A Population-based Analysis of Outpatient Colonoscopy in Adults Assisted by an Anesthesiologist

Background The use of propofol to sedate patients for colonoscopy, generally administered by an anesthesiologist in North America, is increasingly popular. In the United States, regional use of anesthesiologist-assisted endoscopy appears to correlate with local payor policy. This study's objective was to identify nonpayor factors (patient, physician, institution) associated with anesthesiologist assistance at colonoscopy. Methods The authors performed a population-based cross-sectional analysis using Ontario health administrative data, 1993-2005. All outpatient colonoscopies performed on adults were identified. Hierarchical multivariable modeling was used to identify patient (age, sex, income quintile, comorbidity), physician (specialty, colonoscopy volume), and institution (type, volume) factors associated with receipt of anesthesiologist-assisted colonoscopy. Results During the study period, 1,838,879 colonoscopies were performed on 1,202,548 patients. The proportion of anesthesiologist-assisted colonoscopies rose from 8.4% in 1993 to 19.1% in 2005 (P < 0.0001). In the hierarchical model, patients in low-volume community hospitals were five times more likely to receive anesthesiologist-assisted colonoscopy than patients in high-volume community hospitals (odds ration 4.9; 95% confidence interval 4.4-5.5). Less than 1% of colonoscopies in academic hospitals were anesthesiologist-assisted. Compared to gastroenterologists, surgeons were more likely to perform anesthesiologist-associated colonoscopy (odds ratio 1.7; 95% confidence interval 1.1-2.6). Conclusions In Ontario, rates of anesthesiologist-assisted colonoscopy have risen dramatically. Institution type was most strongly associated with this practice. Further investigation is needed to determine the most appropriate criteria for the use of anesthesiology services during colonoscopy.

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Factors Associated with Colonoscopy Performed in Nonhospital Settings

Canadian Journal of Gastroenterology ◽

10.1155/2010/151232 ◽

2010 ◽

Vol 24 (7) ◽

pp. 419-424 ◽

Cited By ~ 4

Author(s):

Othman Alharbi ◽

Linda Rabeneck ◽

Lawrence F Paszat ◽

Duminda N Wijeysundera ◽

Rinku Sutradhar ◽

...

Keyword(s):

Outcome Measure ◽

High Volume ◽

Population Based ◽

Income Quintile ◽

Physician Specialty ◽

Cross Sectional ◽

Health Administrative Data ◽

Factors Associated ◽

Sectional Analysis

BACKGROUND: Colonoscopy is being increasingly performed in facilities outside of hospitals. Regulation of these facilities is variable, and concerns regarding the quality of procedures in nonhospital (NH) settings have been raised. Further study is needed to better understand endoscopic practice in these facilities.OBJECTIVES: To describe NH-based colonoscopy practice in Ontario from 1993 to 2005, and to identify patient (age, sex, income quintile and comorbidity) and physician (specialty and colonoscopy volume) factors associated with this practice.METHODS: The present study was a population-based, cross-sectional analysis using health administrative data from Ontario adults who underwent at least one outpatient colonoscopy between 1993 and 2005. A total of 1,240,781 patients underwent 1,917,714 colonoscopies. The main outcome measure was the receipt of colonoscopy in an NH facility.RESULTS: An increase in NH-based colonoscopy from 10.0% in 1993 to 15.1% in 2005 (P<0.0001) was found. In the multivariate model, younger, healthier men living in higher income areas were significantly more likely to undergo NH-based colonoscopy. Surgeons and other practitioners (eg, nongastroenterologists and noninternists) were significantly more likely to practice in NH settings. Physicians in the highest colonoscopy volume quintile were 25 times more likely to practice in NH settings than those in the lowest volume quintile (P<0.0001).CONCLUSION: Rates of NH-based colonoscopy are rising in Ontario. High-volume endoscopists and surgeons are most likely to practice in NH settings. Given its increasing use, further study of the practice and the regulation of NH colonoscopy is warranted.

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Cross-Sectional Analysis of the Associations Between Four Common Cancers and Disability

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7551 ◽

2020 ◽

Vol 18 (8) ◽

pp. 1031-1044 ◽

Cited By ~ 3

Author(s):

Lisa I. Iezzoni ◽

Sowmya R. Rao ◽

Nicole D. Agaronnik ◽

Areej El-Jawahri

Keyword(s):

Signs And Symptoms ◽

The United States ◽

Population Based ◽

High Risk Population ◽

Complex Activity ◽

Cross Sectional Survey ◽

Sampling Weights ◽

Cross Sectional ◽

Nationally Representative ◽

Sectional Analysis

Background: Approximately 61 million Americans have a disability. Little research has explored whether disability is associated with subsequent diagnosis of cancer, the second-leading cause of death in the United States. The objective of this study was to explore associations between cancer and disability, focusing on 4 cancers that may present with nonspecific symptoms that could be conflated with aspects of disability, thus delaying cancer diagnoses. An analysis of a nationally representative survey using sampling weights to produce national estimates was performed. Methods: Civilian, noninstitutionalized US residents responding to the 2010–2017 National Health Interview Surveys totaling 259,392 Sample Adult Core survey respondents were included. We used self-reported functional status limitations to identify persons with movement difficulties (MD), complex activity limitations (CAL), and no disability. Multivariable regressions predicting cancer diagnosis included sociodemographic characteristics, tobacco use, body mass index, access to care indicators, and disability status. Results: Persons with preexisting disability had significantly higher rates of cancer (ranging from 0.40 [SE, 0.05] for ovarian to 3.38 [0.14] for prostate) than did those without disability (0.20 [0.02] and 1.26 [0.04] for the same cancers; all P<.0001). Multivariable analyses found strong associations of preexisting MD and CAL with colorectal cancer, with adjusted odds ratios (aORs) of 1.5 (95% CI, 1.2–1.9) and 1.9 (1.5–2.4), respectively. For non-Hodgkin’s lymphoma, the aOR for CAL was 1.5 (1.1–2.1). For prostate cancer, aORs for MD were 1.2 (1.0–1.3) and 1.1 (1.0–1.3) for CAL. Using cross-sectional survey data, we could only identify statistical associations, not causality. Conclusions: Our population-based analyses suggest that persons with disability may constitute a high-risk population, with higher cancer incidence. Optimizing appropriate screening and fully investigating new signs and symptoms are therefore critical for patients with disability.

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The association between serum alanine aminotransferase and hypertension: A national based cross-sectional analysis among over 21 million Chinese adults

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01948-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiajing Jia ◽

Ying Yang ◽

Fangchao Liu ◽

Minjin Zhang ◽

Qin Xu ◽

...

Keyword(s):

Alanine Aminotransferase ◽

Elevated Serum ◽

Population Based ◽

Reproductive Age ◽

Chinese Adults ◽

Cross Sectional ◽

Serum Alanine Aminotransferase ◽

Cross Sectional Analysis ◽

Registration Data ◽

Sectional Analysis

Abstract Background Inconsistent results were found in the association between serum alanine aminotransferase (ALT) and hypertension among population-based studies. This study evaluated the association between ALT and hypertension among Chinese reproductive-age population by utilizing registration data from National Free Pre-pregnancy Checkups Project in 2016–2017. Methods The 21,103,790 registered participants were eligible for analysis, including women who were 20–49 years old and men who were 20–59 years old with available data for ALT and blood pressure (BP). Logistic regression was conducted to estimate odds ratio (OR) for the association between ALT and hypertension as a binary outcome. Linear regression was used to examine the association between ALT and BP as a continuous outcome. Results In total, 4.21% of the participants were hypertensive, and 11.67% had elevated ALT (> 40 U/L). Hypertension prevalence was 3.63% and 8.56% among participants with normal and elevated ALT levels. A strong linear relationship was found between serum ALT levels and the odds of hypertension after adjustment for potential confounders. The multivariable-adjusted ORs for hypertension were 1, 1.22 (1.21, 1.22), 1.67 (1.65 1.68), 1.78 (1.76, 1.80), and 1.92 (1.90, 1.94) in participants with ALT levels of ≤ 20, 20.01–40, 40.01–60, 60.01–80, and > 80 U/L, respectively. Systolic and diastolic BPs rose by 1.83 and 1.20 mmHg on average, for each 20 U/L increase in ALT (P for trend < 0.001). The association was consistent among subgroups and tended to be stronger among populations who are overweight (body mass index ≥ 24 kg/m2) (χ2 = 52,228, P < 0.001), alcohol drinking (χ2 = 100,730, P < 0.001) and cigarette smoking (χ2 = 105,347, P < 0.001). Conclusions Our cross-sectional analysis suggested a linear association between serum ALT and hypertension or BP, which indicated that abnormal liver metabolism marked by elevated serum ALT could play a role in hypertension or elevated BP condition.

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The Opioid Epidemic and Homicide in the United States

Journal of Research in Crime and Delinquency ◽

10.1177/0022427820986848 ◽

2021 ◽

pp. 002242782098684

Author(s):

Richard Rosenfeld ◽

Joel Wallman ◽

Randolph Roth

Keyword(s):

United States ◽

Death Rate ◽

The United States ◽

Opioid Epidemic ◽

Drug Markets ◽

Cross Sectional ◽

Homicide Rates ◽

Overdose Death ◽

Sectional Analysis ◽

The Relationship

Objectives: Evaluate the relationship between the opioid epidemic and homicide rates in the United States. Methods: A county-level cross-sectional analysis covering the period 1999 to 2015. The race-specific homicide rate and the race-specific opioid-related overdose death rate are regressed on demographic, social, and economic covariates. Results: The race-specific opioid-related overdose death rate is positively associated with race-specific homicide rates, net of controls. The results are generally robust across alternative samples and model specifications. Conclusions: We interpret the results as reflecting the violent dynamics of street drug markets, although more research is needed to draw definitive conclusions about the mechanisms linking opioid demand and homicide.

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Costs of Early Stage Alzheimer’s Disease in the United States: Cross-Sectional Analysis of a Prospective Cohort Study (GERAS-US)1

Journal of Alzheimer s Disease ◽

10.3233/jad-191212 ◽

2020 ◽

Vol 75 (2) ◽

pp. 437-450

Author(s):

Rebecca L. Robinson ◽

Dorene M. Rentz ◽

Jeffrey Scott Andrews ◽

Anthony Zagar ◽

Yongin Kim ◽

...

Keyword(s):

United States ◽

Alzheimer’S Disease ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Early Stage ◽

The United States ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Demographic Variations in Patient Populations and Regional Distributions Between Male and Female Ophthalmologists in the United States: Cross-Sectional Analysis

Seminars in Ophthalmology ◽

10.1080/08820538.2021.1891264 ◽

2021 ◽

pp. 1-8

Author(s):

Meghana Kalavar ◽

Arjun Watane ◽

Kara M Cavuoto ◽

Elizabeth a Vanner ◽

Jayanth Sridhar

Keyword(s):

United States ◽

The United States ◽

Cross Sectional ◽

Male And Female ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Association between food insecurity and access to a mental health professional: cross-sectional analysis of NHANES 2007–2014

BMC Public Health ◽

10.1186/s12889-021-10818-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nina Camille Burruss ◽

Marina Girgis ◽

Karen Elizabeth Green ◽

Lingyi Lu ◽

Deepak Palakshappa

Keyword(s):

Mental Health ◽

Health Professional ◽

Food Insecurity ◽

Mental Health Professional ◽

The United States ◽

Bivariate Analysis ◽

Cross Sectional ◽

The Past ◽

Cross Sectional Analysis ◽

Sectional Analysis

Abstract Background To determine if individuals with food insecurity (FI) were less likely to have seen a mental health professional (MHP) within the past year than individuals without FI. Methods This is a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) conducted in the United States between 2007 and 2014. All participants 20 years of age or older were eligible for this study. We excluded participants who were pregnant, missing FI data, or missing data from the Patient Health Questionnaire (PHQ-9). The primary outcome was self-reported contact with a MHP in the past 12 months. We used multivariable logistic regression models to test the association between FI and contact with a MHP, controlling for all demographic and clinical covariates. Results Of the 19,789 participants, 13.9% were food insecure and 8.1% had major depressive disorder (MDD). In bivariate analysis, participants with FI were significantly more likely to have MDD (5.3% vs 2.8%, p < 0.0001) and to have been seen by a MHP in the preceding 12 months (14.0% vs 6.9%, p < 0.0001). In multivariable models, adults with FI had higher odds of having seen a MHP (OR = 1.32, CI: 1.07, 1.64). Conclusions This study demonstrates that individuals with FI were significantly more likely to have seen a MHP in the preceding 12 months compared to individuals without FI. Given the growing interest in addressing unmet social needs in healthcare settings, this data suggests that visits with MHPs may be a valuable opportunity to screen for and intervene on FI.

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Prevalence of systemic lupus erythematosus in Spain: higher than previously reported in other countries?

Rheumatology ◽

10.1093/rheumatology/kez668 ◽

2020 ◽

Vol 59 (9) ◽

pp. 2556-2562 ◽

Cited By ~ 4

Author(s):

Raúl Cortés Verdú ◽

José M Pego-Reigosa ◽

Daniel Seoane-Mato ◽

Mercedes Morcillo Valle ◽

Deseada Palma Sánchez ◽

...

Keyword(s):

Lupus Erythematosus ◽

Adult Population ◽

Geographical Area ◽

Geographic Origin ◽

The United States ◽

Epidemiological Studies ◽

Population Based ◽

Cross Sectional Study ◽

Medical Visit ◽

Cross Sectional

Abstract Objectives Prevalence of SLE varies among studies, being influenced by study design, geographical area and ethnicity. Data about the prevalence of SLE in Spain are scarce. In the EPISER2016 study, promoted by the Spanish Society of Rheumatology, the prevalence estimate of SLE in the general adult population in Spain has been updated and its association with sociodemographic, anthropometric and lifestyle variables has been explored. Methods Population-based multicentre cross-sectional study, with multistage stratified and cluster random sampling. Participants were contacted by telephone to carry out a questionnaire for the screening of SLE. Investigating rheumatologists evaluated positive results (review of medical records and/or telephone interview, with medical visit if needed) to confirm the diagnosis. To calculate the prevalence and its 95% CI, the sample design was taken into account and weighing was calculated considering age, sex and geographic origin. Multivariate logistic regression models were defined to analyse which sociodemographic, anthropometric and lifestyle variables included in the telephone questionnaire were associated with the presence of SLE. Results 4916 subjects aged 20 years or over were included. 16.52% (812/4916) had a positive screening result for SLE. 12 cases of SLE were detected. The estimated prevalence was 0.21% (95% CI: 0.11, 0.40). SLE was more prevalent in the rural municipalities, with an odds ratio (OR) = 4.041 (95% CI: 1.216, 13.424). Conclusion The estimated prevalence of SLE in Spain is higher than that described in most international epidemiological studies, but lower than that observed in ethnic minorities in the United States or the United Kingdom.

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