ESRD From Lupus Nephritis in the United States, 1995–2010

Background and objectives

While ESRD from lupus nephritis (ESLN) increased in the United States after the mid-1990s and racial disparities were apparent, current trends are unknown.

Design, setting, participants, & measurements

Retrospective US Renal Data System data (n=1,557,117) were used to calculate standardized incidence ratios (standardized to 1995–1996) and outcomes of ESLN (n=16,649). For events occurring after initiation of RRT, follow-up ended on June 30, 2011.

Results

Overall ESLN rates (95% confidence intervals [95% CIs]) in 1995–1996 were 3.1 (2.9 to 3.2) cases per million per year. Rates were higher for subgroups characterized by African-American race (11.1 [95% CI, 10.3 to 11.9]); other race (4.9 [95% CI, 4.0 to 5.8]); female sex (4.9 [95% CI, 4.6 to 5.2]); and ages 20–29 years (4.9 [95% CI, 4.4 to 5.4]), 30–44 years (4.6 [95% CI, 4.2 to 5.0]), and 45–64 years (4.0 [95% CI, 3.7 to 4.4]). Standardized incidence ratios for the overall population in subsequent biennia were 1.19 (1.14 to 1.24) in 1997–1998, 1.17 (1.12 to 1.22) in 1999–2000, 1.17 (1.12 to 1.22) in 2001–2002, 1.21 (1.16 to 1.26) in 2003–2004, 1.18 (1.13 to 1.23) in 2005–2006, 1.16 (1.11 to 1.21) in 2007–2008, and 1.05 (1.01 to 1.09) in 2009–2010, respectively. During a median (interquartile range) follow-up of 4.4 (6.3) years, 42.6% of patients with ESLN died, 45.3% were listed for renal transplant, and 28.7% underwent transplantation. Patients with ESLN were more likely than matched controls to be listed for and to undergo transplantation, and mortality rates were similar. Among patients with ESLN, African Americans were less likely to undergo transplantation (adjusted hazard ratio, 0.54 [0.51 to 0.58]) and more likely to die prematurely (adjusted hazard ratio, 1.23 [1.17 to 1.30]).

Conclusions

While ESLN appears to have stopped increasing in the last decade, racial disparities in outcomes persist.     

Factors Associated with Parent–Child Communication About HIV/AIDS in the United States and Kenya: A Cross-Cultural Comparison

This study explored parent–child communication about HIV/AIDS among two populations disproportionately affected by HIV. Similar computer-assisted surveys were completed by parents of pre-teens, including 1,115 African American parents of 9–12-year-old children in southeastern US and 403 parents of 10–12-year-old children in Nyanza Province, Kenya. Multivariate analyses identified factors associated with parental report of ever talking to their child about HIV/AIDS. Twenty-nine percent of US parents and 40% in Kenya had never talked to their pre-teen about HIV/AIDS. In both countries, communication was more likely if parents perceived their child to be ready to learn about sex topics, had gotten information to educate their child about sex, and had greater sexual communication responsiveness (skill, comfort, and confidence communicating about sexuality). Programs are needed that help parents assess children’s readiness to learn about sexual issues; access accurate information about adolescent sexual risks; and acquire the responsiveness needed to discuss sexual issues, including HIV/AIDS.     

Comparison of the Asthma in America and Asthma Insight and Management surveys: did asthma burden and care improve in the United States between 1998 and 2009?

Significant changes in asthma treatment guidelines and therapies occurred between the period of time in which the Asthma in America (AIA) and Asthma Insight and Management (AIM) surveys were conducted: 1998 and 2009, respectively. This study compares asthma burden and management in 1998 and 2009. Both surveys were telephone based and conducted across the United States. The AIA survey included 2509 patients with asthma (aged <1 year to 89 years old), 512 physicians, and 1000 adults from the general population. The AIM survey included 2500 patients (aged ≥12 years), 309 physicians, and 1090 adults from the general population. Patient responses were weighted to match the entire population of U.S. patients with asthma. The impact of asthma burden and care on the general population and on asthma patients was slightly lower or unchanged in the AIM survey versus the AIA survey. Acute care use (hospitalizations, emergency department visits, or other urgent care visits) was common in AIA (36%) and AIM (34%) surveys. Most physicians were aware of guidelines in AIA (90%) and AIM (96%), but fewer "always" followed them (AIA, 36%; AIM, 28%). Spirometry was often used to aid in diagnosis by asthma care specialists (AIA, 73%; AIM, 76%) but infrequently by nonsubspecialists (AIA, 27%; AIM, 38%). Most physicians prescribed inhaled corticosteroids (ICSs) for mild (AIA, 70%; AIM, 83%) or moderate (AIA, 89%; AIM, 83%) persistent asthma. In the AIM survey, 38% of specialists prescribed ICSs combined with a long-acting β2-agonist for moderate asthma. The state of U.S. asthma care and clinical outcomes changed little from 1998 to 2009.     

Strongyloidiasis-Related Deaths in the United States, 1991–2006

The objective of this study was to 1) assess the incidence of strongyloidiasis in the United States, 2) evaluate demographic and regional associations, and 3) identify comorbid conditions as risk factors for death. A population-based case–control study was performed by using mortality data during 1991–2006. We identified 347 strongyloidiasis deaths (0.79 per 10 million deaths, 14–29 deaths per year), which decreased slightly over time. Deaths occurred primarily among older (median age = 66.0 years), white (57.6%) and Hispanic (22.2%) men (69.2%), residing in the Southeastern United States (49.3%). Associated health conditions included chronic obstructive pulmonary disease (28.7%, odds ratio [OR] = 4.0, 95% confidence interval [CI] = 3.0–5.4) and infection with human immunodeficiency virus (12.5%, OR = 4.6, 95% CI = 2.7–7.9). Strongyloidiasis deaths in the second half of the study period (1999–2006) were less likely to be associated with chronic obstructive pulmonary disease (19.4%, OR = 1.2, 95% CI = 0.7–1.9), but continued to be associated with human immunodeficiency virus infection (12.9%, OR = 2.8, 95% CI = 1.3–6.0). Early detection and treatment of at-risk patients with latent strongyloidiasis infections is needed to reduce strongyloidiasis mortality.     

Hospitalization for Achalasia in the United States 1997–2006

Background and Aims  The Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) was used to study the demographic characteristics of achalasia patients. Methods  HCUP data from 1997 to 2006 were stratified by categories pertaining to patient demographics, such as age, sex, race, income, residence in metropolitan area, and region of the United States, as well as categories pertaining to hospital characteristics, such teaching status, location, and bed size. The distributions of inpatients among different categories were compared between achalasia and all other diagnoses, using odds ratios and their 95% confidence intervals for comparison. Results  The annual hospitalization rates of achalasia revealed a clear-cut age-dependent rise between the youngest age group less than 18 years old (0.25/100,000) and the oldest age group over 85 years old (37.35/100,000). Between 1997 and 2007, the rates of hospitalization remained largely unchanged for all age groups alike. Achalasia was equally distributed among men and women and among various ethnic groups. Compared with other diagnoses, achalasia was more frequent among hospitalized patients from zip codes associated with a higher average income (1.26, 1.23–1.29), living in metropolitan areas (1.12, 1.09–1.15), and living in the northeast region of the United States (1.27, 1.25–1.30). Achalasia patients were mostly seen in large hospitals (1.22, 1.19–1.26), teaching hospitals (1.73, 1.70–1.76), and hospitals located in metropolitan areas (1.15, 1.14–1.15). Conclusions  With exception of its striking age-dependence, the epidemiology of achalasia does not reveal any clues about its yet unsolved etiology.     

Cysticercosis-Related Hospitalizations in the United States, 1998–2011

Cysticercosis has become increasingly recognized as an important infection in the United States in recent decades. Despite its potential impact, there is a lack of comprehensive information on the nationwide burden of disease. To better define the burden of cysticercosis in the United States, we analyzed in-patient records using the Nationwide Inpatient Sample for 1998–2011 to estimate cysticercosis-related hospitalizations and patient/institutional characteristics. There were an estimated 33,060 (95% confidence interval [95% CI] = 29,610.5–36,510.3) cysticercosis-related hospitalizations nationwide, representing a hospitalization rate of 8.03 per million population. The highest proportion of cases were male (54.8%), Hispanic (62.0%), aged 18–44 (58.8%), and occurred in the West (45.1%). An estimated 459 deaths occurred, representing an in-hospital case-fatality rate of 1.4%. These findings indicate the burden of cysticercosis-related hospitalizations in the United States is considerable and may be greater than currently appreciated. Cysticercosis should be a nationally reportable disease.     

What do anti‐Toxoplasma gondii IgA and IgG subclasses in human saliva indicate?

Diagnostic tests for toxoplasmosis are based on serological techniques due to their high sensitivity. Some IgG subclasses are related to clinical outcome in the congenital form. In this work, we determined the levels of IgG, IgA, IgG1, IgG2, IgG3 and IgG4 anti‐Toxoplasma gondii antibodies in paired saliva and serum samples from 91 women by indirect ELISA using a crude extract of the RH strain. The levels of IgA, IgG2, IgG3 and IgG4 antibodies and, to a lesser extent, IgG1 did not correlate between saliva and serum, that is, most cases that were positive for one Ig class in a sample were negative or very low in the other, and vice versa. We also observed that most samples of saliva that were positive for one IgG subclass were also positive for at least 2 of the other 3; this contrasted with findings in serum, wherein each person was positive almost exclusively for one subclass, as demonstrated before by us and other researchers. Although these findings are disappointing for the use in diagnosis, the richer response in saliva might indicate local exposure to T. gondii antigens without systemic infection; thus, saliva might be reflecting a local (protective?) response against this protozoan.     

Hlstochemical changes of the white cells of mice infected with Toxoplasma gondii.

Studies were made on the white cells of mice infected with tachyzoites of Toxoplasmagondii by means of methyl green-pyronin staining and Feulgen reaction. After stainingwith methyl green-pyronin, some small red granules could be found in the cytoplasm     

Factors Associated with Asthma Prevalence among Racial and Ethnic Groups—United States, 2009–2010 Behavioral Risk Factor Surveillance System

Background. Although the causes of asthma are poorly understood, multiple factors (e.g., genetic, environmental, socioeconomic, and lifestyle) have been implicated in the development and exacerbation of the disease, Objectives. To identify the potential predictive factors of current asthma and to assess if the predictive ability of some factors differs by race and ethnicity, Methods. We used the Centers for Disease Control and Prevention’s 2009–2010 Behavioral Risk Factor Surveillance System data to estimate asthma prevalence and to examine the potential predictive factors for asthma (sex, age, educational attainment, household income, obesity, smoking, physical activity, and health insurance) by race and ethnicity, Results. Of the 869,519 adult respondents in the survey, 8.6% reported having asthma. Asthma prevalence for all race/ethnic group was significantly higher among adults with a household income of <$15,000 (13.3%; adjusted prevalence ratio [aPR] of 1.9) than those with income of ≥$75,000 (6.8%). The prevalence was also higher among obese adults (11.6%; aPR = 1.5) than non-obese (7.3%), current and former smokers (10.5%; aPR = 1.2 and 8.8%; 1.2) than non-smokers (7.8%), and adults with health insurance (8.6%; aPR = 1.3) than adults without it (7.8%). However, the prevalence was lower among adults aged 65+ (7.8; aPR = 0.7) than adults aged 18–34 (9.3%) and among adults who reported having leisure time physical activity (7.8%; aPR = 0.8) than adults who did not report it (10.7%). When examined among the racial/ethnic groups, these associations were observed among whites and blacks but not for the other four racial/ethnic groups, Conclusions. Predictive factors for asthma vary among the racial/ethnic groups. Identifying race/ethnicity-specific modifiable environmental and host-related factors (mold, pollens, house dust mites, cockroaches, animal allergens, other pollutants, education, income, obesity, smoking, physical activity, and health insurance status) can be important in developing targeted interventions to reduce the health and economic impact of asthma among the disproportionately affected segments of the United States population.