CONTEXT: The US government manages a large number of data sets, including federally funded data collection activities that examine infectious and chronic conditions, as well as risk and protective factors for adverse health outcomes. Although there currently is no mature, comprehensive metadata repository of existing data sets, US federal agencies are working to develop and make metadata repositories available that will improve discoverability. However, because these repositories are not yet operating at full capacity, researchers must rely on their own knowledge of the field to identify available data sets. PROGRAM OR POLICY: We sought to identify and consolidate a practical and annotated listing of those data sets. IMPLEMENTATION AND/OR DISSEMINATION: Creative use of data resources to address novel questions is an important research skill in a wide range of fields including public health. This report identifies, promotes, and encourages the use of a range of data sources for health, behavior, economic, and policy research efforts across the life span. EVALUATION: We identified and organized 28 federal data sets by the age-group of primary focus; not all groups are mutually exclusive. These data sets collectively represent a rich source of information that can be used to conduct descriptive epidemiologic studies. DISCUSSION: The data sets identified in this article are not intended to represent an exhaustive list of all available data sets. Rather, we present an introduction/overview of the current federal data collection landscape and some of its largest and most frequently utilized data sets.

INTRODUCTION: Rapid growth of the older adult population requires greater epidemiologic characterization of dementia. We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk United States (US) population. METHODS: We analyzed Centers for Medicare & Medicaid administrative enrollment and claims data for 100% of Medicare fee-for-service beneficiaries enrolled during 2011-2013 and age ≥68 years as of December 31, 2013 (n = 21.6 million). RESULTS: Over 3.1 million (14.4%) beneficiaries had a claim for a service and/or treatment for any dementia subtype. Dementia not otherwise specified was the most common diagnosis (present in 92.9%). The most common subtype was Alzheimer's (43.5%), followed by vascular (14.5%), Lewy body (5.4%), frontotemporal (1.0%), and alcohol induced (0.7%). The prevalence of other types of diagnosed dementia was 0.2%. DISCUSSION: This study is the first to document concurrent prevalence of primary dementia subtypes among this US population. The findings can assist in prioritizing dementia research, clinical services, and caregiving resources.

One of the great pleasures of being the Editor in Chief of Preventing Chronic Disease: Public Health Research, Practice, and Policy (PCD) is to read the papers submitted by the next generation of public health professionals for the annual PCD Student Contest. This year was no exception. We received 59 papers on a range of critical public health topics that used novel analytic methods. In collaboration with members of the Editorial Board, it is my pleasure to announce that Nelly Mejia at the Pardee RAND Graduate School has won the 2015 PCD Student Contest. In this paper, Mejia and colleagues describe their analysis of the association between living in a food desert and eating fruits and vegetables (1). Understanding the influence of food deserts on public health is critical to designing, implementing, and evaluating the impact of policy and environmental changes to improve access to nutritious foods. | Much of the published literature has documented both the prevalence of food deserts and disparities in access to nutritious foods (2–5). In the past several years, there has been a substantial effort to place farmers markers in areas considered to be food deserts (4–6). These interventions have documented some success; however, there are a number remaining challenges. Access to healthier foods is necessary but not sufficient to improve nutrition and mitigate the short-term and long-term health effects of suboptimal nutritional intake. Interventions must also address issues of preparation of these healthier foods for consumption. Access and purchasing behavior are first steps in changing dietary intake.

The 2 articles by Urban and colleagues published this week in Preventing Chronic Disease report 15-year trends in sodium, trans fat, and saturated fat, 3 food components associated with increased risk for cardiovascular disease and obesity, in frequently ordered meal items (French fries, cheeseburgers, grilled chicken sandwiches, and regular cola) from leading US national fast food chain restaurants (1,2). These longitudinal findings track these 3 food components in foods that are frequently consumed by Americans. In recent surveys, almost half of Americans report eating fast food at least weekly (http://www.gallup.com/poll/163868/fast-food-major-part-diet.aspx), and similarly, nearly half report drinking soda daily (http://www.gallup.com/poll/156116/Nearly-Half-Americans-Drink-Soda-Daily.aspx). The findings by Urban et al confirm a substantial reduction in the content of trans fat and saturated fat in French fries but not in cheeseburgers or chicken sandwiches. Changes were inconsistent in sodium, saturated fat, and calories among food products, with the exception of sodas, where there was an increase in portion size. The authors conclude that, unlike the reduction observed in artificial trans fat in French fries, the content of sodium, saturated fat, and calories in the selected foods did not change much. Taken together, these findings indicate that little improvement has been made in the quality or energy density of popular fast food products and suggest the need for interventions to improve population health. | It is important to consider these findings in the larger context as public health researchers, practitioners, and policy makers develop and implement interventions to reduce intake of excessive calories, saturated fat, and artificial trans fat. Cheeseburgers, French fries, and a soda represent a quintessential part of American culture. Banter about them was central to the Saturday Night Live skit made famous by the late John Belushi. Similarly, songs made popular by performers such as Jimmy Buffett, Charlie Pride, the Gang of Four, and the Village People are all about having a cheeseburger, French fries, and a soda. These staples of the American diet are unlikely to disappear. However, central to American food choices is an unacceptably high prevalence of diet-related risk factors that compromise the health of Americans and contribute to the high costs of chronic disease. During the period examined by Urban and colleagues, the late 1990s through 2013, the US prevalence of chronic disease risk factors such as overweight, obesity, and hypertension have remained high, cardiovascular disease remains the leading cause of death, and prevalence of prediabetes and diabetes continues to increase (3). The continued popularity of fast food restaurants and continued high prevalence of diet-related risk factors remind public health researchers, practitioners, and policy makers that there is much that needs to be done.

In this issue of Mayo Clinic Proceedings, Rocca et al1 report the results of a study of multimorbidity in a patient sample that represents nearly the total population of Olmsted County, Minnesota. (In this context, multimorbidity refers to the situation in which a patient receiving medical care for a sentinel condition has at least one additional chronic condition.) To our knowledge, this is the first report that uses the list of chronic conditions developed by the US Department of Health and Human Services (DHHS) to assist in systematically documenting the epidemiology and burden of chronic multimorbidity at this jurisdictional level.2 Other investigators have reported their use of the DHHS set of conditions to examine the burden of multimorbidity among nationally representative samples of persons in communities and in health care settings.3, 4, 5, 6 In addition, the Centers for Medicare and Medicaid Services has provided statistics on the prevalence of multiple chronic conditions for Medicare beneficiaries at the state, county, and hospital referral region level.7 However, the report by Rocca et al expands this understanding substantially by taking this work directly to the local level through their examination of multimorbidity in the setting of nearly all persons in a single, highly documented county who have had encounters with the health care system.

Each year since 2011 Preventing Chronic Disease (PCD) has issued a special call for student papers for our Student Research Paper Contest. This year PCD received 67 submissions from students throughout the world. We are very excited to recognize Kathleen Li and colleagues as the winners of the 2014 contest for their paper entitled “Evaluation of the Placement of Mobile Fruit and Vegetable Vendors to Alleviate Food Deserts in New York City” (1). Ms Li is currently a medical student at the University of California, San Francisco, School of Medicine, and she conducted the study described in her paper with Dr Carol Horowitz and colleagues at the Icahn School of Medicine at Mount Sinai’s Department of Health Evidence and Policy. | In their paper Ms Li and colleagues described their investigation of how the placement of mobile fruit and vegetable vendors affects access to fresh fruit and vegetables in areas that have been designated food deserts. Evidence suggests that people in neighborhoods with access to supermarkets are more likely to have healthier diets and lower levels of obesity than those in food deserts (2). A substantial investment in promotion of mobile fruit and vegetable vendors in the past several years has been at least partially effective in increasing access in areas that lack retail outlets with healthful selections (3–5). The strategic placement of these vendors has been central to the New York City licensing program. In addition to placement, efforts have been made to facilitate the vendor acceptance of Electronic Benefit Transfer (EBT) cards from the Supplemental Nutrition Assistance Program and other assistance programs.

This is an invited commentary for a special issue on CPPW. In this invited commentary, we review definition frameworks for community health and examine factors having core relevance to shaping the meaning of this term and growing field. We conclude by suggesting a potential framework for conceptualizing and advancing this field of public health practice through improved understanding of the meaning, scope, and science of community health.

Mixed-method designs are increasingly used in sexually transmitted infection (STI) and HIV prevention research. The authors designed a mixed-method approach and applied it to estimate and evaluate a predictor of continued female condom use (6+ uses, among those who used it at least once) in a 6-month prospective cohort study. The analysis included 402 women who received an intervention promoting use of female and male condoms for STI prevention and completed monthly quantitative surveys; 33 also completed a semistructured qualitative interview. The authors identified a qualitative theme (couples' female condom enjoyment [CFCE]), applied discriminant analysis techniques to estimate CFCE for all participants, and added CFCE to a multivariable logistic regression model of continued female condom use. CFCE related to comfort, naturalness, pleasure, feeling protected, playfulness, ease of use, intimacy, and feeling in control of protection. CFCE was associated with continued female condom use (adjusted odds ratio: 2.8, 95% confidence interval: 1.4-5.6) and significantly improved model fit (p < .001). CFCE predicted continued female condom use. Mixed-method approaches for "scaling up" qualitative findings from small samples to larger numbers of participants can benefit HIV and STI prevention research.

INTRODUCTION: Public health and clinical strategies for meeting the emerging challenges of multiple chronic conditions must address the high prevalence of lifestyle-related causes. Our objective was to assess prevalence and trends in the chronic conditions that are leading causes of disease and death among adults in the United States that are amenable to preventive lifestyle interventions. METHODS: We used self-reported data from 196,240 adults aged 25 years or older who participated in the National Health Interview Surveys from 2002 to 2009. We included data on cardiovascular disease (coronary heart disease, angina pectoris, heart attack, and stroke), cancer, chronic obstructive pulmonary disease (emphysema and chronic bronchitis), diabetes, and arthritis. RESULTS: In 2002, an unadjusted 63.6% of participants did not have any of the 5 chronic conditions we assessed; 23.9% had 1, 9.0% had 2, 2.9% had 3, and 0.7% had 4 or 5. By 2009, the distribution of co-occurrence of the 5 chronic conditions had shifted subtly but significantly. From 2002 to 2009, the age-adjusted percentage with 2 or more chronic conditions increased from 12.7% to 14.7% (P < .001), and the number of adults with 2 or more conditions increased from approximately 23.4 million to 30.9 million. CONCLUSION: The prevalence of having 1 or more or 2 or more of the leading lifestyle-related chronic conditions increased steadily from 2002 to 2009. If these increases continue, particularly among younger adults, managing patients with multiple chronic conditions in the aging population will continue to challenge public health and clinical practice.

Current trends in US population growth, age distribution, and disease dynamics foretell rises in the prevalence of chronic diseases and other chronic conditions. These trends include the rapidly growing population of older adults, the increasing life expectancy associated with advances in public health and clinical medicine, the persistently high prevalence of some risk factors, and the emerging high prevalence of multiple chronic conditions. Although preventing and mitigating the effect of chronic conditions requires sufficient measurement capacities, such measurement has been constrained by lack of consistency in definitions and diagnostic classification schemes and by heterogeneity in data systems and methods of data collection. We outline a conceptual model for improving understanding of and standardizing approaches to defining, identifying, and using information about chronic conditions in the United States. We illustrate this model's operation by applying a standard classification scheme for chronic conditions to 5 national-level data systems.

In 2003, Drs James Marks and Lynne Wilcox began developing a plan to realize their vision of creating a scholarly journal that would strengthen the links connecting public health research, practice, and policy with regard to chronic diseases. Their vision resulted in the publication the following year of Preventing Chronic Disease: Public Health Research, Practice, and Policy (PCD). As we start our 10th year of publication, we can reflect on what has been accomplished and what might be on the horizon. In the accompanying editorial, Dr Wilcox describes the importance of the journal’s focus on chronic disease in 2004 and highlights some of the early milestones in the journal’s development (1). One of the core drivers for starting PCD was the recognition that the field of public health would benefit from an open access forum for sharing successes and lessons learned in order to increase the quality, relevance, and effectiveness of our efforts and to improve their efficiency. The journal’s focus on chronic conditions and its commitment to providing a forum for sharing best practices and innovations is just as important today as it was a decade ago, and will increasingly be so in the future. | PCD has grown and changed with advances in technology and public health science to meet the changing demands of the field. In 2004, the journal was among the first to be published only in electronic format. The landscape of e-publishing has dramatically changed since then. In a world of increasing demand and constricting resources, there is an increasing push to use these resources effectively and efficiently. Since its inception, the journal has evolved to meet these challenges. PCD will continue to build on its solid foundation and expand its efforts by increasing its quality, relevance, impact, and efficiency.

OBJECTIVE: To compare frequencies of complications among HIV-infected and-uninfected women undergoing common gynecological surgical procedures in inpatient settings. METHODS: We used 1994-2007 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, a nationally representative sample of inpatient hospitalizations. Our analysis included discharge records of women aged ≥15 undergoing hysterectomy, oophorectomy, salpingectomy for ectopic pregnancy, bilateral tubal sterilization, or dilation and curettage. Associations between HIV infection status and surgical complications were evaluated in multivariable logistic regression models, adjusting for key covariates. RESULTS: For each surgery, HIV infection was associated with experiencing ≥1 complication. Adjusted ORs ranged from 2.0 (95% confidence interval (CI): 1.7, 2.2) for hysterectomy with oophorectomy to 3.1 (95% CI: 2.4, 4.0) for bilateral tubal sterilization with no comorbidity present. HIV infection was positively associated with extended length of stay and infectious complications of all of the surgeries examined. For some surgeries, it was positively associated with transfusion and anemia due to acute blood loss. Among HIV-infected women, the odds of infectious and other complications did not decrease between 1994-2000 and 2001-2007. CONCLUSION: HIV infection was associated with elevated frequencies of complications of gynecologic surgeries in the US, even in the era of HAART.

For many decades, early access to prenatal care has been considered the gold standard for improving birth outcomes. In Contra Costa County, a diverse urban and suburban county of over one million people in the San Francisco Bay Area, the Family Maternal and Child Health Programs of Contra Costa Health Services (CCHS) have seen high rates of early entry into prenatal care since 2000. Yet despite our best efforts to increase access to quality prenatal care, our rates of low birth weight and infant mortality, especially among African Americans, continue to be high. When we were introduced to the Life Course Perspective in 2003 as an organizational framework for our programmatic activities, we recognized that emerging scientific evidence in the literature demonstrated the importance of social and environmental factors in determining health and health equity, and supported a general impression in the field that prenatal care was not enough to improve birth outcomes. The Life Course Perspective suggests that many of the risk and protective factors that influence health and wellbeing across the lifespan also play an important role in birth outcomes and in health and quality of life beyond the initial years. In this article, we describe the Life Course Perspective and how one local Maternal and Child Health Program adopted and adapted this paradigm by creating and launching a Life Course Initiative to guide our programs and services. The Life Course Initiative implemented by CCHS is designed to reduce inequities in birth outcomes, improve reproductive potential, and change the health of future generations by introducing a longitudinal, integrated, and ecological approach to implementing maternal and child health programs.

Never before has the global population included as many older adults as it does today. Over the past century in the United States alone, the proportion of persons aged 65 years or older increased more than threefold, from 4.1% to 12.9%.1 This issue of the Journal devoted to “Healthy Aging” opens a dialogue for examining innovative roles for public health and the health care system in relation to a broad spectrum of priorities involving the aging population. Despite the acknowledged challenges of limited resources and economic uncertainty, as this issue's articles suggest, opportunities abound to improve the health and functioning of older adults and enhance intergenerational programs and policies that enrich all of society. Additional articles for this series will be published in subsequent Journal issues over the coming years.

This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital.

OBJECTIVE: To describe reproductive health-related visits to Maryland emergency departments (EDs) among women aged 15-44 years from 1999 to 2005. METHODS: We obtained data from the Healthcare Cost and Utilization Project State Emergency Department Database and State Inpatient Database. ICD-9-CM diagnosis codes were used to classify reproductive health-related visits. We calculated the annual rate of reproductive health visits to Maryland EDs from 1999 to 2005 for women aged 15-44 years and tested time trends using linear regression. Admission rates were defined as the percentage of ED visits that resulted in inpatient admission. We calculated age-specific and race-specific rate ratios for diagnoses using Poisson regression and admission rate ratios using Cochran-Mantel-Haenszel statistics. RESULTS: From 1999 to 2005, the rate of ED visits in Maryland increased 50%, from 28.0 to 42.1 visits per 1000 women. Lower genital tract infections were the most common diagnosis (21.4%). The rates were higher for women aged 15-24 than for women aged 25-44 (rate ratio 1.18, 95% confidence interval [CI] 1.17-1.18) and nearly three times higher for black women than white women (rate ratio 2.94, 95% CI 2.92-2.96). Admission rates were lower for women aged 15-24 than for women aged 25?44 (rate ratio 0.34, 95% CI 0.33?0.35) and were higher among black than white women (rate ratio 1.16, 95% CI 1.14-1.18). CONCLUSIONS: Disparities by age and race are evident for reproductive health-related ED visits in Maryland, and many of these ED visits are for conditions that are amenable to preventive measures.

I am pleased to announce that A Common Denominator: Calculating Hospitalization Rates for Ambulatory Care–Sensitive Conditions in California by Camillia K. Lui and Steven P. Wallace is the winner of the first annual Preventing Chronic Disease (PCD) Student Research Contest. Ms Lui is a fourth-year doctoral student at the University of California, Los Angeles, in the Department of Community Health Sciences. Her advisor is Dr Steven Wallace. | PCD is dedicated to being the venue for sharing advances in public health research, practice, and policy, and we are committed to the development of young public health professionals as part of this effort. To this end, we have instituted the Student Research Contest as a way to engage students in the publication process and recognize the outstanding work of the next generation of the public health workforce. In July 2010, we announced our first annual call for student papers and reached out to multiple partners to distribute the call and encourage students to submit their work to PCD. | Papers were due in January 2011, and we received submissions on a range of topics from institutions throughout the United States. In February and March, a small team of editorial board members (Drs Bowman, Brownson, Lengerich, and Remington), PCD’s founding editor (Dr Lynne Wilcox), and I reviewed the submitted manuscripts. In March we selected the paper by Ms Lui and Dr Wallace as the winner.

OBJECTIVE: To describe poisoning hospitalisations among reproductive-aged women from 1998 to 2006. METHODS: 1998-2006 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilisation Project were used to identify hospitalisations for poisonings among US women aged 15-44 years. Differences in hospitalisation characteristics were compared by intent using chi(2) statistics. Trends in poisoning hospitalisation rates were calculated overall and by subgroup. RESULTS: There were approximately 636,000 poisoning hospitalisations in women aged 15-44 years during 1998-2006. Hospitalisations for intentionally self-inflicted poisonings had a higher proportion of women aged 15-24 years and privately insured women than did unintentional poisonings (p<0.001). Poisoning hospitalisations in rural areas and those that resulted in death were more likely to be of undetermined intent than those for which intent was specified (p<0.001). Co-diagnoses of substance abuse (34.5%) or mental disorders (66.5%) were high. The rate of poisoning hospitalisations overall and unintentional poisoning hospitalisations increased 6% and 22%, respectively, during this period (p<0.001). The most frequently diagnosed poisoning agent was acetaminophen. Poisonings attributable to acetaminophen, opioids, central nervous system stimulants and benzodiazepines increased, while poisonings attributable to antidepressants decreased (p<0.05). CONCLUSIONS: The increase in unintentional poisoning hospitalisations among women aged 15-44 years and the changing profile of poisoning agents should inform the healthcare community's poisoning prevention strategies. Poisoning prevention strategies should include a component to address substance abuse and mental health disorders among reproductive-age women.

OBJECTIVES: Researchers have begun looking at joint responsibility for contraceptive decision making as a mechanism to increase effective contraceptive use. This analysis identifies correlates of partner involvement in contraceptive decision making. METHODS: Participants were first-time users of either oral contraceptives or Depo-Provera recruited from 10 family planning clinics in Texas (n = 481). Participants completed a self-administered questionnaire that was available in both English and Spanish. Chi-square statistics were used to compare demographics, relationship characteristics, and condom use before and after initiation of the new hormonal method by who is responsible for birth control use. Characteristics that were significant in bivariate testing were then included in a multivariate logistic regression model. RESULTS: Forty-five percent of women reported sole responsibility for contraceptive use and 55% reported joint responsibility with their partners. In multivariate models, consistent condom use before and after the initiation of hormonal contraception and duration of sexual activity with main partner for less than 2 years were associated with increased likelihood of joint responsibility for contraceptive decision making. Women whose partners were classified as high risk had reduced the odds of joint responsibility for contraceptive decision making. CONCLUSION: Women at increased risk for sexually transmitted diseases (high-risk partners) and their partners may represent a target population for interventions aimed at increasing joint responsibility for contraception use. Continuous engagement in contraceptive decision making among long-term couples should also be encouraged.

We describe hospitalization trends of invasive pneumococcal disease (IPD) among HIV-infected adolescents and adults since the introduction of highly active antiretroviral therapy (HAART) and the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States, using the nation-wide inpatient sample. We estimated national trends of IPD hospitalizations during 3 periods: 1994-1995 (pre-HAART/pre-PCV7); 1998-1999 (HAART/pre-PCV7); and 2004-2005 (HAART/ early PCV7). The number of IPD hospitalizations among HIV-infected individuals declined 49.2% between 1994/1995 and 2004/2005. Compared with 1994-1995, the adjusted odds ratio for IPD hospitalizations of HIV-infected adolescents and adults in the United States during 2004-2005 was 0.64 (95% confidence interval: 0.54 to 0.77). The decrease was observed after introduction of the PCV7.

OBJECTIVE: We sought to examine rates of birth trauma in 2 groupings (all International Classification of Diseases, Ninth Revision codes for birth trauma, and as defined by the Agency for Healthcare Research and Quality Patient Safety Indicator [PSI]) among infants born by vaginal and cesarean delivery. STUDY DESIGN: Data on singleton infants were obtained from the 2004-2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. RESULTS: The rates of Agency for Healthcare Research and Quality PSI and all birth trauma were 2.45 and 25.85 per 1000 births, respectively. Compared with vaginal, cesarean delivery was associated with increased odds of PSI birth trauma (odds ratio [OR], 1.71), primarily due to an increased risk for "other specified birth trauma" (OR, 2.61). Conversely, cesarean delivery was associated with decreased odds of all birth trauma (OR, 0.55), due to decreased odds of clavicle fractures (OR, 0.07), brachial plexus (OR, 0.10), and scalp injuries (OR, 0.55). CONCLUSION: Infants delivered by cesarean are at risk for different types of birth trauma from infants delivered vaginally.

We describe hospitalization trends of invasive pneumococcal disease (IPD) among human immunodeficiency virus-infected individuals <25 years of age since the introduction of highly active antiretroviral therapy (HAART) and the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States, using the Nationwide Inpatient Sample. We estimated national trends of IPD hospitalizations during 3 periods: 1994 to 1995 (pre-HAART and pre-PCV7 era); 1998 to 1999 (HAART and pre-PCV7 era); and 2004 to 2005 (HAART and early PCV7 era). The number of IPD hospitalizations among human immunodeficiency virusinfected children and youth <25 years in the United States declined by 78.7% between 1994/1995 and 2004/2005 (P = 0.03). This decrease was more pronounced among younger children.

Psychiatric illnesses commonly co-occur with HIV infection and such illnesses have been linked to women's poorer medication adherence and suicide. Using hospital discharge data from the 1994-2004 Nationwide Inpatient Sample, we conducted this study to describe hospitalizations with psychiatric diagnoses from 1994 through 2004 and evaluate the association of specific psychiatric disorders among hospitalized HIV-infected women in the USA with their lack of adherence to medical treatment and suicide attempt. Multivariable logistic regression analyses were used to examine trends in hospitalizations with psychiatric diagnoses among nonpregnant HIV-infected women and the association between specific disorders and women's lack of adherence to medical treatment and suicide attempt. Between 1994 and 2004, the estimated number of all hospitalizations among nonpregnant HIV-infected women increased by 8%, while the number of hospitalizations with a psychiatric diagnosis in this population increased by 73%. After adjusting for demographic factors and alcohol/substance abuse, we found that HIV-infected women were more likely to be hospitalized for mood (odds ratio (OR): 2.35; 95% confidence interval (CI): 1.93-2.88), anxiety (OR: 2.24, 95%CI: 1.74-2.88), and psychotic (OR: 1.45, 95%CI: 1.10-1.90) disorders in 2004 than in 1994. There was a significant association of alcohol/substance abuse with mood, adjustment, anxiety, personality, and psychotic disorders. Noncompliance with medical treatment was significantly associated with psychotic disorders, whereas suicide attempt/self-inflicted injury was significantly associated with mood, adjustment, anxiety, personality, and psychotic disorders. The number of hospitalizations with a psychiatric diagnosis among HIV-infected women in the USA has increased substantially. As HIV-infected women live longer, these results highlight the need for targeted public health interventions to address mental health issues in this population.

The prevalence of diabetes in the United States is rising. As HIV-infected people live longer, they become more susceptible to chronic diseases such as diabetes. Additionally, some antiretroviral agents have been linked to impaired glucose tolerance and increased diabetes risk. To estimate the burden and trends of diabetes among hospitalized HIV-infected persons in the United States, we used data from the 1994-2004 Nationwide Inpatient Sample, a nationally representative survey of inpatient hospitalizations. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for demographic and hospital characteristics using logistic regression. Between 1994 and 2004, the rate of hospitalizations with a diabetes code per 100 hospitalizations increased from 3.9 to 8.4 (2.2 fold) among HIV-infected persons. Among HIV-uninfected people, the corresponding rate increased from 12.8 to 17.7 (1.4 fold). Since 1998, the mean age of HIV-infected hospitalized people with a diabetes diagnosis rose from 45 to 66 years and became similar to that of HIV-uninfected people. Compared to 1994-1996, in 2002-2004 the probability of hospitalizations with diabetes increased among both HIV-infected and HIV-uninfected persons (OR, 1.92, 95% CI, 1.79-2.05 and OR, 1.38, 95% CI, 1.36-1.40, respectively). Given the increasing prevalence of diabetes in hospitalized HIV-infected persons, it will be important to monitor the trends closely in addition to the effects of different types of antiretroviral regimens, in order to optimize comprehensive long-term care of HIV-infected persons.