scholarly journals Mapping Geographic Variability of Severe Uncontrolled Asthma in the United States: Management Implications

2021 ◽  
Author(s):  
Eugene R. Bleecker ◽  
Hitesh Gandhi ◽  
Ileen Gilbert ◽  
Kevin R. Murphy ◽  
Geoffrey L. Chupp
Keyword(s):  
United States ◽  
The United States ◽  
Geographic Variability ◽  
Uncontrolled Asthma ◽  
Management Implications

scholarly journals 1164. County-Level Geographic Distribution of Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae Across Outpatient Settings of the Veterans Health Administration, 2000–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S350-S351
Author(s):  
Michihiko Goto ◽  
Rajeshwari Nair ◽  
Daniel Livorsi ◽  
Marin Schweizer ◽  
Michael Ohl ◽  
...  
Keyword(s):  
United States ◽  
Veterans Health Administration ◽  
The United States ◽  
Incidence Rates ◽  
County Level ◽  
Veterans Health ◽  
Health Administration ◽  
Geographic Variability ◽  
Extended Spectrum ◽  
Outpatient Settings

Abstract Background Extended-spectrum cephalosporin resistance (ESCR) among Enterobacteriaceae has emerged globally over the last two decades, with increased prevalence in the community. Data from European countries and healthcare-associated isolates in the United States have demonstrated substantial geographic variability in the prevalence of ESCR, but community-onset isolates in the United States have been less studied. We aimed to describe geographic distribution and spread of ESCR among outpatient settings across the Veterans Health Administration (VHA) over 18 years. Methods We analyzed a retrospective cohort of all patients who had any positive clinical culture specimen for ESCR Enterobacteriaceae collected in an outpatient setting; ESCR was defined by phenotypic nonsusceptibility to at least one extended-spectrum cephalosporin agent or detection of an extended-spectrum β-lactamase. Patient-level data were grouped by county of residence, and the total number of unique patients who received care within VHA for each county was used as a denominator. We aggregated data by time terciles (2000–2005, 2006–2011, and 2012–2017), and overall and county-level incidence rates were calculated as the number of unique patients in each year with ESCR Enterobacteriaceae per person-year. Results During the study period, there were 1,980,095 positive cultures for Enterobacteriaceae from 870,797 unique patients across outpatient settings of VHA, from a total of 107,404,504 person-years. Among those, 136,185 cultures (6.9%) from 75,500 unique patients (8.7%) were ESCR. The overall incidence rate was 9.0 cases per 10,000 person-years, which increased from 6.3 per 10,000 person-years in 2000 to 14.6 per 10,000 person-years in 2017. County-level incidence rates ranged widely but increased overall (interquartile range [IQR] in 2000–2005: 0–6.7; 2006–2011: 0–9.1; 2012–2017: 3.1–14.3 per 10,000 person-years), with some geographic clustering (figure). Conclusion This study demonstrates that there has been geographic variation both in incidence rates and trends of ESCR Enterobacteriaceae in outpatient settings of VHA, which suggests the importance of tailoring local antibiotic-prescribing guidelines incorporating geographic variability in epidemiology. Disclosures M. Ohl, Gilead Sciences, Inc.: Grant Investigator, Research grant.

Estimated Prevalence and Economic Burden of Severe, Uncontrolled Asthma in the United States

2013 ◽  
Vol 131 (2) ◽  
pp. AB126 ◽  
Author(s):  
Cheryl S. Hankin ◽  
Amy Bronstone ◽  
Zhaohui Wang ◽  
Mary Buatti Small ◽  
Philip Buck
Keyword(s):  
United States ◽  
Economic Burden ◽  
The United States ◽  
Uncontrolled Asthma

Patterns of Breast Cancer Presentation in the United States: Does Geography Matter?

2009 ◽  
Vol 75 (7) ◽  
pp. 545-550 ◽  
Author(s):  
Jack Sariego
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Significant Relationship ◽  
Early Stage ◽  
The United States ◽  
Geographic Variability ◽  
The South ◽  
Cancer Data ◽  
Stage Disease ◽  
Time Of Presentation

Distribution of breast cancer varies widely throughout the United States. The factors that influence this geographic variability have not been completely defined. In addition, though a number of studies look at regional and state-to-state variability, few studies have examined this issue with regard to the nation as a whole. State-specific breast cancer data were available from the American College of Surgeons National Cancer Data Base in a series of Benchmark Reports. These data were reviewed and stratified with regard to: age at the time of presentation, race, and stage at the time of presentation. The data were further collected into regional cohorts that corresponded to the United States Census Bureau regions. Statistical analyses were then performed to identify any linked or related variables. A total of 811,652 patients with breast cancer were reported. There was a statistically significant relationship between stage at the time of presentation and census region. The greatest percentage of early-stage disease was recorded in the Northeast and the lowest in the South. There was no significant association between age at presentation and geographic region, but there was a significant relationship between race and stage. The nonwhite subgroup had a greater percentage of patients presenting with advanced-stage disease. Finally, regions with a larger percentage of nonurban population had a higher percentage of later-stage disease at presentation. A relationship exists between the pattern of breast cancer presentation and geographical location within the United States. The Northeast–with the highest percentage of urban areas and white population–reported the highest percentage of early-stage breast cancer at presentation, suggesting a link between these variables. Conversely, the South–with more rural and nonwhite population–had the highest percentage of later-stage disease. The causal relationships are not clear-cut, however, and the relationship between geography and breast cancer presentation is likely multifactorial. Further analysis is indicated to uncover any link between geographic variability and overall breast cancer treatment and survival.

scholarly journals Demographic and geographic variability of kidney stones in the United States

1994 ◽  
Vol 46 (3) ◽  
pp. 893-899 ◽  
Author(s):  
J. Michael Soucie ◽  
Michael J. Thun ◽  
Ralph J. Coates ◽  
William McClellan ◽  
Harland Austin
Keyword(s):  
United States ◽  
Kidney Stones ◽  
The United States ◽  
Geographic Variability

scholarly journals The projected economic and health burden of uncontrolled asthma in the United States

2019 ◽  
Author(s):  
Mohsen Yaghoubi ◽  
Amin Adibi ◽  
Abdollah Safari ◽  
J Mark FitzGerald ◽  
Mohsen Sadatsafavi ◽  
...  
Keyword(s):  
United States ◽  
Asthma Control ◽  
Economic Burden ◽  
Indirect Costs ◽  
State Level ◽  
The United States ◽  
Suboptimal Control ◽  
Asthma Prevalence ◽  
Uncontrolled Asthma ◽  
Life Years

AbstractRationaleDespite effective treatments, a large proportion of asthma patients do not achieve sustained asthma control. The ‘preventable’ burden associated with lack of proper control is likely taking a high toll at the population level.ObjectiveWe predicted the future health and economic burden of uncontrolled asthma among American adults for the next 20 years.MethodsWe built a probabilistic model that linked state-specific estimates of population growth, asthma prevalence rates, and distribution of asthma control levels. We conducted several meta-analyses to estimate the adjusted differences in healthcare resource use, quality-adjusted life years (QALYs), and productivity loss across control levels. We projected, nationally and at the state-level, total direct and indirect costs (in 2018 USD) and QALYs lost due to uncontrolled asthma from 2019 to 2038 in the United States.Measurements and Main ResultsOver the next 20 years, the total undiscounted direct costs associated with suboptimal asthma control will be $300.6 billion (95% confidence interval [CI] $190.1 – $411.1). When indirect costs are added, total economic burden will be $963.5 billion (95%CI $664.1 – $1,262.9). American adolescents and adults will lose 15.46 million (95%CI 12.77 million – 18.14 million) QALYs over this period due to suboptimal control of asthma. In state-level analysis, the average 20-year per-capita costs due to uncontrolled asthma ranged from $2,209 (Arkansas) to $6,132 (Connecticut).ConclusionThe burden of uncontrolled asthma will continue to grow for the next twenty years. Strategies towards better management of asthma may be associated with substantial return on investment.

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