scholarly journals Sociodemographic and Clinical Risk Factors Associated With Tuberculosis Mortality in the United States, 2009-2013

2017 ◽  
Vol 132 (3) ◽  
pp. 366-375 ◽  
Author(s):  
Haylea A. Hannah ◽  
Roque Miramontes ◽  
Neel R. Gandhi
Keyword(s):  
United States ◽  
Risk Factors ◽  
Multinomial Logistic Regression ◽  
The United States ◽  
Multidrug Resistant ◽  
Multinomial Logistic Regression Analysis ◽  
Factors Associated ◽  
Specific Mortality ◽  
Stage Renal Disease ◽  
End Stage

Objectives: The objectives of our study were (1) to determine risk factors associated with tuberculosis (TB)–specific and non–TB-specific mortality among patients with TB and (2) to examine whether risk factors for TB-specific mortality differed from those for non–TB-specific mortality. Methods: We obtained data from the National Tuberculosis Surveillance System and included all patients who had TB between 2009 and 2013 in the United States and its territories. We used multinomial logistic regression analysis to determine the adjusted odds ratio (aOR) of each risk factor for TB-specific and non–TB-specific mortality. Results: Of 52 175 eligible patients with TB, 1404 died from TB, and 2413 died from other causes. Some of the risk factors associated with the highest odds of TB-specific mortality were multidrug-resistant TB diagnosis (aOR = 3.42; 95% CI, 1.95-5.99), end-stage renal disease (aOR = 3.02; 95% CI, 2.23-4.08), human immunodeficiency virus infection (aOR = 2.63; 95% CI, 2.02-3.42), age 45-64 years (aOR = 2.57; 95% CI, 2.01-3.30) or age ≥65 years (aOR = 5.76; 95% CI, 4.37-7.61), and immunosuppression (aOR = 2.20; 95% CI, 1.71-2.83). All of these risk factors except multidrug-resistant TB were also associated with increased odds of non–TB-specific mortality. Conclusion: TB patients with certain risk factors have an elevated risk of TB-specific mortality and should be monitored before, during, and after treatment. Identifying the predictors of TB-specific mortality may help public health authorities determine which subpopulations to target and where to allocate resources.

scholarly journals Pre-End-Stage Renal Disease Care Not Associated with Dialysis Facility Neighborhood Poverty in the United States

2014 ◽  
Vol 39 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Laura C. Plantinga ◽  
Min Kim ◽  
Margarethe Goetz ◽  
David G. Kleinbaum ◽  
William McClellan ◽  
...  
Keyword(s):  
United States ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Neighborhood Poverty ◽  
Dialysis Facility ◽  
Stage Renal Disease ◽  
End Stage

Environmental risk factors associated with Helicobacter pylori seroprevalence in the United States: a cross-sectional analysis of NHANES data

2015 ◽  
Vol 143 (12) ◽  
pp. 2520-2531 ◽  
Author(s):  
W. S. KRUEGER ◽  
E. D. HILBORN ◽  
R. R. CONVERSE ◽  
T. J. WADE
Keyword(s):  
United States ◽  
Risk Factors ◽  
Helicobacter Pylori ◽  
Environmental Risk ◽  
The United States ◽  
Environmental Risk Factors ◽  
Living Conditions ◽  
Well Water ◽  
Factors Associated ◽  
H Pylori

SUMMARYHelicobacter pylori imparts a considerable burden to public health. Infections are mainly acquired in childhood and can lead to chronic diseases, including gastric ulcers and cancer. The bacterium subsists in water, but the environment's role in transmission remains poorly understood. The nationally representative National Health and Nutrition Examination Survey (NHANES) was examined for environmental risk factors associated with H. pylori seroprevalence. Data from 1999–2000 were examined and weighted to represent the US population. Multivariable logistic regression estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for associations with seropositivity. Self-reported general health condition was inversely associated with seropositivity. Of participants aged <20 years, seropositivity was significantly associated with having a well as the source of home tap water (aOR 1·7, 95% CI 1·1–2·6) and living in a more crowded home (aOR 2·3, 95% CI 1·5–3·7). Of adults aged ⩾20 years, seropositivity was not associated with well water or crowded living conditions, but adults in soil-related occupations had significantly higher odds of seropositivity compared to those in non-soil-related occupations (aOR 1·9, 95% CI 1·2–2·9). Exposures to both well water and occupationally related soil increased the effect size of adults' odds of seropositivity compared to non-exposed adults (aOR 2·7, 95% CI 1·3-5·6). Environmental exposures (well-water usage and occupational contact with soil) play a role in H. pylori transmission. A disproportionate burden of infection is associated with poor health and crowded living conditions, but risks vary by age and race/ethnicity. These findings could help inform interventions to reduce the burden of infections in the United States.

scholarly journals High Costs of Dialysis Transportation in the United States: Exploring Approaches to a More Cost-effective Delivery System

10.36469/9861 ◽  
2013 ◽  
Vol 1 (2) ◽  
pp. 134-150 ◽  
Author(s):  
J. Mark Stephens ◽  
Samuel Brotherton ◽  
Stephan C. Dunning ◽  
Larry C. Emerson ◽  
David T. Gilbertson ◽  
...  
Keyword(s):  
United States ◽  
Public Transportation ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Levels Of Care ◽  
Dialysis Facility ◽  
Effective Delivery ◽  
Stage Renal Disease ◽  
End Stage

Background: The costs of transporting end-stage renal disease (ESRD) patients to dialysis centers are high and growing rapidly. Research has suggested that substantial cost savings could be achieved if medically appropriate transport was made available and covered by Medicare. Objectives: To estimate US dialysis transportation costs from a purchaser’s perspective, and to estimate cost savings that could be achieved if less expensive means of transport were utilized. Methods: Costs were estimated using an actuarial model. Travel distance estimates were calculated using GIS software from patient ZIP codes and dialysis facility addresses. Cost and utilization estimates were derived from fee schedules, government reports, transportation websites and peer-reviewed literature. Results: The estimated annual cost of dialysis transportation in the United States is $3.0 billion, half of which is for ambulances. Most other costs are due to transport via ambulettes, wheelchair vans and taxis. Approximately 5% of costs incurred are for private vehicle or public transportation use. If ambulance use dropped to 1% of trips from the current 5%, costs could be reduced by one-third. Conclusions: Decision-makers should consider policies to reduce ambulance use, while providing appropriate levels of care.

Abstract MP10: Increasing Obesity Prevalence in the United States End-stage Renal Disease Population

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Brittany Shelton ◽  
Deanna McWilliams ◽  
Rhiannon D Reed ◽  
Margaux Mustian ◽  
Paul MacLennan ◽  
...  
Keyword(s):  
United States ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Obesity Prevalence ◽  
The Us ◽  
Prevalence Of Obesity ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Obesity has become a national epidemic, and is associated with increased risk for comorbid diseases including end-stage renal disease (ESRD). Among ESRD patients, obesity may improve dialysis-survival but decreases likelihood of transplantation, and as such, obesity prevalence may directly impact growth of the incident dialysis population. Methods: Incident adult ESRD patients with complete body mass index (BMI, kg/m 2 ) data were identified from the United States Renal Data System from 01/01/1995-12/31/2010 (n=1,822,598). Data from the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (n=4,303,471) represented the US population when weighted. Trends in BMI and obesity classes I (BMI of 30-34.9), II (BMI of 35-39.9), and III (BMI ≥40) were examined by year of dialysis initiation. Trends in median BMI slope were compared between the ESRD and US populations using linear regression. Results: Median BMI of ESRD patients in 1995 was 24.2 as compared to 28.0 in 2010, a 15.7% increase, while the US population’s median BMI increased from 24.2 in 1995 to 25.6 in 2010, a 5.8% increase. Comparable trends were noted with respect to prevalence of obesity classes I, II, and III (Table). BMI increase among the ESRD population was significantly more rapid than among the US population (β: 0.15, 95% CI: 0.14-0.17, p<0.001) (Figure). Conclusion: The median BMI of ESRD patients and prevalence of obesity among ESRD patients is increasing more rapidly than the US population. Given the increased dialysis-survival and decreased likelihood of transplantation associated with obesity, healthcare costs will likely increase, and thus, future research should be directed at examining medical expenditures.

Acid–Base Disturbances

2014 ◽  
pp. 594-602
Author(s):  
Julian L. Seifter
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
End Stage Renal Disease ◽  
The United States ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Stage Renal Disease ◽  
End Stage

According to projections from the United States Renal Data Service (USRDS), 〉600,000 individuals in the United States will have end-stage renal disease (ESRD) by 2010. The leading cause of ESRD in the United State is diabetes, followed by hypertension. As the care of diabetic patients has improved, particularly in the area of cardiovascular disease, they are living through their cardiovascular complications long enough to develop ESRD. As a consequence, since the inception of the Medicare ESRD program. the dialysis population has gradually become older with increasing numbers of comorbid conditions. Renal replacement therapy in the form of hemodialysis or peritoneal dialysis may serve as a bridge to the best form of renal replacement, renal transplantation. The demand for suitable kidneys for transplantation far exceeds the supply, leaving many patients on dialysis for extended periods of time.

Sign in / Sign up

Export Citation Format

Share Document