medications. After adjustment, black patients remained less likely than white to receive AUD medications (OR 0.68; 95% CI 0.65-0.71; p<0.0001); no difference between Hispanic and white patients was observed (OR 0.94; 95% CI 0.87-1.00; p=0.07). CONCLUSIONS: In this national study of patients with AUD, blacks were less likely to receive AUD medications than whites. Future research is needed to identify why these disparities exist.


Assuntos
Afro-Americanos/etnologia , Alcoolismo/etnologia , Grupos Étnicos/estatística & dados numéricos , Saúde dos Veteranos/etnologia , Grupos de Populações Continentais , Grupo com Ancestrais do Continente Europeu , Hispano-Americanos , Humanos , Grupos Minoritários , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos
6.
J Gen Intern Med ; 32(Suppl 1): 11-17, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28271422

RESUMO

BACKGROUND: Most US adults are overweight or obese. Understanding differences in obesity prevalence across subpopulations could facilitate the development and dissemination of weight management services. OBJECTIVES: To inform Veterans Health Administration (VHA) weight management initiatives, we describe obesity prevalence among subpopulations of VHA patients. DESIGN: Cross-sectional descriptive analyses of fiscal year 2014 (FY2014) national VHA administrative and clinical data, stratified by gender. Differences ≥5% higher than the population mean were considered clinically significant. PARTICIPANTS: Veteran VHA primary care patients with a valid weight within ±365 days of their first FY2014 primary care visit, and a valid height (98% of primary care patients). MAIN MEASURES: We used VHA vital signs data to ascertain height and weight and calculate body mass index, and VHA outpatient, inpatient, and fee basis data to identify sociodemographic- and comorbidity-based subpopulations. KEY RESULTS: Among nearly five million primary care patients (347,112 women, 4,567,096 men), obesity prevalence was 41% (women 44%, men 41%), and overweight prevalence was 37% (women 31%, men 38%). Across the VHA's 140 facilities, obesity prevalence ranged from 28% to 49%. Among gender-stratified subpopulations, obesity prevalence was high among veterans under age 65 (age 18-44: women 40%, men 46%; age 45-64: women 49%, men 48%). Obesity prevalence varied across racial/ethnic and comorbidity subpopulations, with high obesity prevalence among black women (51%), women with schizophrenia (56%), and women and men with diabetes (68%, 56%). CONCLUSIONS: Overweight and obesity are common among veterans served by the VHA. VHA's weight management initiatives have the potential to avert long-term morbidity arising from obesity-related conditions. High-risk groups-such as black women veterans, women veterans with schizophrenia, younger veterans, and Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native veterans-may require particular attention to ensure that systems improvement efforts at the population level do not inadvertently increase health disparities.


Assuntos
Obesidade/epidemiologia , Saúde dos Veteranos/estatística & dados numéricos , Adulto , Afro-Americanos/estatística & dados numéricos , Distribuição por Idade , Idoso , Índice de Massa Corporal , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Sobrepeso/epidemiologia , Sobrepeso/fisiopatologia , Prevalência , Distribuição por Sexo , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos , Saúde dos Veteranos/etnologia , Adulto Jovem
7.
J Natl Med Assoc ; 109(1): 49-54, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28259216

RESUMO

PURPOSE: Several studies suggest that a baseline prostate specific antigen (PSA) measured in young men predicts future risk of prostate cancer. Considering recent recommendations against PSA screening, high-risk populations (e.g. black men, men with a high baseline PSA) may be particularly vulnerable in the coming years. Thus, we investigated the relationship between baseline PSA and future prostate cancer in a black majority-minority urban population. MATERIALS AND METHODS: A retrospective analysis was performed of the prostate biopsy database (n = 994) at the Brooklyn Veterans Affairs Hospital. These men were referred to urology clinic for elevated PSA and biopsied between 2007 and 2014. Multivariate logistic regression was used to predict positive prostate biopsy from log-transformed baseline PSA, race (black, white, or other), and several other variables. RESULTS: The majority of men identified as black (50.2%). Median age at time of baseline PSA and biopsy was 58.6 and 64.8, respectively. Median baseline PSA was similar among black men and white men (2.70 vs 2.91 for black men vs white men, p = 0.232). Even so, black men were more likely than white men to be diagnosed with prostate cancer (OR 1.62, p < 0.0001). Black men less than age 70 were at particularly greater risk than their white counterparts. Baseline PSA was not a statistically significant predictor of future prostate cancer (p = 0.101). CONCLUSIONS: Black men were more likely to be diagnosed with prostate cancer than were white men, despite comparable baseline PSA. In our pre-screened population at the urology clinic, a retrospective examination of baseline PSA did not predict future prostate cancer.


Assuntos
Biópsia , Antígeno Prostático Específico/análise , Neoplasias da Próstata , Afro-Americanos/estatística & dados numéricos , Idoso , Biópsia/métodos , Biópsia/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/etnologia , Estados Unidos/epidemiologia , Saúde dos Veteranos/etnologia , Saúde dos Veteranos/estatística & dados numéricos
8.
Dig Dis Sci ; 62(3): 607-614, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28012103

RESUMO

BACKGROUND: Identifying patient-level and disease-specific predictors of healthcare utilization in inflammatory bowel disease (IBD) may allow targeted interventions to reduce costs and improve outcomes. AIM: To identify demographic and clinical predictors of healthcare utilization among veterans with IBD. METHODS: We conducted a single-center cross-sectional study of veterans with IBD from 1998 to 2010. Demographics and disease characteristics were abstracted by manual chart review. Annual number of IBD-related visits was estimated by dividing total number of IBD-related inpatient and outpatient encounters by duration of IBD care. Associations between predictors of utilization were determined using stepwise multivariable linear regression. RESULTS: Overall, 676 patients (56% ulcerative colitis (UC), 42% Crohn's disease (CD), and 2% IBD unclassified (IBDU)) had mean 3.08 IBD-related encounters annually. CD patients had 3.59 encounters compared to 2.73 in UC (p < 0.01). In the multivariable model, Hispanics had less visits compared to Caucasians and African-Americans (2.09 vs. 3.09 vs. 3.42), current smokers had more visits than never smokers (3.54 vs. 2.43, p = 0.05), and first IBD visit at age <40 had more visits than age >65 (3.84 vs. 1.75, p = 0.04). UC pancolitis was associated with more visits than proctitis (3.47 vs. 2.15, p = 0.04). CD penetrating phenotype was associated with more encounters than inflammatory type (4.68 vs. 4.15, p = 0.04). CONCLUSIONS: We found that current tobacco use, age <40 at first IBD visit, UC pancolitis, and CD fistuilizing phenotype in addition to Caucasian and African-American race were independent predictors of increased healthcare utilization. Interventions should be targeted at these groups to decrease healthcare utilization and costs.


Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Afro-Americanos , Idade de Início , Idoso , Colite Ulcerativa/economia , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/terapia , Custos e Análise de Custo , Doença de Crohn/economia , Doença de Crohn/epidemiologia , Doença de Crohn/terapia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Doenças Inflamatórias Intestinais/economia , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/epidemiologia , Estados Unidos/epidemiologia , Saúde dos Veteranos/economia , Saúde dos Veteranos/etnologia , Saúde dos Veteranos/estatística & dados numéricos
9.
J Subst Abuse Treat ; 73: 27-34, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28017181

RESUMO

OBJECTIVE: Specialty addictions treatment can improve outcomes for patients with alcohol use disorders (AUD). Thus, initiation of and engagement with specialty addictions treatment are considered quality care for patients with AUD. Previous studies have demonstrated racial/ethnic differences in alcohol-related care but whether differences exist in initiation of and engagement with specialty addictions treatment among patients with clinically recognized alcohol use disorders is unknown. We investigated racial/ethnic variation in initiation of and engagement with specialty addictions treatment in a national sample of Black, Hispanic, and White patients with clinically recognized alcohol use disorders (AUD) from the US Veterans Health Administration (VA). METHODS: National VA data were extracted for all Black, Hispanic, and White patients with a diagnosed AUD during fiscal year 2012. Mixed effects regression models estimated the odds of two measures of initiation (an initial visit within 180days of diagnosis; and initiation defined consistent with Healthcare Effectiveness Data and Information Set (HEDIS) as a documented visit ≤14days after index visit or inpatient admission), and three established measures of treatment engagement (≥3 visits within first month after initiation; ≥2 visits in each of the first 3months after initiation; and ≥2 visits within 30days of HEDIS initiation) for Black and Hispanic relative to White patients after adjustment for facility- and patient-level characteristics. RESULTS: Among 302,406 patients with AUD, 30% (90,879) initiated treatment within 180days of diagnosis (38% Black, 32% Hispanic, and 27% White). Black patients were more likely to initiate treatment than Whites for both measures of initiation [odds ratio (OR) for initiation: 1.4, 95% confidence interval (CI) 1.4-1.4; OR for HEDIS initiation: 1.1, 95% CI: 1.1-1.1]. Hispanic patients were more likely than White patients to initiate treatment within 180days (OR: 1.2, 95% CI 1.2-1.3) but HEDIS initiation did not differ between Hispanic and White patients. Engagement results varied depending on the measure but was more likely for Black patients relative to White for all measures (OR for engagement in first month: 1.1, 95% CI: 1.0-1.1; OR for engagement in first three months: 1.2, 95% CI: 1.1-1.2; OR for HEDIS measure: 1.1, 95% CI: 1.0-1.1), and did not differ between Hispanic and White patients. CONCLUSIONS: After accounting for facility- and patient-level characteristics, Black and Hispanic patients with AUD were more likely than Whites to initiate specialty addictions treatment, and Black patients were more likely than Whites to engage. Research is needed to understand underlying mechanisms and whether differences in initiation of and engagement with care influence health outcomes.


Assuntos
Afro-Americanos/etnologia , Transtornos Relacionados ao Uso de Álcool/etnologia , Transtornos Relacionados ao Uso de Álcool/terapia , Grupo com Ancestrais do Continente Europeu/etnologia , Hispano-Americanos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Saúde dos Veteranos/etnologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/etnologia , United States Department of Veterans Affairs/estatística & dados numéricos , Adulto Jovem
10.
Transplantation ; 101(6): 1191-1199, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27482965

RESUMO

BACKGROUND: Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. METHODS: We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. RESULTS: There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66-0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. CONCLUSIONS: Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.


Assuntos
Tomada de Decisão Clínica , Grupos Étnicos , Disparidades em Assistência à Saúde/etnologia , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Grupos Minoritários , Seleção de Pacientes , United States Department of Veterans Affairs , Saúde dos Veteranos/etnologia , Idoso , Distribuição de Qui-Quadrado , Características Culturais , Emoções , Grupos Étnicos/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Entrevistas como Assunto , Estimativa de Kaplan-Meier , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etnologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Educação de Pacientes como Assunto , Avaliação de Processos em Cuidados de Saúde , Modelos de Riscos Proporcionais , Fatores de Risco , Estados Unidos , Listas de Espera
11.
Int Urol Nephrol ; 48(12): 2015-2021, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27580731

RESUMO

PURPOSE: Racial differences in the incidence of prostate cancer on initial biopsy are well established, but the predictive value of African American race on the probability of prostate cancer detection on repeat biopsy is unknown. MATERIALS AND METHODS: At a single institution between January 2007 and June 2014, we reviewed 277 men who first underwent a negative transrectal ultrasound guided needle biopsy of the prostate, and who then subsequently underwent a second biopsy. Detection rates were compared via Chi-square analysis. Race, age, PSA, presence of high-grade prostatic intraepithelial neoplasia, presence of atypical small acinar proliferation, prostate volume, PSA velocity and PSA density were compared via a multivariate logistic regression analysis. RESULTS: 496 AA men and 352 Caucasian men underwent initial biopsy, and AA men had a 49 % cancer detection rate, compared to 34 % in Caucasians (p < 0.0001). AA men also had a greater incidence of Gleason 7 cancers (p = 0.00018) and a smaller mean TRUS volume (p = 0.006) compared to Caucasians. On repeat biopsy, AA men no longer had a higher cancer detection rate (p = 0.227), nor difference in Gleason 7 detection or TRUS volume (p = 0.0992). On initial biopsy, AA race and increasing PSA were both associated with an increased likelihood for cancer detection (p < 0.001 for both). After an initial negative biopsy, AA race no longer predicted for future malignancy detection (p = 0.57), nor did PSA (p = 0.36). CONCLUSIONS: In a cohort of men with high pre-test probability of prostate cancer and an initial negative biopsy, African American race in a veteran population fails to predict the detection of future prostate cancer.


Assuntos
Próstata/patologia , Neoplasia Prostática Intraepitelial , Neoplasias da Próstata , Afro-Americanos/estatística & dados numéricos , Idoso , Biópsia por Agulha/métodos , Biópsia por Agulha/estatística & dados numéricos , Humanos , Biópsia Guiada por Imagem/métodos , Incidência , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Tamanho do Órgão , Antígeno Prostático Específico/análise , Neoplasia Prostática Intraepitelial/diagnóstico , Neoplasia Prostática Intraepitelial/etnologia , Neoplasia Prostática Intraepitelial/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Ultrassonografia/métodos , Estados Unidos/epidemiologia , Saúde dos Veteranos/etnologia , Saúde dos Veteranos/estatística & dados numéricos
12.
Geriatr Gerontol Int ; 16(8): 920-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26338088

RESUMO

AIM: To examine self-rated health (SRH) and its association with social participation, along with physical and mental health indicators, among USA male veterans and non-veterans aged ≥65 years. METHODS: The two waves of the National Health and Aging Trend Study provided data (n = 2845 at wave 1; n = 2235 at wave 2). Multilevel mixed effects generalized linear models were fit to test the hypotheses. RESULTS: Despite their older age, veterans did not differ from non-veterans in their physical, mental and cognitive health, and they had better SRH. However, black and Hispanic veterans had lower SRH than non-Hispanic white veterans. Formal group activities and outings for enjoyment were positively associated with better SRH for veterans, non-veterans and all veteran cohorts. CONCLUSIONS: Aging veterans, especially black and Hispanic veterans, require programs and services that will help increase their social connectedness. Geriatr Gerontol Int 2016; 16: 920-927.


Assuntos
Autorrelato , Participação Social/psicologia , Saúde dos Veteranos/etnologia , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Estudos Transversais , Inquéritos Epidemiológicos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Saúde Mental , Determinação de Necessidades de Cuidados de Saúde , Qualidade de Vida , Estados Unidos , Veteranos/psicologia , Veteranos/estatística & dados numéricos
13.
World J Gastroenterol ; 21(19): 6001-7, 2015 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-26019466

RESUMO

AIM: To evaluate the association between patient disease knowledge of inflammatory bowel disease (IBD) and health related quality of life (HRQoL) and identify patient and disease related predictors of patient knowledge of IBD. METHODS: We performed a cross-sectional study of IBD patients with an established diagnosis of IBD longer than 3 mo prior to enrollment. The Crohn's and colitis knowledge score (CCKNOW) and short inflammatory bowel disease questionnaire (SIBDQ) were self-administered to assess patient knowledge of IBD and HRQoL, respectively. Demographic and disease characteristics were abstracted from the electronic medical record. The correlation between CCKNOW and SIBDQ scores was assessed by a linear regression model. Associations of patient knowledge and the variables of interest were calculated using ANOVA. RESULTS: A total of 101 patients were recruited. Caucasian race, younger age at diagnosis, and having a college or post-graduate degree were significantly associated with higher CCKNOW scores. Patients with CD had higher CCKNOW scores compared to patients with ulcerative colitis and inflammatory bowel disease type unclassified, P < 0.01. There was no significant correlation between overall CCKNOW and SIBDQ scores (r (2) = 0.34, P = 0.13). The knowledge sub-domain of diet in CCKNOW was negatively correlated with HRQoL (r (2) = 0.69, P < 0.01). CONCLUSION: IBD diagnosis at a younger age in addition to Caucasian race and higher education were significantly associated with higher knowledge about IBD. However, patient knowledge of IBD was not correlated with HRQoL. Further studies are required to study the effect of patient knowledge of IBD on other clinical outcomes.


Assuntos
Colite Ulcerativa/psicologia , Doença de Crohn/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Qualidade de Vida , Saúde dos Veteranos , Veteranos/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/etnologia , Doença de Crohn/diagnóstico , Doença de Crohn/etnologia , Estudos Transversais , Escolaridade , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Saúde dos Veteranos/etnologia , Adulto Jovem
14.
Int J Epidemiol ; 44(3): 819-25, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25183748

RESUMO

The National Academy of Sciences-National Research Council Twin Registry (NAS-NRC Twin Registry) is a comprehensive registry of White male twin pairs born in the USA between 1917 and 1927, both of the twins having served in the military. The purpose was medical research and ultimately improved clinical care. The cohort was assembled in the early 1960s with identification of approximately 16,000 twin pairs, review of service records, a brief mailed questionnaire assessing zygosity, and a health survey largely comparable to questionnaires used at that time with Scandinavian twin registries. Subsequent large-scale data collection occurred in 1974, 1985 and 1998, repeating the health survey and including information on education, employment history and earnings. Self-reported data have been supplemented with mortality, disability and medical data through record linkage. Potential collaborators should access the study website [http://www.iom.edu/Activities/Veterans/TwinsStudy.aspx] or e-mail the Medical Follow-up Agency at [Twins@nas.edu]. Questionnaire data are being prepared for future archiving with the National Archive of Computerized Data on Aging (NACDA) at the Inter-University Consortium for Political and Social Research (ICPSR), University of Michigan, MI.


Assuntos
Estudos de Coortes , Interação Gene-Ambiente , Estudos em Gêmeos como Assunto , Gêmeos/genética , Saúde dos Veteranos/etnologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças em Gêmeos/epidemiologia , Grupo com Ancestrais do Continente Europeu , Humanos , Masculino , Pessoa de Meia-Idade , National Academy of Sciences, U.S. , Sistema de Registros , Inquéritos e Questionários , Estados Unidos , II Guerra Mundial , Adulto Jovem
15.
J Natl Med Assoc ; 103(6): 492-7, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21830632

RESUMO

African Americans have lower vitamin D levels and reduced health outcomes compared to white Americans. Vitamin D deficiency may contribute to adverse health outcomes in African Americans. We hypothesized that race would be associated with vitamin D status and testing in African Americans veterans, and that vitamin D status is a major contributor to health care costs in African American veterans compared to white veterans. A retrospective analysis of the medical data in the Veterans Integrated Service Network 9 (southeastern United States) was performed, and 14148 male veterans were identified. Race was designated by the patient and its relationship to vitamin D levels/status and costs was assessed. Vitamin D levels were significantly lower and the percent of patients with vitamin D deficiency was significantly higher in African American veterans. This difference was independent of latitude and seasonality. Vitamin D testing was done significantly more in white veterans compared to African American veterans (5.4% vs 3.8%). While follow-up testing was 42% more likely if a patient was found to be vitamin D deficient, white veterans were 34% more likely than African American veterans to have at least 1 follow-up 25-hydroxyvitamin D performed. African American veterans had significantly higher health care costs, which were linked to lower vitamin D levels; however, the cost differential persisted even after adjusting for vitamin D status. Vitamin D deficiency is highly prevalent in African American veterans and needs improved management within the Veteran Administration system. Vitamin D status appears not to be the sole contributor to increased health care costs in African American veterans.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Administração dos Cuidados ao Paciente/normas , Saúde dos Veteranos/etnologia , Deficiência de Vitamina D , Afro-Americanos , Idoso , Calcifediol/sangue , Grupo com Ancestrais do Continente Europeu , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Estudos Retrospectivos , Sudeste dos Estados Unidos , Estados Unidos , United States Department of Veterans Affairs/normas , Veteranos , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/economia , Deficiência de Vitamina D/etnologia
16.
J Community Health ; 35(5): 519-26, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20143139

RESUMO

There is a growing diabetes epidemic in the United States and if we are to halt its progress we need to better understand the social determinants of this disease and its control. Social capital, which has been associated with general health and mortality, may be one important mediator of glucose control. In this study we determine if neighborhood social capital is associated with glucose control, independent of individual factors. We performed a cross-sectional study of Black veterans with diabetes living in Philadelphia. We merged individual-level data from surveys and charts with six area-level social capital descriptors. Holding all other variables constant, patients who lived in neighborhoods that scored near the 5th percentile of working together to improve the neighborhood were estimated to have glycosylated hemoglobin (HbA1c) values that were at least one point above a conservative clinical definition of "diabetes control" (HbA1c ≤ 8%). If these same patients were to live in neighborhoods in the 95th percentile, their expected HbA1c would be over ½ a point below the cut-off value 8%. No other measure of social capital was associated with HbA1c. In this study of black veterans with diabetes we observed that living in neighborhoods where people work together is associated with better glucose control.


Assuntos
Afro-Americanos/estatística & dados numéricos , Diabetes Mellitus/etnologia , Hemoglobina A Glicada/análise , Características de Residência , Apoio Social , Saúde dos Veteranos/etnologia , Glicemia/análise , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/prevenção & controle , Epidemias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Fatores Socioeconômicos
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