Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
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Query Trace: Engelgau MM [original query] |
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Precision Health Analytics With Predictive Analytics and Implementation Research: JACC State-of-the-Art Review.
Pearson TA , Califf RM , Roper R , Engelgau MM , Khoury MJ , Alcantara C , Blakely C , Boyce CA , Brown M , Croxton TL , Fenton K , Green Parker MC , Hamilton A , Helmchen L , Hsu LL , Kent DM , Kind A , Kravitz J , Papanicolaou GJ , Prosperi M , Quinn M , Price LN , Shireman PK , Smith SM , Szczesniak R , Goff DC Jr , Mensah GA . J Am Coll Cardiol 2020 76 (3) 306-320 Emerging data science techniques of predictive analytics expand the quality and quantity of complex data relevant to human health and provide opportunities for understanding and control of conditions such as heart, lung, blood, and sleep disorders. To realize these opportunities, the information sources, the data science tools that use the information, and the application of resulting analytics to health and health care issues will require implementation research methods to define benefits, harms, reach, and sustainability; and to understand related resource utilization implications to inform policymakers. This JACC State-of-the-Art Review is based on a workshop convened by the National Heart, Lung, and Blood Institute to explore predictive analytics in the context of implementation science. It highlights precision medicine and precision public health as complementary and compelling applications of predictive analytics, and addresses future research and training endeavors that might further foster the application of predictive analytics in clinical medicine and public health. |
Emerging Concepts in Precision Medicine and Cardiovascular Diseases in Racial and Ethnic Minority Populations.
Mensah GA , Jaquish C , Srinivas P , Papanicolaou GJ , Wei GS , Redmond N , Roberts MC , Nelson C , Aviles-Santa L , Puggal M , Green Parker MC , Minear MA , Barfield W , Fenton KN , Boyce CA , Engelgau MM , Khoury MJ . Circ Res 2019 125 (1) 7-13 Cardiovascular diseases remain the leading cause of mortality and a major contributor to preventable deaths worldwide. The dominant modifiable risk factors and the social and environmental determinants that increase cardiovascular risk are known, and collectively, are as important in racial and ethnic minority populations as they are in majority populations. Their prevention and treatment remain the foundation for cardiovascular health promotion and disease prevention. Genetic and epigenetic factors are increasingly recognized as important contributors to cardiovascular risk and provide an opportunity for advancing precision cardiovascular medicine. In this review, we explore emerging concepts at the interface of precision medicine and cardiovascular disease in racial and ethnic minority populations. Important among these are the lack of racial and ethnic diversity in genomics studies and biorepositories; the resulting misclassification of benign variants as pathogenic in minorities; and the importance of ensuring ancestry-matched controls in variant interpretation. We address the relevance of epigenetics, pharmacogenomics, genetic testing and counseling, and their social and cultural implications. We also examine the potential impact of precision medicine on racial and ethnic disparities. The National Institutes of Health's All of Us Research Program and the National Heart, Lung, and Blood Institute's Trans-Omics for Precision Medicine Initiative are presented as examples of research programs at the forefront of precision medicine and diversity to explore research implications in minorities. We conclude with an overview of implementation research challenges in precision medicine and the ethical implications in minority populations. Successful implementation of precision medicine in cardiovascular disease in minority populations will benefit from strategies that directly address diversity and inclusion in genomics research and go beyond race and ethnicity to explore ancestry-matched controls, as well as geographic, cultural, social, and environmental determinants of health. |
Predictive analytics: Helping guide the implementation research agenda at the National Heart, Lung, and Blood Institute
Engelgau MM , Khoury MJ , Roper RA , Curry JS , Mensah GA . Glob Heart 2019 14 (1) 75-79 Global biomedical research investments have resulted | in important discoveries and many effective preventive and | therapeutic interventions for heart, lung, blood, and sleep | (HLBS) disorders—the focus areas for the National Heart, | Lung, and Blood Institute (NHLBI) at the National | Institutes of Health (NIH). In most high-income countries, | extensive efforts have synthesized this knowledge through | systematic reviews and developed evidence-based guidelines for intervention delivery within health care systems | and community-based settings [1e7]. In low- and middleincome countries, the World Economic Forum and World | Health Organization have studied the economic toll of | noncommunicable diseases and the cost of scaling up a set | of proven-effective interventions, so-called best buys (e.g., | providing drug therapy and counseling for eligible persons | at high risk to prevent heart attacks and strokes) [8]. Thus, | effective interventions are now available and recommended | for implementation across the globe. However, adaptable | and sustainable implementation strategies for HLBS interventions are lacking and return on investment for this | vast knowledge base is diminished. This has led many to | call for a more developed implementation research | agenda—including leadership from institutions such as the | World Health Organization [9], World Bank [10], | academia [11], US Agency for International Development | [12], and NIH [13e19]. |
Economic dimensions of health inequities: The role of implementation research
Engelgau MM , Zhang P , Jan S , Mahal A . Ethn Dis 2019 29 103-112 Health inequities are well-documented, but their economic dimensions have received less attention. In this report, we describe four economic dimensions of health inequities in the United States. First, we describe an economic conceptual framework that connects poverty and health inequities at both individual and population levels and conveys the concept of reverse causality, where poverty worsens health inequities and health inequities worsen poverty. This framework can help us understand the key elements of health inequity and its drivers. Second, we describe economic measurements used for quantifying the economic burden of health inequalities and summarize the empirical findings from studies. Third, we review the evidence on the return-on-investment of economic interventions that are aimed at reducing health inequities. Finally, we highlight the importance of cross disciplinary perspectives from economics and implementation research in effectively delivering interventions that can mitigate health inequities. |
HLBS-PopOmics: an online knowledge base to accelerate dissemination and implementation of research advances in population genomics to reduce the burden of heart, lung, blood, and sleep disorders.
Mensah GA , Yu W , Barfield WL , Clyne M , Engelgau MM , Khoury MJ . Genet Med 2018 21 (3) 519-524 Recent dramatic advances in multiomics research coupled with exponentially increasing volume, complexity, and interdisciplinary nature of publications are making it challenging for scientists to stay up-to-date on the literature. Strategies to address this challenge include the creation of online databases and warehouses to support timely and targeted dissemination of research findings. Although most of the early examples have been in cancer genomics and pharmacogenomics, the approaches used can be adapted to support investigators in heart, lung, blood, and sleep (HLBS) disorders research. In this article, we describe the creation of an HLBS population genomics (HLBS-PopOmics) knowledge base as an online, continuously updated, searchable database to support the dissemination and implementation of studies and resources that are relevant to clinical and public health practice. In addition to targeted searches based on the HLBS disease categories, cross-cutting themes reflecting the ethical, legal, and social implications of genomics research; systematic evidence reviews; and clinical practice guidelines supporting screening, detection, evaluation, and treatment are also emphasized in HLBS-PopOmics. Future updates of the knowledge base will include additional emphasis on transcriptomics, proteomics, metabolomics, and other omics research; explore opportunities for leveraging data sets designed to support scientific discovery; and incorporate advanced machine learning bioinformatics capabilities. |
Influence of improvement or worsening of glucose tolerance on risk of stroke in persons with impaired glucose tolerance
Shen X , Zhang P , Wang J , An Y , Gregg EW , Zhang B , Li H , Gong Q , Chen Y , Shuai Y , Engelgau MM , Hu Y , Bennett PH , Li G . Int J Stroke 2018 13 (9) 1747493018784432 Background and aim We sought to determine the effect of regression to normal glucose tolerance (NGT) or progression to diabetes in early years of impaired glucose tolerance (IGT) on subsequent risk of stroke. Methods In 1986, 576 adults aged 25 years and older with impaired glucose tolerance in Da Qing, China, were randomly assigned by clinic to control, diet, exercise, or diet plus exercise intervention groups for a six-year period. Subsequently participants received medical care in their local clinics. We tracked participants for additional 17 years to ascertain stroke events and other outcomes. Results At the end of 23-year follow-up, 272 (50.2%) had progressed to diabetes, 169 (31.2%) regressed to normal glucose tolerance, and 101 (18.6%) remained impaired glucose tolerance. During the subsequent 17-year follow-up, 173 (31.9%) developed a stroke, 26.7% of normal glucose tolerances, 30.7% of impaired glucose tolerances, and 36.1% of those with diabetes. After controlling for age, sex, baseline blood pressure, smoking, total cholesterol, previous cardiovascular disease and intervention group, those who developed diabetes in the first six years had a higher incidence of stroke than those who reverted to normal glucose tolerance (HR = 1.49, 95% CI 1.01-2.19, p = 0.04), whereas for those who remained impaired glucose tolerance compared to those who regressed to normal glucose tolerance the HR was 1.25 (95% CI 0.80-1.93; p = 0.30). A 1-mmol/L increase in both fasting and 2-h post-load plasma glucose from entry to end of the six-year trial was significantly associated with a higher risk of development of stroke in the subsequent 17 years, respectively (HR = 1.07, 95% CI 1.03-1.11, p < 0.0001 for fasting glucose, HR = 1.05, 95% CI 1.02-1.09, p = 0.007 for 2-h post-load plasma glucose). Conclusions Among Chinese adults with impaired glucose tolerance, early progression to diabetes predicted a higher risk of stroke, compared those who regressed to normal glucose tolerance. |
Implementation research to address the United States health disadvantage: Report of a National Heart, Lung, and Blood Institute Workshop
Engelgau MM , Narayan KMV , Ezzati M , Salicrup LA , Belis D , Aron LY , Beaglehole R , Beaudet A , Briss PA , Chambers DA , Devaux M , Fiscella K , Gottlieb M , Hakkinen U , Henderson R , Hennis AJ , Hochman JS , Jan S , Koroshetz WJ , Mackenbach JP , Marmot MG , Martikainen P , McClellan M , Meyers D , Parsons PE , Rehnberg C , Sanghavi D , Sidney S , Siega-Riz AM , Straus S , Woolf SH , Constant S , Creazzo TL , de Jesus JM , Gavini N , Lerner NB , Mishoe HO , Nelson C , Peprah E , Punturieri A , Sampson U , Tracy RL , Mensah GA . Glob Heart 2018 13 (2) 65-72 Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders. Recommendations for National Heart, Lung, and Blood Institute consideration were made in several areas including understanding the drivers of the disadvantage, identifying potential solutions, creating strategic partnerships with common goals, and finally enhancing and fostering a research workforce for implementation research. Key recommendations included exploring why the United States is doing better for health indicators in a few areas compared with peer countries; targeting populations across the entire socioeconomic spectrum with interventions at all levels in order to prevent missing a substantial proportion of the disadvantage; assuring partnership have high-level goals that can create systemic change through collective impact; and finally, increasing opportunities for implementation research training to meet the current needs. Connecting with the research community at large and building on ongoing research efforts will be an important strategy. Broad partnerships and collaboration across the social, political, economic, and private sectors and all civil society will be critical-not only for implementation research but also for implementing the findings to have the desired population impact. Developing the relevant knowledge to tackle the U.S. health disadvantage is the necessary first step to improve U.S. health outcomes. |
Text to Quit China: An mHealth smoking cessation trial
Augustson E , Engelgau MM , Zhang S , Cai Y , Cher W , Li R , Jiang Y , Lynch K , Bromberg JE . Am J Health Promot 2017 31 (3) 217-225 PURPOSE: To assess the feasibility, acceptability, and efficacy of a text message-based smoking cessation intervention in China. DESIGN: Study design was a randomized control trial with a 6-month follow-up assessment of smoking status. SETTING: Zhejiang, Heilongjiang, and Shaanxi provinces in China provided the study setting. SUBJECTS: A total of 8000 adult smokers in China who used Nokia Life Tools and participated in phase 2 (smoking education via text message) of the study were included. INTERVENTION: The high-frequency text contact (HFTC) group received one to three messages daily containing smoking cessation advice, encouragement, and health education information. The low-frequency text contact (LFTC) group received one weekly message with smoking health effects information. MEASURES: Our primary outcome was smoking status at 0, 1, 3, and 6 months after intervention. Secondary outcomes include participant perceptions of the HFTC intervention, and factors associated with smoking cessation among HFTC participants. ANALYSIS: Descriptive and chi2 analyses were conducted to assess smoking status and acceptability. Factors associated with quitting were assessed using multiple logistic regression analyses. RESULTS: Quit rates were high in both the HFTC and LFTC groups (HFTC: 0 month, 27.9%; 1 month, 30.5%; 3 months, 26.7%; and 6 months, 27.7%; LFTC: 0 month, 26.7%; 1 month, 30.4%; 3 months, 28.1%; and 6 months, 27.7%), with no significant difference between the two groups in an intent-to-treat analysis. Attitudes toward the HFTC intervention were largely positive. CONCLUSION: Our findings suggest that a text message-based smoking cessation intervention can be successfully delivered in China and is acceptable to Chinese smokers, but further research is needed to assess the potential impact of this type of intervention. |
Reducing health inequities in the U.S.: recommendations from the NHLBI's health inequities Think Tank meeting
Sampson UK , Kaplan RM , Cooper RS , Diez Roux AV , Marks JS , Engelgau MM , Peprah E , Mishoe H , Boulware LE , Felix KL , Califf RM , Flack JM , Cooper LA , Gracia JN , Henderson JA , Davidson KW , Krishnan JA , Lewis TT , Sanchez E , Luban NL , Vaccarino V , Wong WF , Wright JT Jr , Meyers D , Ogedegbe OG , Presley-Cantrell L , Chambers DA , Belis D , Bennett GC , Boyington JE , Creazzo TL , de Jesus JM , Krishnamurti C , Lowden MR , Punturieri A , Shero ST , Young NS , Zou S , Mensah GA . J Am Coll Cardiol 2016 68 (5) 517-24 The National, Heart, Lung, and Blood Institute convened a Think Tank meeting to obtain insight and recommendations regarding the objectives and design of the next generation of research aimed at reducing health inequities in the United States. The panel recommended several specific actions, including: 1) embrace broad and inclusive research themes; 2) develop research platforms that optimize the ability to conduct informative and innovative research, and promote systems science approaches; 3) develop networks of collaborators and stakeholders, and launch transformative studies that can serve as benchmarks; 4) optimize the use of new data sources, platforms, and natural experiments; and 5) develop unique transdisciplinary training programs to build research capacity. Confronting health inequities will require engaging multiple disciplines and sectors (including communities), using systems science, and intervening through combinations of individual, family, provider, health system, and community-targeted approaches. Details of the panel's remarks and recommendations are provided in this report. |
Cervical cancer screening among adult women in China, 2010
Wang B , He M , Chao A , Engelgau MM , Saraiya M , Wang L , Wang L . Oncologist 2015 20 (6) 627-34 INTRODUCTION: Cervical cancer is one of the most commonly diagnosed cancers among women in China. The World Health Organization (WHO) recommends routine screening for cervical cancer, and the WHO Global Monitoring Framework suggests that every nation monitors cervical cancer screening. However, little information is available on cervical cancer screening behavior among women in China. METHODS: We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 51,989 women aged 18 years and older. We report the proportion of women who reported ever having had a Papanicolaou (Pap) test, stratified by sociodemographic characteristics and geographic region. Multivariable logistic regression modeling was performed to adjust for potential confounders. RESULTS: Overall, 21% of 51,989 women reported having ever had a Pap test. The highest proportion was reported among women aged 30-39 years (30.1%, 95% confidence interval, 26.8%-33.4%). In all geographic regions, women in rural areas were consistently less likely than women in urban areas to report having had a Pap test. Among women who reported ever having a Pap test, 82% reported having the most recent test in the past 3 years. Factors associated with reporting ever having a test were being aged 30-49 years, higher education, being married, and having urban health insurance. CONCLUSION: Our results indicate that screening programs need to be strengthened along with a more intense focus on specific demographic groups. National cervical cancer screening guidelines and comprehensive implementation strategies are needed to make screening services available and accessible to all women. |
Cardiovascular and all-cause mortality over a 23-year period among Chinese with newly diagnosed diabetes in the Da Qing IGT and Diabetes Study
An Y , Zhang P , Wang J , Gong Q , Gregg EW , Yang W , Li H , Zhang B , Shuai Y , Chen Y , Engelgau MM , Cheng Y , Hu Y , Bennett PH , Li G . Diabetes Care 2015 38 (7) 1365-71 OBJECTIVE: Despite its growing prevalence in China, the extent to which diabetes leads to excess cardiovascular disease (CVD) mortality and all-cause mortality is unclear. RESEARCH DESIGN AND METHODS: We compared death rates and causes of death among 630 people with newly diagnosed diabetes (NDD) and 519 with normal glucose tolerance (NGT) who, in 1986, were identified as a result of screening 110,660 adults aged 25-74 years for diabetes in Da Qing, China. RESULTS: During 23 years of follow-up, 338 (56.5%) participants with NDD and 100 (20.3%) with NGT died. CVD was the predominant cause of death in those with diabetes (47.5% in men and 49.7% in women), almost half of which was due to stroke (52.3% in men and 42.3% in women). The age-standardized incidence of all-cause death was three times as high in those with NDD as in those with NGT with incidences (per 1,000 person-years) of 36.9 (95% CI 31.5-42.3) vs. 13.3 (10.2-16.5) in men (P < 0.0001) and 27.1 (22.9-31.4) vs. 9.2 (7.8-10.6) in women (P < 0.0001). The incidence of CVD deaths in men and women with NDD (17.5 [13.8-21.2] vs. 13.5 [1.5-16.5]) did not differ significantly. Significantly higher death rates attributable to renal disease and infection were also found in the NDD group. CONCLUSIONS: Diabetes is associated with a substantially increased risk of death in Chinese adults, especially from CVD, almost half of which is due to stroke. |
Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study
Li G , Zhang P , Wang J , An Y , Gong Q , Gregg EW , Yang W , Zhang B , Shuai Y , Hong J , Engelgau MM , Li H , Roglic G , Hu Y , Bennett PH . Lancet Diabetes Endocrinol 2014 2 (6) 474-80 BACKGROUND: Lifestyle interventions among people with impaired glucose tolerance reduce the incidence of diabetes, but their effect on all-cause and cardiovascular disease mortality is unclear. We assessed the long-term effect of lifestyle intervention on long-term outcomes among adults with impaired glucose tolerance who participated in the Da Qing Diabetes Prevention Study. METHODS: The study was a cluster randomised trial in which 33 clinics in Da Qing, China-serving 577 adults with impaired glucose tolerance-were randomised (1:1:1:1) to a control group or lifestyle intervention groups (diet or exercise or both). Patients were enrolled in 1986 and the intervention phase lasted for 6 years. In 2009, we followed up participants to assess the primary outcomes of cardiovascular mortality, all-cause mortality, and incidence of diabetes in the intention-to-treat population. FINDINGS: Of the 577 patients, 439 were assigned to the intervention group and 138 were assigned to the control group (one refused baseline examination). 542 (94%) of 576 participants had complete data for mortality and 568 (99%) contributed data to the analysis. 174 participants died during the 23 years of follow-up (121 in the intervention group vs 53 in the control group). Cumulative incidence of cardiovascular disease mortality was 11.9% (95% CI 8.8-15.0) in the intervention group versus 19.6% (12.9-26.3) in the control group (hazard ratio [HR] 0.59, 95% CI 0.36-0.96; p=0.033). All-cause mortality was 28.1% (95% CI 23.9-32.4) versus 38.4% (30.3-46.5; HR 0.71, 95% CI 0.51-0.99; p=0.049). Incidence of diabetes was 72.6% (68.4-76.8) versus 89.9% (84.9-94.9; HR 0.55, 95% CI 0.40-0.76; p=0.001). INTERPRETATION: A 6-year lifestyle intervention programme for Chinese people with impaired glucose tolerance can reduce incidence of cardiovascular and all-cause mortality and diabetes. These findings emphasise the long-term clinical benefits of lifestyle intervention for patients with impaired glucose tolerance and provide further justification for adoption of lifestyle interventions as public health measures to control the consequences of diabetes. FUNDING: Centers for Disease Control and Prevention, WHO, the China-Japan Friendship Hospital, Da Qing First Hospital. |
Convergence of non-communicable and infectious diseases in low- and middle-income countries
Remais JV , Zeng G , Li G , Tian L , Engelgau MM . Int J Epidemiol 2012 42 (1) 221-7 The convergence of non-communicable disease (NCD) and infectious disease (ID) in low- and middle-income countries (LMICs) presents new challenges and new opportunities to enact responsive changes in policy and research. Most LMICs have significant dual disease burdens of NCDs such as cardiovascular disease, diabetes and cancer, and IDs including tuberculosis, HIV/AIDS and parasitic diseases. A combined strategy is needed in surveillance and disease control; yet, experts, institutions and policies that support prevention and control of these two overarching disease categories have limited interaction and alignment. NCDs and IDs share common features, such as long-term care needs and overlapping high-risk populations, and there are also notable direct interactions, such as the association between certain IDs and cancers, as well as evidence of increased susceptibility to IDs in individuals with NCDs. Enhanced simultaneous surveillance of NCD and ID comorbidity in LMIC populations would generate the empirical data needed to better understand the dual burden, and to target coordinated care. Where IDs and NCDs are endemic, focusing on vulnerable populations by strengthening social protections and improving access to health services is crucial, as is the re-alignment of efforts to combine NCD and ID screening, treatment programmes, and the assessment of their impact. Integrating public health activities for ID and NCD should extend beyond health care services to prevention, which is widely seen as crucial to successful NCD and ID control campaigns alike. The convergence of NCD and ID in LMICs has the potential to overstretch already strained health systems. With some LMICs now focused on major health system reforms, a unique opportunity is available to address NCD and ID challenges with newfound urgency and novel approaches. |
Tackling the global diabetes burden: will screening help?
Engelgau MM , Gregg EW . Lancet 2012 380 (9855) 1716-8 Worldwide, cases of type 2 diabetes have doubled from nearly 150 million in 1980 to almost 350 million today,1 and effective strategies to reduce the burden of disease are greatly needed. A large and highly variable proportion of cases are undiagnosed,2 and in view of the available evidence-based treatments,3 early detection through diabetes screening is worth careful consideration. Diabetes screening and diagnosis can be done with relative ease, which further escalates popular support for wide-scale screening. However, these compelling arguments overlook the screening costs, potential harms, and lack of clear evidence that screening improves health outcomes compared with current routine clinical diagnosis. In The Lancet, Rebecca Simmons and colleagues4 report their findings from the ADDITION study, the most earnest attempt to date to try to settle the diabetes screening quandary. | The ADDITION study is a clinic-level cluster randomised trial of patients aged 40–69 years who are receiving care from general practices in eastern England, and represent the top 25% of the risk distribution for undiagnosed diabetes.4 Entire clinics were randomly assigned to screening or no screening (control group). In the screening clinics, treatment focused on glycaemic control and cardiovascular risk reduction through two care patterns: intensive multifactorial diabetes treatment or standard national guideline-based diabetes care. This study has both a pragmatic public health design with intention-to-screen while integrating a clinical design of intensive versus standard treatment. Clinic-level randomisation also allowed better uniformity across the interventions. Of 16 047 individuals invited for screening, 466 (3%) were newly diagnosed with diabetes. After a 10-year follow-up, there was no significant difference in all-cause mortality between screening and control groups (hazard ratio 1·06, 95% CI 0·90–1·25). Moreover, the mortality hazard ratios for cardiovascular disease, cancer, and diabetes were similar in the intervention and control populations, leaving no evidence of long-term mortality benefits associated with screening—a finding not unlike the small non-significant reduction in cardiovascular events and death found in a similar study with a shorter follow-up period.5 Long-term microvascular benefits, such as diabetic retinopathy and kidney disease, are not reported. This study has also previously reported on screening risks for participants such as anxiety and depression, which were found to be low;6 however, it found little beneficial change in lifestyle behaviours, with the exception of modest improvement in some dietary habits.7 |
The economic impact of non-communicable diseases on households in India
Engelgau MM , Karan A , Mahal A . Global Health 2012 8 (1) 9 BACKGROUND: In India, Non Communicable Diseases (NCDs) and injuries account for an estimated 62% of the total age-standardized burden of forgone Disability Adjusted Life Years (DALYs). Public and private financing of clinical services to reduce the NCD burden is a major challenge. METHODS: We used National Sample Survey Organization (NSSO) survey data from 1995-96 and 2004 covering nearly 200 thousand households to assess healthcare utilization patterns and out of pocket health spending by disease category. For this purpose, self-reported diseases and conditions were categorized into NCDs and non-NCDs. Survey data were used to assess how households financed their overall health expenditures and related this pattern to specific health conditions. We measured catastrophic spending on NCD-related hospitalization, defined as occurring when health expenditures exceeded 40% of a household's ability to pay, that is, household consumption spending less combined survival consumption expenditure; and impoverishment when per capita expenditure within the household decreased to below the poverty line once health spending was netted out. RESULTS: The share of NCDs in out of pocket health expenses incurred by households increased over time, from 31.6 percent in 1995-96 to 47.3 percent in 2004. In both years, own savings and income were the most important source of financing for many health conditions, typically between 40-60 percent of all spending, whereas 30-35 percent was from borrowing. The odds of catastrophic hospitalization expenditures for cancer was nearly 170% greater and for CVD and injuries 22 percent greater than the odds due to communicable diseases. Impoverishment patterns were similar. CONCLUSIONS: Out of pocket expenses for treating NCDs rose sharply over the period from 1995-96 to 2004. When NCDs are present, the financial risks to which Indians households are exposed are significant. |
Physical activity levels and differences in the prevalence of diabetes between the United States and Canada
Zhang X , Geiss LS , Caspersen CJ , Cheng YJ , Engelgau MM , Johnson JA , Plotnikoff RC , Gregg EW . Prev Med 2010 50 241-5 OBJECTIVE: To examine the American-Canadian difference in physical activity (PA) and its association with diabetes prevalence. METHODS: We used cross-sectional data from nationally representative samples of adults (8688 persons aged ≥18years) participating in the 2004 Joint Canada/U.S. Survey of Health. Using data on up to 22 activities in the past 3months, we defined 3 PA groups (in MET-hours/day) as: low (<1.5), moderate (1.5-2.9), and high (≥3.0). We employed logistic regression models in our analyses. RESULTS: Self-reported diabetes prevalence was 7.6% in the U.S. and 5.4% in Canada. The prevalence of low PA was considerably higher in the U. S. (70.9%) than in Canada (52.3%), while levels of moderate and high PA were higher in Canada (24.6% and 23.1%, respectively) than in the U.S. (14.3% and 14.8%, respectively). Using nationality (Canada as reference) to predict diabetes status, the adjusted odds ratio was 1.48 (95%CI, 1.22-1.79), and became 1.38 (95%CI, 1.15-1.66) when additionally adjusting for PA level. We estimate that 20.8% of the U.S.-Canada difference in diabetes prevalence is associated with PA. CONCLUSIONS: The difference in the prevalence of diabetes between U.S. and Canadian adults may be partially explained by differences in PA between the two countries. |
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