Determinants of quality of life among people with asthma: findings from the Behavioral Risk Factor Surveillance System.

Asthma is a major contributor to impaired quality of life in the U.S. population. Little is known about population-based determinants of quality of life among people with asthma, however. Using data from the 2000 Behavioral Risk Factor Surveillance System, we examined the associations between selected sociodemographic, behavioral, and other determinants and quality of life among 12,111 participants with current asthma. In multiple logistical regression models, three variables--employment status, smoking status, and physical activity--were significantly associated with all measures of impaired quality of life (poor or fair health, > or = 14 physically unhealthy days, > 14 mentally unhealthy days, > or = 14 activity limitation days, or > or = 14 physically or mentally unhealthy days). Education was significantly and inversely related to impaired quality of life for all measures except activity limitation days. Men were less likely than women to report having > or = 14 physically unhealthy days, > or = 14 mentally unhealthy days, or > or = 14 physically or mentally unhealthy days. Compared with whites, Hispanics were more likely to report being in poor or fair health, and African Americans were less likely to report having > or = 14 physically unhealthy days or > or = 14 physically or mentally unhealthy days. In addition, participants with lower incomes were more likely to report impaired quality of life for three measures (general health status, > or = 14 physically unhealthy days, and activity limitation days). The heaviest participants were more likely to be in poor or fair health or to report having more > or = 14 physically unhealthy days, or > or = 14 physically or mentally unhealthy days. Insurance coverage and the time since their last routine checkup were not significantly associated with any of the quality-of-life measures. These results show that three potentially modifiable factors (smoking status, physical activity, body mass index) are associated with quality of life among persons with asthma. Furthermore, among people with asthma, the elderly, women, poorly educated, and low-income participants are especially likely to experience impaired quality of life.     

Measuring health disparities: trends in racial−ethnic and socioeconomic disparities in obesity among 2- to 18-year old youth in the United States, 2001–2010

PurposeAlthough eliminating health disparities by race, ethnicity, and socioeconomic status (SES) is a top public health priority internationally and in the United States, weight-related racial/ethnic and SES disparities persist among adults and children in the United States. Few studies have examined how these disparities have changed over time; these studies are limited by the reliance on rate differences or ratios to measure disparities. We sought to advance existing research by using a set of disparity metrics on both the absolute and relative scales to examine trends in childhood obesity disparities over time.MethodsData from 7066 children, ages 2 to 18 years, in the National Health and Nutrition Examination Surveys were used to explore trends in racial/ethnic and SES disparities in pediatric obesity from 2001 to 2010 using a set of different disparity metrics.ResultsRacial/ethnic and SES-related disparities in pediatric obesity did not change significantly from 2001 to 2010 and remain significant.ConclusionsDisparities in obesity have not improved during the past decade. The use of different disparity metrics may lead to different conclusions with respect to how disparities have changed over time, highlighting the need to evaluate disparities using a variety of metrics.     

Does the relationship between waist circumference,morbidity and mortality depend on measurement protocol for waist circumference?

There is currently no consensus regarding the optimal protocol for measurement of waist circumference (WC), and no scientific rationale is provided for any of the WC protocols recommended by leading health authorities. A panel of experts conducted a systematic review of 120 studies (236 samples) to determine whether measurement protocol influenced the relationship of WC with morbidity of cardiovascular disease (CVD) and diabetes and with mortality from all causes and from CVD. Statistically significant associations with WC were reported for 65% (152) of the samples across all outcomes combined. Common WC protocols performed measurement at the minimal waist (33%), midpoint (26%) and umbilicus (27%). Non-significant associations were reported for 27% (64) of the samples. Most of these protocols measured WC at the midpoint (36%), umbilicus (28%) or minimal waist (25%). Significant associations were observed for 17 of the remaining 20 samples, but these were not significant when adjustment was made for covariates. For these samples, the most common WC protocols were the midpoint (35%) and umbilicus (30%). Similar patterns of association between the outcomes and all WC protocols were observed across sample size, sex, age, race and ethnicity. Our findings suggest that WC measurement protocol has no substantial influence on the association between WC, all-cause and CVD mortality, CVD and diabetes.     

Cost-effectiveness of West Nile virus vaccination

West Nile virus (WNV) was first detected in the Western Hemisphere in 1999 in New York City. From 1999 through 2004, >16,600 cases of WNV-related illnesses were reported in the United States, of which >7,000 were neuroinvasive disease and >600 were fatal. Several approaches are under way to develop a human vaccine. Through simulations and sensitivity analysis that incorporated uncertainties regarding future transmission patterns of WNV and costs of health outcomes, we estimated that the range of values for the cost per case of WNV illness prevented by vaccination was US 20,000 dollars-59,000 dollars(mean 36,000 dollars). Cost-effectiveness was most sensitive to changes in the risk for infection, probability of symptomatic illness, and vaccination cost. Analysis indicated that universal vaccination against WNV disease would be unlikely to result in societal monetary savings unless disease incidence increases substantially over what has been seen in the past 6 years.     

Aspirin use among U.S. adults: Behavioral Risk Factor Surveillance System

BACKGROUND: The role of aspirin in prevention of cardiovascular disease (CVD) and cardiovascular complications among people with diabetes has been examined. A Healthy People 2010 objective calls for increasing the proportion of people with diabetes aged>or=40 years who take aspirin>or=15 times per month. METHODS: Data from 2003 Behavioral Risk Factor Surveillance System were used to examine (1) the prevalence of aspirin intake, (2) aspirin use among those with CVD, (3) aspirin use among those with diabetes, (4) current status with respect to Healthy People objective 5-16, and (5) changes in aspirin intake from 1999. RESULTS: Daily or every-other-day aspirin use was reported by 36.2% of participants in 2003. Aspirin intake among those with CVD and diabetes was 82.8% and 62.6%, respectively. The Healthy People 2010 objective of increasing the proportion of adults with diabetes aged>or=40 years who take aspirin to 30% was achieved. The prevalence of aspirin intake was higher in 2003 compared to 1999 among all participants, those with CVD, and those with diabetes (relative increase of about 20%, 12%, and 36%, respectively). Most participants (74%) reported cardiovascular reasons for aspirin use. Among those without CVD or diabetes, the prevalence of aspirin intake increased with the increasing number of CVD risk factors. CONCLUSIONS: Regular aspirin use increased over a 4-year period. Greater use of inexpensive and easily accessible interventions to prevent cardiovascular events is encouraging. Increased efforts to continue preventive uses of available treatment and reduction in risk by modifying other risk factors will help lower future disease burden.