Abstract 281: Contemporary Epidemiology of Atrial Fibrillation Among Medicare Beneficiaries, 2004-2013

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Joshua Parker ◽  
Rohan Khera ◽  
Ambarish Pandey ◽  
Daniel Cheeran ◽  
Colby Ayers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Black Men ◽  
White Men ◽  
National Sample ◽  
Outpatient Setting ◽  
Relative Increase ◽  
Racial Groups ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Men And Women

Background: Atrial fibrillation (AF) is the most common dysrhythmia in clinical practice, and is a significant contributor to morbidity and mortality. Prior reports have projected a large increase in AF burden over time. A contemporary assessment of epidemiology is needed to assess if an emphasis of prevention strategies over the last decade has been effective in alleviating this risk. Methods: We used a 5% national sample of all Medicare beneficiaries in the US from 2002 through 2013 to construct a longitudinal cohort of 2.3 million fee-for-service Medicare beneficiaries administratively followed for ≥2 years using claims data. Trends in incident and prevalent AF were assessed for 2004 through 2013. Using ICD-9 codes, encounters with AF were identified from inpatient, outpatient, and physician claims. AF during the first 2 years of entry into the cohort was defined as pre-existing AF. Incident AF was defined as having either 1 inpatient claim with a diagnosis of AF or 2 outpatient or physician claims with AF. Calendar-year prevalence comprised pre-existing and incident AF for the respective years as well as those with incident AF in preceding years. Age-adjusted time trends were assessed using Poisson regression. Results: Between 2002 and 2013, 219,570 patients had incident AF. At incidence, mean age was 79 years, 55% were women, and 92% and 5% were white and black, respectively. Age-adjusted AF incidence decreased by 0.4/1000 per year between 2004 (20/1000) and 2013 (17/1000). While incidence declined for white men and women (P<.05), it has remained unchanged for black men and women (Figure). Proportion of incident events in the outpatient setting increased from 26% to 40%. One-year mortality was 9%, and remained unchanged throughout the study period. Over this period, the overall prevalence of AF decreased by 0.9/1000 per year (p<.05), however, there was a relative increase in AF prevalence among black men. Conclusions: Between years 2004 and 2013, the overall incidence and prevalence of AF among a 5% sample of Medicare beneficiaries stabilized. There were, however, differences across racial groups, with a slight decline in incidence among white men and women, which was not observed in black men and women.

Abstract 15: Trends in Atrial Fibrillation-related Cardiovascular Mortality Rates in The United States: 1999-2017

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Yoshihiro Tanaka ◽  
Nilay Shah ◽  
Rod Passman ◽  
Philip Greenland ◽  
Sadiya Khan
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Black Men ◽  
Cause Of Death ◽  
Age Groups ◽  
White Men ◽  
The United States ◽  
Mortality Rates ◽  
Men And Women ◽  
Black And White

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and the prevalence is increasing due to the aging of the population and the growing burden of vascular risk factors. Although deaths due to cardiovascular disease (CVD) death have dramatically decreased in recent years, trends in AF-related CVD death has not been previously investigated. Purpose: We sought to quantify trends in AF-related CVD death rates in the United States. Methods: AF-related CVD death was ascertained using the CDC WONDER online database. AF-related CVD deaths were identified by listing CVD (I00-I78) as underlying cause of death and AF (I48) as contributing cause of death among persons aged 35 to 84 years. We calculated age-adjusted mortality rates (AAMR) per 100,000 population, and examined trends over time estimating average annual percent change (AAPC) using Joinpoint Regression Program (National Cancer Institute). Subgroup analyses were performed to compare AAMRs by sex-race (black and white men and women) and across two age groups (younger: 35-64 years, older 65-84 years). Results: A total of 522,104 AF-related CVD deaths were identified between 1999 and 2017. AAMR increased from 16.0 to 22.2 per 100,000 from 1999 to 2017 with an acceleration following an inflection point in 2009. AAPC before 2009 was significantly lower than that after 2009 [0.4% (95% CI, 0.0 - 0.7) vs 3.5% (95% CI, 3.1 - 3.9), p < 0.001). The increase of AAMR was observed across black and white men and women overall and in both age groups (FIGURE), with a more pronounced increase in black men and white men. Black men had the highest AAMR among the younger decedents, whereas white men had the highest AAMR among the older decedents. Conclusion: This study revealed that death rate for AF-related CVD has increased over the last two decades and that there are greater black-white disparities in younger decedents (<65 years). Targeting equitable risk factor reduction that predisposes to AF and CVD mortality is needed to reduce observed health inequities.

scholarly journals Gender Differences in 30-Day Re-Hospitalization Among Medicare Beneficiaries With Alzheimer’s and Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 697-697
Author(s):  
Andrea Gilmore-Bykovskyi
Keyword(s):  
Gender Differences ◽  
Cognitive Decline ◽  
Primary Outcome ◽  
African American Men ◽  
White Men ◽  
National Sample ◽  
Medicare Beneficiaries ◽  
Index Hospitalization ◽  
The Impact ◽  
Racial Ethnic

Abstract Hospitalization is associated with accelerated cognitive decline for persons with Alzheimer’s disease and related dementia (ADRD), which disproportionately impacts women. Persons with ADRD are also at higher risk for 30-day rehospitalization, which may compound the impact of hospitalization-related exposures that precipitate decline. Evidence surrounding the intersections between gender and rehospitalization risk among diverse, representative populations with ADRD are lacking. This retrospective cohort study used a 100% national sample of Medicare beneficiaries with a diagnosis of ADRD and qualifying index hospitalization in 2014 (n= 1,033,144 unique beneficiaries and 1,672,238 unique stays). The primary outcome was rate of 30-day rehospitalization by gender and race. Within each racial group, men have higher rehospitalization rates than women: 2.6% higher among white men, 1.7% among African American men, and 2.6% higher among other racial/ethnic minorities. Findings highlight the importance of elucidating mechanisms underlying gender differences in hospital utilization and subsequent impact on cognitive decline.

scholarly journals National Rates of Warfarin Use in Medicare Patients with Atrial Fibrillation: Results from the National Stroke Project

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 328-328
Author(s):  
David S Nilasena ◽  
Timothy F Kresowik ◽  
Anton F Piskac ◽  
Rebecca A Hemann ◽  
Marian A Brenton ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Warfarin Therapy ◽  
District Of Columbia ◽  
National Sample ◽  
The State ◽  
Medicare Beneficiaries ◽  
Medicare Patients ◽  
Project Data ◽  
Demographic Subgroups ◽  
Univariate Analyses

66 Background: The National Stroke Project is a HCFA initiative to improve stroke related hospital care for Medicare beneficiaries. As part of the evaluation of these efforts, HCFA is measuring performance on a set of quality indicators at the state and national levels. We report the baseline results for a key quality indicator for this project: warfarin at discharge for patients with atrial fibrillation (AF). Methods: Project data were abstracted from a national sample of Medicare inpatient charts with a principal or secondary diagnosis of AF (ICD-9-CM 427.31) and discharged between 4/98 and 3/99. All U.S. states, the District of Columbia, and Puerto Rico were sampled using a systematic random approach. Eligible patients were required to have physician confirmation of AF during the hospitalization and at discharge, or intermittent AF. The main outcome measure was a prescription or physician documented plan for warfarin at discharge. Results: Of 38,925 cases reviewed, 12,303 met the inclusion criteria. Many of the cases (38.3%) were excluded due to a history or current finding of hemorrhage. Nationwide, 6,633 (unadjusted rate, 53.9%) patients were prescribed warfarin at discharge or had a plan to start warfarin after discharge. The state-specific rates ranged from 30.7% to 65.3%. Univariate analyses showed that warfarin was prescribed less frequently (p<0.002) for adults 85 years of age and older (rate=39.9%, OR=0.47, 95% CI=0.43–0.51) and women (rate=52.0%, OR=0.83, 95% CI=0.78–0.90). African-Americans (rate=47.2%, OR=0.76 95% CI=0.63–0.90) and Asians (n=108, rate=37.0%, OR=0.50, 95% CI=0.34–0.74) were also found to have lower warfarin therapy rates. Conclusions: The results from this large national sample confirm the findings from other reports that there is substantial under-utilization of warfarin therapy for stroke prevention among Medicare patients with AF. This is particularly true for demographic subgroups at high risk for stroke. Quality improvement efforts are currently underway through HCFA’s National Stroke Project (AF topic) to increase warfarin use in appropriate AF patients.

Abstract TP493: Herpes Zoster Vaccine Live And Risk For Stroke Among Medicare Beneficiaries: Population Based Matched Cohort Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Quanhe YANG ◽  
Anping Chang ◽  
Xin Tong ◽  
Robert Merritt
Keyword(s):  
Herpes Zoster ◽  
Hemorrhagic Stroke ◽  
Population Based ◽  
Racial Groups ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Zoster Vaccine ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of

Introduction: Herpes zoster (HZ) is associated with increased risk of stroke, and Zoster Vaccine Live (ZVL) reduces risk of HZ. No study examined the association between ZVL and risk for stroke. The present study examined this association among US older population. Methods: We included 1,382,051 Medicare fee-for-service beneficiaries age ≥66 years without a history of stroke and who received ZVL during 2008-2014, and 1,382,051 matched controls (using a comprehensive list of matching variables) without ZVL followed from ZVL receipt to December 31 2016. We used Cox proportional hazard models to examine the association between ZVL and composite fatal/non-fatal incident stroke outcomes. Results: During a median of 3.9 years follow-up (interquartile range 2.7-5.4), we documented 42,267 stroke events including 33,510 acute ischemic strokes (AIS) and 4,318 hemorrhagic strokes among beneficiaries who received ZVL over 5,890,113 person years. The corresponding numbers for controls were 48,139, 39,334, and 4,713 during 5,693,943 person years. Crude incidence comparing beneficiaries with and without ZVL were 7.18 vs. 8.45 per 1000 person years for all stroke, 5.40 vs. 6.53 for AIS, and 0.73 vs. 0.82 for hemorrhagic stroke (p<0.001 for difference). Adjusted hazard ratios comparing beneficiaries with ZVL to controls were 0.84 (95% CI 0.83-0.85), 0.82 (0.81-0.83), and 0.88 (0.84-0.91) for all stroke, AIS and hemorrhagic stroke respectively. The association between ZVL and risk for stroke appeared to be stronger among beneficiaries 66-79 years compared to those ≥80 years of age (p=0.020 for interaction), but largely consistent across sex, and racial groups. Conclusion: Among Medicare beneficiaries, receipt of ZVL was associated with lower incidence of stroke. Further study is needed to confirm our findings.

Abstract P001: Retirement Age And 20-year Cognitive Decline: The Atherosclerosis Risk In Communities Neurocognitive Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Albert Liu ◽  
Mehul D Patel ◽  
Alden L Gross ◽  
Thomas Mosley ◽  
Andreea Rawlings ◽  
...  
Keyword(s):  
Black Women ◽  
Cognitive Decline ◽  
Black Men ◽  
Occupational Status ◽  
White Men ◽  
Men And Women ◽  
Atherosclerosis Risk In Communities ◽  
Status Score ◽  
Lower Baseline ◽  
Atherosclerosis Risk

Background: The effect of retirement on cognitive functioning is not clear. We examined the association between age at retirement, midlife occupation, and cognitive decline in the large Atherosclerosis Risk in Communities (ARIC) biracial community-based cohort. Methods: Retirement status after ARIC visit 4 (1996-98) was reported in annual follow-up questionnaires administered in 1999-2007 (n= 8,426), and classified as occurring before or after age 70. Current or most recent occupation at visit 1 (1987-89) was categorized based on 1980 US census major occupation groups and tertiles of Nam-Powers-Boyd occupational status score (a measure of socioeconomic status of occupations, hereby used as a proxy for occupational complexity). Generalized estimating equation models were used to examine the associations of retirement with trajectories of a global cognitive factor score, assessed in 1990-92 (visit 2), 1996-98 (visit 4) and 2011-2013 (visit 5). Models were a priori stratified by race and sex and adjusted for demographics and comorbidities. To account for attrition, we also performed multiple imputation by chained equations. Results: Retirement before age 70 is associated with higher educational level and higher occupational status score in white men and women, and in black men. We observed associations between retirement before age 70 and lower baseline cognitive scores, as well as slower cognitive decline in white men and women, and in black men (Figure). The results did not change substantially after adjusting for the occupational status score or accounting for attrition. Conclusion: Retirement before age 70 was significantly associated with lower baseline cognitive scores and slower cognitive decline in whites and in black men. The lack of similar associations in black women and the investigation of reasons for the observed associations warrant further research.

Confronting Removal

2018 ◽  
pp. 83-100
Author(s):  
Amy Murrell Taylor
Keyword(s):  
Black Women ◽  
Black Men ◽  
Mississippi River ◽  
White Men ◽  
People Of Color ◽  
Men And Women ◽  
Racial Ideologies ◽  
The People ◽  
Competing Ideas ◽  
The Relationship

This chapter focuses on the relationship between race and space—between competing ideas for how people of different races should reside spatially—by looking at the Union army’s various attempts to remove refugees en masse. These removals attempted to resettle the people in places far removed from active combat, including northern states, islands in the Mississippi River, and even Haiti. Some of these efforts bore a great deal of resemblance to antebellum colonization plans, and, as in those cases, black men and women in the Civil War largely resisted being sent away. Most of the removals were justified by white officials in environmental terms, driven by racial ideologies that linked particular climates and landscapes to people of color. The chapter also argues that removals were sometimes triggered by concerns about gender and sex too—by beliefs that the physical proximity of black women and white men in military encampments had made rape inevitable.

scholarly journals Impact of Incident Cancer on Short-Term Coronary Artery Disease–Related Healthcare Expenditures Among Medicare Beneficiaries

2019 ◽  
Vol 17 (2) ◽  
pp. 149-158
Author(s):  
Ishveen Chopra ◽  
Malcolm D. Mattes ◽  
Patricia Findley ◽  
Xi Tan ◽  
Nilanjana Dwibedi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Home Healthcare ◽  
Close Monitoring ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Healthcare Expenditures ◽  
Men And Women ◽  
Incident Cancer ◽  
Artery Disease

Background: Healthcare spending for coronary artery disease (CAD)–related services is higher than for other chronic conditions. Diagnosis of incident cancer may impede management of CAD, thereby increasing the risk of CAD-related complications and associated healthcare expenditures. This study examined the relationship between incident cancer and CAD-related expenditures among elderly Medicare beneficiaries. Patients and Methods: A retrospective longitudinal study was conducted using the SEER-Medicare linked registries and a 5% noncancer random sample of Medicare beneficiaries. Elderly fee-for-service Medicare beneficiaries with preexisting CAD and with incident breast, colorectal, or prostate cancer (N=12,095) or no cancer (N=34,237) were included. CAD-related healthcare expenditures comprised Medicare payments for inpatient, home healthcare, and outpatient services. Expenditures were measured every 120 days during the 1-year preindex and 1-year postindex periods. Adjusted relationship between incident cancer and expenditures was analyzed using the generalized linear mixed models. Results: Overall, CAD-related mean healthcare expenditures in the preindex period accounted for approximately 32.6% to 39.5% of total expenditures among women and 41.5% to 46.8% among men. All incident cancer groups had significantly higher CAD-related expenditures compared with noncancer groups (P<.0001). Men and women with colorectal cancer (CRC) had 166% and 153% higher expenditures, respectively, compared with their noncancer counterparts. Furthermore, men and women with CRC had 57% and 55% higher expenditures compared with those with prostate or breast cancer, respectively. Conclusions: CAD-related expenditures were higher for elderly Medicare beneficiaries with incident cancer, specifically for those with CRC. This warrants the need for effective programs and policies to reduce CAD-related expenditures. Close monitoring of patients with a cancer diagnosis and preexisting CAD may prevent CAD-related events and expenditures.

scholarly journals Dietary intake of Brazilian black and white men and its relationship to the bone mineral density of the femoral neck

2006 ◽  
Vol 124 (5) ◽  
pp. 267-270 ◽  
Author(s):  
Patrícia Constante Jaime ◽  
Maria do Rosário Dias de Oliveira Latorre ◽  
Alex Antonio Florindo ◽  
Tomoe Tanaka ◽  
Cristiano Augusto de Freitas Zerbini
Keyword(s):  
Bone Mineral Density ◽  
Femoral Neck ◽  
Black Men ◽  
Energy Intake ◽  
Bone Mineral ◽  
White Men ◽  
Racial Groups ◽  
Mineral Density ◽  
Black And White ◽  
The Relationship

CONTEXT AND OBJECTIVE: Osteoporosis and fragility fractures are an important public health problem. Although bone loss occurs with age universally, the incidence of bone loss fractures varies greatly between racial groups. The aim of this study was to examine the relationship between calcium, protein and energy intake and the bone mineral density of the femoral neck in Brazilian black and white men. DESIGN AND SETTING: This was a cross-sectional study, carried out in a teaching hospital in São Paulo. METHODS: The participants were 277 volunteer men, aged 50 years or older. The bone mineral density of the femoral neck (FNBMD) was measured by dual energy x-ray absorptiometry. The relationship between FNBMD and calcium, protein and energy intake, as assessed by a three-day food record, was analyzed using multiple linear regression models and was adjusted for age, height, physical activity and education level. The analysis was stratified by race (white and black). RESULTS: FNBMD presented similar means in the two racial groups (p = 0.538). Protein and energy intake did not show a significant correlation with FNBMD, either in the white or in the black population. Calcium intake showed a strong and independent correlation with FNBMD in the black men (partial r = 0.42). CONCLUSION: Calcium intake was a determinant of FNBMD for black men, aged 50 years or older, but not for the white ones.

Literacy Skills and Earnings: Race and Gender Differences

2007 ◽  
Vol 34 (3-4) ◽  
pp. 231-243 ◽  
Author(s):  
Roberto M. De Anda ◽  
Pedro M. Hernandez
Keyword(s):  
Black Women ◽  
Black Men ◽  
Adult Literacy ◽  
White Men ◽  
Literacy Skills ◽  
Literacy Skill ◽  
Men And Women ◽  
Race And Gender ◽  
And Gender ◽  
Document Literacy

This study examines differences in returns to literacy skills on earnings of black and white men and women. Literacy skill is a composite measure of three scales: reading comprehension, document literacy (the ability to locate and use information in, say, tables and graphs), and mathematics proficiency. Using data from the National Adult Literacy Survey (NALS), we estimate earnings determination models separately for each racial/gender group. Our findings show that the effect of literacy on earnings varies by race and gender. Literacy skills favorably rewarded black men relative to black women and white men and women, net of education and other relevant variables. More importantly, literacy completely explained the effect of a high school diploma and some college on earnings of black men. We conclude that the economic importance of literacy skills is particularly salient for less-educated black men.

The Earnings of Women and Ethnic Minorities, 1959–1979

ILR Review ◽  
1988 ◽  
Vol 41 (4) ◽  
pp. 530-546 ◽  
Author(s):  
Leonard A. Carlson ◽  
Caroline Swartz
Keyword(s):  
Asian Indian ◽  
White Women ◽  
Census Data ◽  
White Men ◽  
Racial Groups ◽  
Japanese Men ◽  
Men And Women ◽  
Earnings Gap ◽  
Minority Men ◽  
Annual Earnings

Using 1980 Census data, the authors present estimates of annual earnings equations for twelve ethnic and racial groups, by gender, for 1979, and compare their results with an earlier study's estimates for 1959 and 1969. All minority men and women except Asian Indian and Japanese men earned less than white men in the years for which data were available. The earnings gap for most groups of men and women, however, declined over those years, and the portion of that gap that might be assignable to discrimination (the unexplained “residual”) also declined. A notable exception was white women, whose mean earnings relative to white men's changed little between 1969 and 1979, even when corrected for differences in productive characteristics.

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