Emerging Multimorbidity Patterns and Its Linkages With Selected Health Outcomes Among Working-Agegroup Population: Findings From Odisha, India

The study utilized data on 2912 individuals in the age-group 15-64 years collected under the burden of diseases study among patients attending public health care settings of Odisha, India. The findings suggested that 2.4% of the individuals in the working age-group were affected with multimorbidity. We utilized a latent class analysis (LCA) to identify commonly occurring disease clusters. Based on the LCA model fits, i.e., lowest AIC and BIC values, two latent disease classes were identified. These classes were named low co-morbidity and Hypertension-Diabetes-Arthritis; based on the item responseprobabilities. Binary logistic regression adjusted for age, sex, ethnicity, educationlevel, marital status, socio-economic status, residence, and health insurance, highlighted thatage, belonging to a non-aboriginal ethnicity and urban area increased the risk of being in the‘Hypertension-Diabetes-Arthritis’group compared to ‘low-comorbidity’ group. Furthermore, 50% of the individual in the ‘Hypertension-Diabetes-Arthritis’ group reportedpoor quality of life, whereas 30% reported poor self-rated health (SRH) compared to only11% reporting poor SRH in the ‘low-comorbidity’ group. Additionally, the mean healthscore reported by the individuals in the ‘Hypertension-Diabetes-Arthritis’ group was 39.9(scale 0-100) compared to 46.9 by their counterparts.

Comparison of Late HIV Diagnosis as a Marker of Care for Aboriginal Versus Non-Aboriginal People Living with HIV in Ontario

BACKGROUND: Studies have found that Aboriginal people living with HIV/AIDS (APHAs) are more likely than non-APHAs to receive suboptimal HIV care, yet achieve similar clinical outcomes with proper care.OBJECTIVE: To compare the proportions of individuals diagnosed late with HIV between APHAs and non-APHAs within the Ontario HIV Treatment Network Cohort Study (OCS).METHODS: The analysis included OCS participants who completed the baseline visit by November 2009. Two definitions of the outcome of late HIV diagnosis were used: the proportion of participants with an AIDS-defining illness (ADI) before or within three months of HIV diagnosis; and the proportion of participants with a CD4+count <200 cells/mL at diagnosis. Logistic regression analysis was used to assess the association between Aboriginal ethnicity and late HIV diagnosis.RESULTS: APHAs were more likely to be female and have lower income, education and employment. No statistically significant differences were noted in the proportions receiving a late HIV diagnosis defined by ADI (Aboriginal 5.2% versus non-Aboriginal 6.3%; P=0.40). Multivariate logistic regression analysis revealed a significant association between Aboriginal ethnicity and late HIV diagnosis defined by CD4+count after adjusting for age and HIV risk factor (OR 1.55; P=0.04).DISCUSSION: APHAs were more likely to have a CD4+count <200 cells/mL at diagnosis but had similar clinical outcomes from late diagnosis when defined by ADI. However, differences may be underestimated due to recruitment limitations and selection bias.CONCLUSION: Additional work is needed to address the socioeconomic and health care needs of APHAs.

Presentation and Management of Pediatric Orbital Cellulitis

BACKGROUND: Orbital cellulitis is a serious, vision-threatening infection.OBJECTIVE: To review the epidemiology and clinical data of pediatric orbital cellulitis in Manitoba.METHODS: A 12-year retrospective review was conducted of all children (younger than 18 years of age) with orbital cellulitis admitted to Manitoba’s only tertiary pediatric centre. Admission rates for orbital cellulitis were compared over three distinct time periods, based on licensure and funding levels of the heptavalent pneumococcal conjugate vaccine (PCV7) in Manitoba.RESULTS: Thirty-eight patients with orbital cellulitis were identified. Of these, 11% were of Aboriginal ethnicity in contrast with 30% to 40% of children who were admitted for other respiratory illnesses. Subperiosteal abscesses occurred in 31.5%. Only eight patients (21%) required surgery. Follow-up imaging after presentation usually did not indicate a need for subsequent surgical drainage. The mean number of orbital cellulitis cases per 1000 admissions for the following periods – before PCV7 licensure, after licensure and before full provincial funding, and after licensure and full funding – were 0.39, 0.53 and 0.90, respectively. No significant difference was noted among any of the periods as PCV7 coverage increased.CONCLUSIONS: The rate of subperiosteal abscesses was lower than other reports. This may be due to the median age at presentation. In contrast to admissions for most other respiratory infections at the Winnipeg Children’s Hospital (Winnipeg, Manitoba), Aboriginal ethnicity was uncommon. Surprisingly, rates of admissions for orbital cellulitis appeared to show an increasing trend with increasing access to PCV7 in Manitoba, although overall the number of cases was very small. Studies into the changing microbiology of orbital cellulitis and sinusitis are warranted.

Factors Associated with Spontaneous Clearance of Hepatitis C Virus among Illicit Drug Users

BACKGROUND: Spontaneous clearance of hepatitis C virus (HCV) occurs in approximately 25% of individuals.METHODS: To better understand the characteristics associated with clearance, the present study evaluated HCV clearance in a community-based cohort study. The Community Health and Safety Evaluation project recruited 3553 individuals via community organizations and door-to-door canvassing of a random sample of single occupancy hotels in the community to monitor uptake of health services and to estimate the incidence of communicable infections. Cohort data were linked with longitudinal laboratory databases, including HCV antibody and polymerase chain reaction assay results.RESULTS: Overall, 762 individuals had HCV antibody and RNA testing performed between 1999 and 2005. Spontaneous HCV clearance was observed in 179 individuals (23.5%), while HCV persistence was observed in 583 individuals (76.5%). The ability to develop protective immunity against HCV, as demonstrated by viral clearance, occurred more often in individuals of Aboriginal ethnicity (adjusted OR [AOR] 2.9, 95% CI 2.0 to 4.3; P<0.001) and female individuals (AOR 1.6, 95% CI 1.1 to 2.4; P=0.01). The rate of spontaneous HCV clearance was reduced in individuals using any type of illicit drugs (AOR 0.54, 95% CI 0.29 to 1.00; P=0.05) and those with HIV coinfection (AOR 0.58, 95% CI 0.38 to 0.88; P=0.01). Of 218 HIV-infected subjects, 48 of 51 (94%) in whom the order of HCV and HIV infection was established were infected with HCV a median of 2.4 years (range 0.2 to 10 years) before becoming infected with HIV.CONCLUSIONS: Aboriginal ethnicity and female sex were associated with increased rates of HCV clearance, while HIV coinfection and illicit drug use were associated with increased HCV persistence.