Luo J.,West Virginia University |
Horn K.,West Virginia University |
Ockene J.K.,University of Massachusetts Medical School |
Simon M.S.,Hudson Webber Cancer Research Center |
And 3 more authors.
American Journal of Epidemiology | Year: 2011
Obesity is a well-established risk factor for postmenopausal breast cancer. Recent studies suggest that smoking increases the risk of breast cancer. However, the effect of co-occurrence of smoking and obesity on breast cancer risk remains unclear. A total of 76,628 women aged 50-79 years enrolled in the Women's Health Initiative Observational Study were followed through August 14, 2009. Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals. Over an average 10.3 years of follow-up, 3,378 incident cases of invasive breast cancer were identified. The effect of smoking on the risk of developing invasive breast cancer was modified significantly by obesity status among postmenopausal women, regardless of whether the obesity status was defined by body mass index (P interaction = 0.01) or waist circumference (P interaction = 0.02). A significant association between smoking and breast cancer risk was noted in nonobese women (hazard ratio = 1.25, 95% confidence interval: 1.05, 1.47) but not in obese women (hazard ratio = 0.96, 95% confidence interval: 0.69, 1.34). In conclusion, this study suggests that the effect of smoking exposure on breast cancer risk was modified by obesity among postmenopausal women. The modification effect did not differ by general versus abdominal obesity. © 2011 The Author.
Kottke T.E.,Health Partners Research Foundation |
Baechler C.J.,University of Minnesota |
Parker E.D.,HealthPartners Research Foundation
Preventing Chronic Disease | Year: 2012
Introduction: We developed a decision support tool that can guide the development of heart disease prevention programs to focus on the interventions that have the most potential to benefit populations. To use it, however, users need to know the prevalence of heart disease in the population that they wish to help. We sought to determine the accuracy with which the prevalence of heart disease can be estimated from health care claims data. Methods: We compared estimates of disease prevalence based on insurance claims to estimates derived from manual health records in a stratified random sample of 480 patients aged 30 years or older who were enrolled at any time from August 1, 2007, through July 31, 2008 (N = 474,089) in HealthPartners insurance and had a HealthPartners Medical Group electronic record. We compared randomly selected development and validation samples to a subsample that was also enrolled on August 1, 2005 (n = 272,348). We also compared the records of patients who had a gap in enrollment of more than 31 days with those who did not, and compared patients who had no visits, only 1 visit, or 2 or more visits more than 31 days apart for heart disease. Results: Agreement between claims data and manual review was best in both the development and the validation samples (Cohen's 8, 0.92, 95% confidence interval [CI], 0.87-0.97; and Cohen's 8, 0.94, 95% CI, 0.89-0.98, respectively) when patients with only 1 visit were considered to have heart disease. Conclusion: In this population, prevalence of heart disease can be estimated from claims data with acceptable accuracy.
Daugherty S.L.,University of Colorado at Denver |
Daugherty S.L.,Kaiser Permanente |
Powers J.D.,University of Colorado at Denver |
Powers J.D.,Kaiser Permanente |
And 12 more authors.
Circulation | Year: 2012
Background: Despite a recent American Heart Association (AHA) consensus statement emphasizing the importance of resistant hypertension, the incidence and prognosis of this condition are largely unknown. Methods and Results-This retrospective cohort study in 2 integrated health plans included patients with incident hypertension in whom treatment was begun between 2002 and 2006. Patients were followed up for the development of resistant hypertension based on AHA criteria of uncontrolled blood pressure despite use of ≥3 antihypertensive medications, with data collected on prescription filling information and blood pressure measurement. We determined incident cardiovascular events (death or incident myocardial infarction, heart failure, stroke, or chronic kidney disease) in patients with and without resistant hypertension with adjustment for patient and clinical characteristics. Among 205 750 patients with incident hypertension, 1.9% developed resistant hypertension within a median of 1.5 years from initial treatment (0.7 cases per 100 person-years of follow-up). These patients were more often men, were older, and had higher rates of diabetes mellitus than nonresistant patients. Over 3.8 years of median follow-up, cardiovascular event rates were significantly higher in those with resistant hypertension (unadjusted 18.0% versus 13.5%, P<0.001). After adjustment for patient and clinical characteristics, resistant hypertension was associated with a higher risk of cardiovascular events (hazard ratio, 1.47; 95% confidence interval, 1.33-1.62). Conclusions-Among patients with incident hypertension in whom treatment was begun, 1 in 50 patients developed resistant hypertension. Patients with resistant hypertension had an increased risk of cardiovascular events, which supports the need for greater efforts toward improving hypertension outcomes in this population. (Circulation. 2012;125:1635-1642.) © 2012 American Heart Association, Inc.
Luo J.,West Virginia University |
Sands M.,University of Pennsylvania |
Wactawski-Wende J.,State University of New York at Buffalo |
Song Y.,Harvard University |
Margolis K.L.,Health Partners Research Foundation
American Journal of Epidemiology | Year: 2013
Sleep disturbance has been found to be associated with numerous adverse health outcomes, including cancers. However, no epidemiologic study has examined the relation between sleep disturbance and thyroid cancer risk. A total of 142,933 postmenopausal women who were 50-79 years of age and enrolled in the Women's Health Initiative between September 1, 1993, and December 31, 1998, were followed up for a mean of 11 years. Cox proportional-hazard regression models were used to estimate hazard ratios and 95% confidence intervals for sleep disturbance (insomnia and sleep duration) and risk of thyroid cancer. Insomnia score was measured using a validated 5-item Women's Health Initiative Insomnia Rating Scale. Overall, a total of 295 thyroid cancer cases were identified. After adjustment for potential confounders, women with greater insomnia scores had a significantly higher risk of thyroid cancer than did women with low scores (hazard ratio = 1.44, 95% confidence interval: 1.01, 2.05). The significant association between insomnia score and thyroid cancer was confined to nonobese women (hazard ratio = 1.71, 95% confidence interval: 1.12, 2.62) and was not seen in obese women (hazard ratio = 0.94 95% confidence interval: 0.48, 1.84) (P for interaction = 0.07). In conclusion, postmenopausal women with greater insomnia scores, especially nonobese women, had a significantly increased risk of thyroid cancer. More studies are needed to confirm these findings. © The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.
Kim H.C.,Northwestern University |
Kim H.C.,Yonsei University |
Greenland P.,Northwestern University |
Rossouw J.E.,U.S. National Institutes of Health |
And 7 more authors.
Journal of the American College of Cardiology | Year: 2010
Objectives: The aim of this study was to investigate whether multiple biomarkers contribute to improved coronary heart disease (CHD) risk prediction in post-menopausal women compared with assessment using traditional risk factors (TRFs) only. Background: The utility of newer biomarkers remains uncertain when added to predictive models using only TRFs for CHD risk assessment. Methods: The Women's Health Initiative Hormone Trials enrolled 27,347 post-menopausal women ages 50 to 79 years. Associations of TRFs and 18 biomarkers were assessed in a nested case-control study including 321 patients with CHD and 743 controls. Four prediction equations for 5-year CHD risk were compared: 2 Framingham risk score covariate models; a TRF model including statin treatment, hormone treatment, and cardiovascular disease history as well as the Framingham risk score covariates; and an additional biomarker model that additionally included the 5 significantly associated markers of the 18 tested (interleukin-6, d-dimer, coagulation factor VIII, von Willebrand factor, and homocysteine). Results: The TRF model showed an improved C-statistic (0.729 vs. 0.699, p = 0.001) and net reclassification improvement (6.42%) compared with the Framingham risk score model. The additional biomarker model showed additional improvement in the C-statistic (0.751 vs. 0.729, p = 0.001) and net reclassification improvement (6.45%) compared with the TRF model. Predicted CHD risks on a continuous scale showed high agreement between the TRF and additional biomarker models (Spearman's coefficient = 0.918). Among the 18 biomarkers measured, C-reactive protein level did not significantly improve CHD prediction either alone or in combination with other biomarkers. Conclusions: Moderate improvement in CHD risk prediction was found when an 18-biomarker panel was added to predictive models using TRFs in post-menopausal women. © 2010 American College of Cardiology Foundation.
O'Connor P.J.,Health Partners Research Foundation |
Ismail-Beigi F.,Case Western Reserve University
Therapeutic Advances in Endocrinology and Metabolism | Year: 2011
Objective: To compare results of clinical trials that assessed the impact of near-normalization of glucose on microvascular complications in type 2 diabetes. Methods: ACCORD (N=10,234) and ADVANCE (N=11,140) tested the hypothesis that nearnormalization of glucose reduces microvascular complications in adults with established type 2 diabetes. Differences in incidence rates (intensive versus standard glucose control) for specific microvascular complications are expressed as 'number needed to treat' (NNT) to prevent one microvascular complication. The impact of blood pressure (BP) control and fenofibrate use on microvascular complications was also assessed. Results: In ADVANCE, near-normalization of glucose reduced new or worsening nephropathy (NNT=77 for 5 years to prevent one occurrence), but not eye or foot complications. In ACCORD, near-normalization of glucose did not reduce prespecified composite measures of advanced microvascular complications, and impact on secondary microvascular outcomes was mixed. The ancillary ACCORD Eye Study found reduced progression in retinopathy with nearnormalization of glucose (NNT=32 for 4 years), and with blinded fenofibrate therapy (NNT=27 for 4 years), but neither intervention reduced vision loss. ADVANCE showed a benefit of intensive BP control (mean BP 133/70 mmHg) on microvascular complications, independent of glucose control. Conclusions: End-stage microvascular complications were not altered by near-normalization of glucose. Some early manifestations of microvascular complications were reduced, with inconsistencies across studies in which were affected. These early and inconsistent microvascular effects must be weighed against significantly increased severe hypoglycemia, weight gain, and (in ACCORD) increased total mortality (NNT=94 for 3.5 years for one excess death) consistently found in all prespecified patient subgroups. Alternative clinical strategies, such as moderate BP control or fenofibrate treatment may reduce microvascular complications independent of glucose control. The data strongly support personalized glucose control goals based on clinical factors and patient preferences for outcomes. © The Author(s), 2010.
Kraschnewski J.L.,Penn State College of Medicine |
Boan J.,Penn State College of Medicine |
Esposito J.,Penn State College of Medicine |
Sherwood N.E.,University of Minnesota |
And 4 more authors.
International Journal of Obesity | Year: 2010
Context: Although the rise in overweight and obesity in the United States is well documented, long-term weight loss maintenance (LTWLM) has been minimally explored. Objective: The aim of this study is to estimate the prevalence and correlates of LTWLM among US adults.Design, setting and participants:We examined weight data from 14 306 participants (age 20-84 years) in the 1999-2006 National Health and Nutrition Examination Survey (NHANES). We defined LTWLM as weight loss maintained for at least 1 year. We excluded individuals who were not overweight or obese at their maximum weight. Results: Among US adults who had ever been overweight or obese, 36.6, 17.3, 8.5 and 4.4% reported LTWLM of at least 5, 10, 15 and 20%, respectively. Among the 17.3% of individuals who reported an LTWLM of at least 10%, the average and median weight loss maintained was 19.1 kg (42.1 pounds) and 15.5 kg (34.1 pounds), respectively. LTWLM of at least 10% was higher among adults of ages 75-84 years (vs ages 20-34, adjusted odds ratio (OR): 1.5; 95% confidence interval (CI): 1.2, 1.8), among those who were non-Hispanic white (vs Hispanic, adjusted OR: 1.6; 95% CI: 1.3, 2.0) and among those who were female (vs male, adjusted OR: 1.2; 95% CI: 1.1, 1.3). Conclusions: More than one out of every six US adults who has ever been overweight or obese has accomplished LTWLM of at least 10%. This rate is significantly higher than those reported in clinical trials and many other observational studies, suggesting that US adults may be more successful at sustaining weight loss than previously thought. © 2010 Macmillan Publishers Limited All rights reserved.
Health Partners Research Foundation and University of Minnesota | Date: 2012-05-07
The invention provides a method to prevent, inhibit or treat one or more neurological symptoms associated with a lysosomal storage disease in a mammal in need thereof, which includes intranasally administering to the mammal a composition comprising an effective amount of a lysosomal storage enzyme or a recombinant adeno-associated virus vector comprising an open reading frame encoding a lysosomal storage enzyme. Also provided are compositions and devices useful in the methods.
Adams A.S.,Kaiser Permanente |
Uratsu C.,Kaiser Permanente |
Dyer W.,Kaiser Permanente |
Magid D.,Kaiser Permanente |
And 6 more authors.
JAMA Internal Medicine | Year: 2013
Background: The purpose of this study was to identify potential health system solutions to suboptimal use of antihypertensive therapy in a diverse cohort of patients initiating treatment. Methods: Using a hypertension registry at Kaiser Permanente Northern California, we conducted a retrospective cohort study of 44 167 adults (age, ≥18 years) with hypertension who were new users of antihypertensive therapy in 2008. We used multivariate logistic regression analysis to model the relationships between race/ethnicity, specific health system factors, and early non-persistence (failing to refill the first prescription within 90 days) and nonadherence (<80% of days covered during the 12 months following the start of treatment), respectively, controlling for sociodemographic and clinical risk factors. Results: More than 30% of patients were early nonpersistent and 1 in 5 were nonadherent to therapy. Non-whites were more likely to exhibit both types of suboptimal medication-taking behavior compared with whites. In logistic regression models adjusted for sociodemo-graphic, clinical, and health system factors, nonwhite race was associated with early nonpersistence (black: odds ratio, 1.56 [95% CI, 1.43-1.70]; Asian: 1.40 [1.29-1.51]; Hispanic: 1.46 [1.35-1.57]) and nonadherence (black: 1.55 [1.37-1.77]; Asian: 1.13 [1.00-1.28]; Hispanic: 1.46 [1.31-1.63]). The likelihood of early nonpersistence varied between Asians and Hispanics by choice of first-line therapy. In addition, racial and ethnic differences in nonadherence were appreciably attenuated when medication copayment and mail-order pharmacy use were accounted for in the models. Conclusions: Racial/ethnic differences in medication-taking behavior occur early in the course of treatment. However, health system strategies designed to reduce patient co-payments, ease access to medications, and optimize the choice of initial therapy may be effective tools in narrowing persistent gaps in the use of these and other clinically effective therapies. © 2013 American Medical Association.
Solberg L.I.,Health Partners Research Foundation
Journal of Ambulatory Care Management | Year: 2011
Medical homes are widely viewed as a solution to the problems with American medical care, despite lack of answers to many important questions. Review of articles from issues of 5 journals devoted to the medical home in 2010 provides few answers to those questions. However, with some exceptions, those answers seem more likely to come from real-life efforts to implement medical homes than from the research literature. In any other industry, that would be the case, especially the key questions about the financial viability of both the transformation of traditional practies and sustainability of the new care model. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.