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Menke A.,Social and Scientific Systems | Rust K.F.,650 Research Boulevard | Fradkin J.,U.S. National Institute of Diabetes and Digestive and Kidney Diseases | Cheng Y.J.,Centers for Disease Control and Prevention | Cowie C.C.,U.S. National Institute of Diabetes and Digestive and Kidney Diseases
Annals of Internal Medicine | Year: 2014

Background: The increase in the prevalence of diabetes over the past few decades has coincided with an increase in certain risk factors for diabetes, such as a changing race/ethnicity distribution, an aging population, and a rising obesity prevalence. Objective: To determine the extent to which the increase in diabetes prevalence is explained by changing distributions of race/ethnicity, age, and obesity prevalence in U.S. adults. Design: Cross-sectional, using data from 5 NHANES (National Health and Nutrition Examination Surveys): NHANES II (1976-1980), NHANES III (1988-1994), and the continuous NHANES 1999-2002, 2003-2006, and 2007-2010. Setting: Nationally representative samples of the U.S. noninstitutionalized civilian population. Patients: 23 932 participants aged 20 to 74 years. Measurements: Diabetes was defined as a self-reported diagnosis or fasting plasma glucose level of 7.0 mmol/L (126 mg/dL) or more. Results: Between 1976 to 1980 and 2007 to 2010, diabetes prevalence increased from 4.7% to 11.2% in men and from 5.7% to 8.7% in women (P for trends for both groups < 0.001). After adjustment for age, race/ethnicity, and body mass index, diabetes prevalence increased in men (6.2% to 9.6%; P for trend < 0.001) but not women (7.6% to 7.5%; P for trend < 0.69). Body mass index was the greatest contributor among the 3 covariates to the change in prevalence estimates after adjustment. Limitation: Some possible risk factors, such as physical activity, waist circumference, and mortality, could not be studied because data on these variables were not collected in all surveys. Conclusion: The increase in the prevalence of diabetes was greater in men than in women in the U.S. population between 1976 to 1980 and 2007 to 2010. After changes in age, race/ethnicity, and body mass index were controlled for, the increase in diabetes prevalence over time was approximately halved in men and diabetes prevalence was no longer increased in women. Source


Fwu C.-W.,Social and Scientific Systems | Eggers P.W.,Urologic | Kimmel P.L.,Urologic | Kusek J.W.,Urologic | Kirkali Z.,Urologic
Kidney International | Year: 2013

The occurrence of urolithiasis in the United States has increased; however, information on long-term trends, including recurrence rates, is lacking. Here we describe national trends in rates of emergency department visits, use of imaging, and drug treatment, primarily using the National Hospital Ambulatory Medical Care Survey to describe trends and the National Health and Nutrition Examination Survey to determine the frequency of lifetime passage of kidney stones. Emergency department visit rates for urolithiasis increased from 178 to 340 visits per 100,000 individuals from 1992 to 2009. Increases in visit rates were greater in women, Caucasians, and in those aged 25-44 years. The use of computed tomography in urolithiasis patients more than tripled, from 21 to 71%. Medical expulsive therapy was used in 14% of the patients with a urolithiasis diagnosis in 2007-2009. Among National Health and Nutrition Examination Survey participants who reported a history of kidney stones, 22.4% had passed three or more stones. Hence, emergency department urolithiasis visit rates have increased significantly, as has the use of computed tomography in the United States. Further research is necessary to determine whether recurrent stone formers receive unnecessary radiation exposure during diagnostic evaluation in the emergency department and allow development of corresponding evidence-based guidelines. © 2012 International Society of Nephrology. Source


Abdus S.,Social and Scientific Systems
Medical Care | Year: 2014

BACKGROUND:: The association between uninsurance and reduced access to care is well known. Few studies, however, examine the relationship between the length of time without coverage and measures of access to care among adults. OBJECTIVES:: To examine the association between access to care and the length of time without coverage during a 12-month period among nonelderly adults. METHODS:: Multivariate logistic regression models of 15 measures of access to care are estimated, using data from the 2005-2010 Medical Expenditure Panel Survey. These models control for length of time without coverage and other factors. The study then examines how access to care varies by the length of time without coverage. RESULTS:: There were large differences in access to care between those with and without coverage for all 12 months. For most of the measures, those lacking coverage for 1-5 months also had less access to care compared with those covered all 12 months. Lastly, for most of the measures, those lacking coverage for all 12 months had less access to care compared with either those lacking coverage for 6-11 months, or those lacking coverage for 1-5 months. CONCLUSIONS:: The study shows the importance of considering the length of time without coverage when examining access to care of the uninsured. Even relatively short periods of uninsurance may be associated with some barriers to health care. In contrast, having some coverage during the year is associated with greater access to care than having no coverage at all. Copyright © 2014 by Lippincott Williams & Wilkins. Source


Abdus S.,Social and Scientific Systems | Selden T.M.,Agency for Healthcare Research and Quality
Medical Care | Year: 2013

Background: A large literature documents cross-sectional differences in adult preventive services across population subgroups. Less is known, however, about how these differences have changed over time. Objectives: This study tracks changes over time in the distribution of preventive services use across groups defined by poverty status, race/ethnicity, insurance coverage, Census region, and urbanicity. Methods: Data from the 1996-2008 Medical Expenditure Panel Survey are used to examine 5 preventive services: general checkups, blood pressure screening, blood cholesterol screening, Pap smears, and mammograms. Multivariate logistic regression models of preventive services use are used to compute adjusted utilization for each subgroup of adults aged 19-64 in 1996/1998, 2002/2003, and 2007/2008. We then examine the extent to which percentage point gaps in utilization rates across subgroups have changed between 1996/1998 and 2007/2008. Results: Our analysis of utilization rates across subgroups and over time identified only rare cases in which subgroup differences narrowed or widened between 1996/1998 and 2007/2008. Rather, differences across subgroups tended to persist over time. Some of the largest (adjusted) gaps are between adults with and without coverage, and only for blood cholesterol screening do we observe significant narrowing of the gap between the uninsured and the privately insured. Regional differences persisted or widened over the study period. Conclusions: On the eve of health reform implementation, a key challenge facing the Affordable Care Act will be to address persistent differences in preventive services use within the US population. © 2013 by Lippincott Williams and Wilkins. Source


Hudson J.L.,Agency for Healthcare Research and Quality | Abdus S.,Social and Scientific Systems
Health Affairs | Year: 2015

Public health insurance for low-income children in the United States is primarily available through Medicaid and the Childrenâ™s Health Insurance Program (CHIP). Mixed eligibility occurs when there is a mix of either âœMedicaid- and CHIP-eligibleâ children or a mix of âœeligible (for public insurance) and ineligible (for public insurance)â children in the family.We used data from the Medical Expenditure Panel Survey (MEPS) Household Component for 2001â"12 to examine insurance coverage, access to care, and health care use for eligible children in families with mixedeligible siblings compared to those in families where all siblings were eligible for one program.We found that mixed eligibility has a significant dampening effect for eligible children in families with a mix of eligible and ineligible siblings. These children were more likely to be uninsured and less likely to have a usual source of care, less likely to have any preventive dental or well-child visits during the year, and less likely to fully adhere to recommended preventive dental and well-child visits than eligible children with all-Medicaid- or all-CHIP-eligible siblings. We found no significant impact for eligible children living in Medicaid-CHIP-mixed families. © 2015 Project HOPE- The People-to-People Health Foundation, Inc. Source

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