Direct and indirect costs of arthritis and other rheumatic conditions--United States, 1997

Arthritis and other rheumatic conditions (AORC) are the leading cause of disability in the United States. The impact of AORC has been measured in terms of disability, ambulatory care, and hospitalization. To estimate the direct and indirect costs of AORC in the United States, CDC analyzed data from the 1997 Medical Expenditure Panel Survey (MEPS). This report summarizes the results of that analysis, which found that, in 1997, the total cost of AORC in the United States was 116.3 billion dollars (i.e., 51.1 billion dollars in direct costs plus 65.2 billion dollars in indirect costs), approximately 1.4% of the U.S. gross domestic product. Total costs attributable to AORC, by state, ranged from 163 million dollars in Wyoming to 11.3 billion dollars in California. These results underscore the need, as the U.S. population ages and treatments grow more costly, for state and local public health officials to implement additional self-management programs to help reduce the cost of AORC and help patients improve the quality of their lives.     

Update: direct and indirect costs of arthritis and other rheumatic conditions--United States, 1997

The medical and societal impact of arthritis and other rheumatic conditions (AORC) has been characterized with respect to disability, ambulatory care, hospitalization, and economic burden. CDC's estimates of the national and state-specific costs of AORC in the United States in 1997 have been published previously. However, CDC has re-estimated indirect costs by enhancing the statistical methods. This report summarizes the results of that analysis, which indicated that indirect costs were 30.1 billion dollars less than previously estimated. The total cost of AORC in the United States in 1997 was 86.2 billion dollars (including 51.1 billion dollars in direct costs and 35.1 billion dollars in indirect costs), approximately 1% of the U.S. gross domestic product. Total costs attributable to AORC by state ranged from 121 million dollars in Wyoming to 8.4 billion dollars in California. Although indirect costs were lower than estimated previously, costs for arthritis remain high and underscore the need for better interventions to reduce the economic burden of arthritis.     

Medical expenditures attributable to injuries--United States, 2000

In the United States, injuries (i.e., unintentional and intentional) are the leading cause of death among persons aged <35 years and the fourth leading cause of death among persons of all ages. Injuries create a substantial burden on society in terms of medical resources used for treating and rehabilitating injured persons, productivity losses caused by morbidity and premature mortality, and pain and suffering of injured persons and their caregivers. To estimate annual injury-attributable medical expenditures in the United States, CDC analyzed data on injury prevalence and costs from the 2000 Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA). This report summarizes the results of that analysis, which indicated that injury-attributable medical expenditures cost as much as 117 billion dollars in 2000, approximately 10% of total U.S. medical expenditures. This finding underscores the need for innovative and effective interventions to prevent injuries.     

State-level estimates of annual medical expenditures attributable to obesity

OBJECTIVE: To provide state-level estimates of total, Medicare, and Medicaid obesity-attributable medical expenditures. RESEARCH METHODS AND PROCEDURES: We developed an econometric model that predicts medical expenditures. We used this model and state-representative data to quantify obesity-attributable medical expenditures. RESULTS: Annual U.S. obesity-attributable medical expenditures are estimated at $75 billion in 2003 dollars, and approximately one-half of these expenditures are financed by Medicare and Medicaid. State-level estimates range from $87 million (Wyoming) to $7.7 billion (California). Obesity-attributable Medicare estimates range from $15 million (Wyoming) to $1.7 billion (California), and Medicaid estimates range from $23 million (Wyoming) to $3.5 billion (New York). DISCUSSION: These estimates of obesity-attributable medical expenditures present the best available information concerning the economic impact of obesity at the state level. Policy makers should consider these estimates, along with other factors, in determining how best to allocate scarce public health resources. However, because they are associated with large SE, these estimates should not be used to make comparisons across states or among payers within states.     

Hearing difficulty attributable to employment by industry and occupation: an analysis of the National Health Interview Survey--United States, 1997 to 2003

OBJECTIVE: To estimate the national burden of hearing difficulty among workers in US industries and occupations. METHODS: Data on 130,102 employed National Health Interview Survey respondents between the ages of 18 to 65 years who were interviewed between 1997 and 2003 were analyzed to estimate the population prevalence, adjusted prevalence ratios, and fractions of hearing difficulty attributable to employment. RESULTS: The estimated population prevalence of hearing difficulty was 11.4% (24% attributable to employment). The adjusted prevalence ratios of hearing difficulty were highest for railroads, mining, and primary metal manufacturing industry. Occupations with increased risk of hearing difficulty were mechanics/repairers, machine operators, and transportation equipment operators. CONCLUSIONS: Hearing difficulty was differentially distributed across various industries. In industries with high rates, employers and workers should take preventive action to reduce the risk of occupational hearing loss.     

National, state, and urban area vaccination coverage among children aged 19-35 months--United States, 2003

Each annual birth cohort in the United States comprises approximately 4 million infants. Maintaining the gains in vaccination coverage achieved during the 1990s among these children poses a continuing challenge for public health practitioners. The National Immunization Survey (NIS) provides estimates of vaccination coverage among children aged 19-35 months for each of the 50 states and 28 selected urban areas. This report summarizes NIS results for 2003, which indicated substantial increases nationwide in coverage with > or =1 dose of varicella vaccine (VAR) and > or =3 doses of pneumococcal conjugate vaccine (PCV) and the highest coverage ever for all vaccines; however, wide variability in coverage continues among states and urban areas. Continued vigilance is needed to maintain high levels of coverage, and sustained efforts will be required to reduce geographic disparities in coverage.     

Intervention programs for arthritis and other rheumatic diseases.

Disability reduction or prevention programs for people with arthritis and other rheumatic conditions reduce long-term pain and disability but reach only a fraction of their target audience. Few public health professionals are aware of these programs or their benefits. The objective of this study is to review and describe packaged (ready-to-use) arthritis self-management education and exerciselphysical activity programs that have had at least preliminary evaluation. Nine intervention programs (five self-management education programs, and four exercise/physical activity programs met study criteria). Several of the packaged arthritis interventions reviewed help people with arthritis and other rheumatic conditions maximize their abilities and reduce pain, functional limitations, and other arthritis-related problems. Other packaged interventions show promise in reducing pain, disability, and depression and in increasing self-care behaviors, but they need to be evaluated more extensively.     

The impact of rheumatoid arthritis on medical expenditures, absenteeism, and short-term disability benefits

OBJECTIVES: The objectives of this study were to estimate medical expenditures, absenteeism, and short-term disability costs for workers with rheumatoid arthritis (RA) and to estimate the relative costs of RA over a 12-month period. METHODS: Using data from nine U.S. employers, direct and indirect costs for 8502 workers with RA were compared with costs for a matched group without RA. Regression analyses controlled for factors that were different even after propensity score matching. RESULTS: Average total costs for workers with RA were $4244 (2003 dollars) greater than for workers without RA. RA was the fourth most costly chronic condition per employee compared with cancers, asthma, bipolar disorder, chronic obstructive pulmonary disease, depression, diabetes, heart disease, hypertension, low back disorders, and renal failure. CONCLUSIONS: RA is a costly disorder and merits consideration as interventions are considered to improve workers' health and productivity.     

Monitoring progress in arthritis management--United States and 25 states, 2003

Arthritis is a chronic disease affecting an estimated 43 million (20.8%) U.S. adults and is the leading cause of disability in the United States. Arthritis results in activity and work limitations, decreased quality of life, and substantial burden to the U.S. health-care system. Promotion of arthritis self-management through weight counseling, physical activity counseling, and arthritis education can reduce pain, improve function and quality of life, and delay disability among persons with arthritis. To encourage arthritis self-management, three objectives were added to the national health objectives for 2010. To monitor progress toward achieving these objectives and assess that progress by selected characteristics, CDC analyzed data from the 2003 National Health Interview Survey (NHIS) and the state-based 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of those analyses, which indicated no statistically significant progress toward reaching the targets for weight counseling, physical activity counseling, and arthritis education. To meet these targets by 2010, public health and health-care agencies should increase efforts to improve awareness of these three factors among both health-care providers and patients. Such interventions will enable persons with arthritis to better self-manage their disease.     

Impact of influenza immunization on medical expenditures among Medicare elderly, 1999-2003

BACKGROUND: The impact of influenza immunization on expenditures for inpatient, outpatient, and professional services among elderly Medicare beneficiaries between 1999 and 2003 was examined. METHODS: Data were from independent annual survey samples of 175,000 beneficiaries. Response rates ranged from 64% to 71%. Survey data included beneficiaries' demographics, education, supplemental insurance, perceived health, and influenza vaccination. Baseline measures, derived from Medicare claims for the year prior to influenza season, included service utilization, comorbidities, influenza immunization, and health status. The outcome measure was medical expenditures for acute and chronic respiratory conditions (ACRCs) for each 33-week annual influenza season. RESULTS: Total expenditures for ACRCs were lower among the immunized population during all four seasons. The amount and statistical significance of the savings varied with the severity of the virus and the vaccine match to the prevalent influenza strains. During the 1999-2000 influenza season, which had the most severe virus and a close vaccine match, average costs for ACRCs were $88 lower among immunized beneficiaries than among nonimmunized beneficiaries (equivalent to a 3.06% savings). During the 2002-2003 season, which had a less severe virus but the highest vaccine match rate, average costs for ACRCs were $103 lower for immunized beneficiaries than for nonvaccinated beneficiaries (equivalent to a 3.12% savings). The relative reduction in ACRC expenditures among vaccinated beneficiaries is attributable to less frequent use of inpatient services. CONCLUSIONS: In addition to improving the health of older Americans, meeting the Healthy People 2010 influenza immunization goal of 90% among the elderly should also result in lower Medicare expenditures.     

Mortality,hospital days and expenditures attributable to ambient air pollution from particulate matter in Israel

Background

Worldwide, ambient air pollution accounts for around 3.7 million deaths annually. Measuring the burden of disease is important not just for advocacy but also is a first step towards carrying out a full cost-utility analysis in order to prioritise technological interventions that are available to reduce air pollution (and subsequent morbidity and mortality) from industrial, power generating and vehicular sources.

Methods

We calculated the average national exposure to particulate matter particles less than 2.5 μm (PM2.5) in diameter by weighting readings from 52 (non-roadside) monitoring stations by the population of the catchment area around the station. The PM2.5 exposure level was then multiplied by the gender and cause specific (Acute Lower Respiratory Infections, Asthma, Circulatory Diseases, Coronary Heart Failure, Chronic Obstructive Pulmonary Disease, Diabetes, Ischemic Heart Disease, Lung Cancer, Low Birth Weight, Respiratory Diseases and Stroke) relative risks and the national age, cause and gender specific mortality (and hospital utilisation which included neuro-degenerative disorders) rates to arrive at the estimated mortality and hospital days attributable to ambient PM2.5 pollution in Israel in 2015. We utilised a WHO spread-sheet model, which was expanded to include relative risks (based on more recent meta-analyses) of sub-sets of other diagnoses in two additional models.

Results

Mortality estimates from the three models were 1609, 1908 and 2253 respectively in addition to 184,000, 348,000 and 542,000 days hospitalisation in general hospitals. Total costs from PM2.5 pollution (including premature burial costs) amounted to $544 million, $1030 million and $1749 million respectively (or 0.18 %, 0.35 % and 0.59 % of GNP).

Conclusions

Subject to the caveat that our estimates were based on a limited number of non-randomly sited stations exposure data. The mortality, morbidity and monetary burden of disease attributable to air pollution from particulate matter in Israel is of sufficient magnitude to warrant the consideration of and prioritisation of technological interventions that are available to reduce air pollution from industrial, power generating and vehicular sources. The accuracy of our burden estimates would be improved if more precise estimates of population exposure were to become available in the future.

     

Terrorism preparedness in state health departments--United States, 2001-2003

The anthrax attacks in fall 2001 highlighted the role of infectious disease (ID) epidemiologists in terrorism preparedness and response. Beginning in 2002, state health departments (SHDs) received approximately 1 billion dollars in new federal funding to prepare for and respond to terrorism, infectious disease outbreaks, and other public health threats and emergencies. This funding is being used in part to improve epidemiologic and surveillance capabilities. To determine how states have used a portion of their new funding to increase ID epidemiology capacity, the Iowa Department of Public Health's Center for Acute Disease Epidemiology and the Iowa State University Department of Microbiology conducted two surveys of U.S. state epidemiologists during September 2000-August 2001 and October 2002-June 2003. This report summarizes the results of these surveys, which determined that although the number of SHD epidemiology workers assigned to ID and terrorism preparedness increased by 132%, concerns remained regarding the ability of SHDs to hire qualified personnel. These findings underscore the need to develop additional and more diverse training venues for current and future ID epidemiologists.     

State prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation--United States, 2003

Arthritis is costly (86 billion dollars annually), highly prevalent (affecting 43 million U.S. adults), the leading cause of disability, and associated with substantial disparities in pain, activity limitations, and compromised quality of life. State-based estimates of arthritis prevalence and impact help define the burden of arthritis and provide state arthritis programs with data for program planning. This report summarizes results from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey on state-specific prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation in 50 states, the District of Columbia (DC), and three territories. The findings indicated that the prevalence of adults with self-reported doctor-diagnosed arthritis ranged from 17.9% to 37.2% (state median: 27.0%) and with arthritis-attributable activity limitation ranged from 6.3% to 16.7% (state median: 9.9%); the proportion of adults with arthritis-attributable activity limitation among those with self-reported doctor-diagnosed arthritis ranged from 30.1% to 49.8% (state median: 37.4%). These high rates of arthritis prevalence and activity limitation are projected to increase with the aging of the population, requiring increased intervention measures to reduce this impact.     

Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation--United States, 2003-2005

Arthritis is highly prevalent among U.S. adults, the leading cause of disability, and associated with substantial activity limitation, work disability, reduced quality of life, and high health-care costs. As the population ages, arthritis is expected to affect an estimated 67 million adults in the United States by 2030. This report updates estimates of the national prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation in the adult U.S. population, using data from the National Health Interview Survey (NHIS) for 2003-2005. The findings indicated that an estimated 21.6% of the adult U.S. population (46.4 million persons) had doctor-diagnosed arthritis, and 8.3% (17.4 million) had arthritis-attributable activity limitations. Public and private health agencies should promote measures to increase the availability of evidence-based arthritis prevention and management interventions.     

National laboratory inventory for global poliovirus containment--United States, November 2003

In anticipation of the interruption of wild poliovirus (WPV) transmission, the United States has joined 122 other poliomyelitis-free countries in taking steps to minimize the risk for reintroducing WPV from laboratories to communities. In October 2002, a nationwide survey of laboratories and biomedical institutions (e.g., universities) that oversee multiple laboratories was conducted to identify those that might be holding WPV-containing materials and to establish a national inventory of institutions and laboratories retaining such materials. A total of 32,429 laboratories and biomedical institutions listed in multiple databases were mailed letters to alert laboratories of the impending global eradication of polio and encourage disposal of unneeded WPV-containing materials. The national inventory is a list of institutions and laboratories whose staff will be kept informed of eradication progress and appropriate WPV-containment procedures. This report summarizes use of the survey to create the national inventory.     

Characteristics of chronic arthritis and other rheumatic condition-related ambulatory care visits, united states, 1997

PURPOSE: To characterize ambulatory medical care visits among persons with arthritis and other rheumatic conditions, the leading cause of disability.METHODS: The 1997 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) collect annual data on the utilization of ambulatory medical services provided by non-federal office-based physicians and hospital outpatient and emergency departments. Arthritis-related visits were defined using a predetermined set of ICD9-CM diagnostic codes developed by an expert panel and designed to include all potential diagnoses for arthritis and other rheumatic conditions. Visits related to acute conditions such as injuries were not included. National estimates and rates of arthritis-related ambulatory care visits were calculated by age, race, and sex groups.RESULTS: In 1997, there were an estimated 959.3 million ambulatory care visits, of which over 38 million (4.0%) were related to arthritis and other rheumatic conditions. Arthritis-related visits were more likely to be made by females (65.4%), white persons (82.2%), non-Hispanic persons (72.7%) and persons aged 25-64 years (61.9%). More than one-third of arthritis-related visits were for osteoarthritis, rheumatoid arthritis and unspecified myalgia/myositis. About half (50.2%) of the office visits for arthritis were made to general/family physicians or internists, while an additional 16.2% were to rheumatologists. Counseling or education related to exercise, diet/nutrition and injury prevention were provided at 18.9%, 9.2% and 2.2% of office and outpatient department visits respectively.CONCLUSIONS: Arthritis and other rheumatic conditions are common conditions associated with ambulatory medical care. These results suggest missed opportunities for counseling patients regarding public health prevention messages for arthritis, including increasing moderate physical activity, weight management and injury prevention.     

Influenza vaccination levels among persons aged > or =65 years and among persons aged 18-64 years with high-risk conditions--United States, 2003

Influenza vaccination is an effective tool for preventing hospitalization and death among persons aged > or =65 years and among persons aged 18-64 years with medical conditions that increase the risk for influenza-related complications. Two national health objectives for 2010 are to increase influenza vaccination coverage to 90% among persons aged > or =65 years and to 60% among persons aged 18-64 years who have one or more high-risk conditions (objectives 14-29a and 14-29c, respectively). To determine influenza vaccination coverage among persons in both targeted groups, CDC analyzed data from the 2003 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which determined that influenza vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with high-risk conditions remains substantially below 2010 target levels. In addition, racial/ethnic disparities in coverage levels persist in both targeted populations. To improve overall influenza vaccination coverage and reduce racial/ethnic disparities, combinations of evidence-based effective interventions should be implemented, and the influenza vaccine supply should be stabilized.     

Change in mortality and years of life lost attributable to tobacco in Japan, 1985 and 1995

Despite the secular trend of decreasing prevalence of smoking and consumption of tobacco in most industrialized countries, the prevalence of smoking in Japan continues to be one of the highest. Based on the alternative measure of population attributable fractions, the present study gives an estimate of the number of deaths and the years of life lost (YLLs) attributable to tobacco in Japan for both 1985 and 1995. This study shows a considerable increase in mortality from tobacco-related diseases over the decade, in particular from lung cancer and chronic obstructive pulmonary disease, a consequence of the intensified exposure to tobacco in the early 1960s. Although the period of the highest exposure to tobacco was in the late 1970s, prevalence of smoking is still considerably high in Japan and the burden from tobacco will persist if proper anti-smoking measures are not implemented immediately.     

Update: cardiac and other adverse events following civilian smallpox vaccination--United States, 2003

During January 24-June 20, 2003, smallpox vaccine was administered to 37,802 civilian health-care and public health workers in 55 jurisdictions to prepare the United States for a possible terrorist attack using smallpox virus. This report updates information on vaccine-associated adverse events among civilians vaccinated since the beginning of the program and among contacts of vaccinees, received by CDC from the Vaccine Adverse Event Reporting System (VAERS) as of June 20. Two cases of dilated cardiomyopathy (DCM) were diagnosed 3 months after vaccination. For the potential relation between smallpox vaccine and DCM to be assessed, identification of additional cases of DCM among vaccinees will be essential. Physicians who treat smallpox vaccine recipients are encouraged to evaluate and report patients with symptoms compatible with DCM, including those that occur several months after vaccination.