Geographic Distribution of Constipation in the United States

Objective : Despite its frequent occurrence, the etiology of constipation has remained poorly understood. The influence of widely accepted risk factors such as inadequate dietary fiber intake, immobility, insufficient fluid intake, and poor muscle tone is unclear. This study examined the geographic distribution of constipation among Medicare beneficiaries to identify potential environmental risk factors. Methods : All Medicare beneficiaries with a diagnosis of constipation were extracted from the total Health Care Financing Administration data file of 1987 and stratified by sex, race, and state of residence. The population of each state by sex, race, and age >65 yr served as the denominator to calculate sex- and race-specific morbidity rates. Results : A distinct geographic distribution was observed. When stratified by individual states, hospital discharges for constipation were more common in rural as compared with urban states. Constipation also appeared to be more common in northern and in poorer states. Conclusion : The distinct geographic pattern of constipation suggests the influence of three global environmental factors: rural living, colder temperature, and lower socioeconomic status.     

Use of Outpatient Intravenous Calcitropes for Heart Failure in the United States

BackgroundOutpatient calcitrope infusions—that is, the cardiac inotropes milrinone and dobutamine—are often used for bridge to transplantation and palliation in advanced heart failure, but few data exist about the real-world use of these agents.Methods and ResultsWe used the Symphony Integrated DataVerse of commercial, managed Medicare, and Medicaid insurance claims of approximately 280 million people (2012–2020) to determine the incidence and characteristics of ambulatory calcitrope use. Demographics were calculated, including geographic densities at the metropolitan statistical area level. A population projection normalized for age, sex, and location was extrapolated to the total US population. Ambulatory dispensing of milrinone was found in 10,533 outpatients, 1867 in 2019. Ambulatory dobutamine use was found in 4967 outpatients, 836 in 2019. The 2019 total US projection was 3411 for milrinone and 1281 for dobutamine. The mean age was 62 years for milrinone and 68 for dobutamine. Males represented 70% of use. There were differences between drugs in geographic distribution, with more milrinone use in the Northeast and South and more dobutamine use in the Midwest. Duration of use was 4.6 ± 7.2 months for milrinone and 1.8 ± 4.0 months for dobutamine. Of the patients receiving milrinone, 30.6% subsequently underwent cardiac transplantation or left ventricular assist device placement, whereas 10% receiving dobutamine went on to advanced therapies. Less than 0.5% of patients received calcitropes while enrolled in hospice care.ConclusionsMore than 4000 patients receive outpatient infusion of calcitropes annually in the outpatient setting. Men are much more likely to receive these medications. A minority of the use is as a bridge to advanced therapies. Geographic variability in use suggests better evidence and consistent guidelines may be helpful.     

Patterns of endoscopy use in the United States

BACKGROUND & AIMS: The aim of this study was to use a large national endoscopic database to determine why routine endoscopy is performed in diverse practice settings. METHODS: A computerized endoscopic report generator was developed and disseminated to gastrointestinal (GI) specialists in diverse practice settings. After reports were generated, a data file was transmitted electronically to a central databank, where data were merged from multiple sites for analysis. RESULTS: From April 1, 1997, to October 28, 1998, 276 physicians in 31 practice sites in 21 states provided 18,444 esophagogastroduodenoscopy (EGD) reports, 20,748 colonoscopy reports, and 9767 flexible sigmoidoscopy reports to the central databank. EGD was most commonly performed to evaluate dyspepsia and/or abdominal pain (23.7%), dysphagia (20%), symptoms of gastroesophageal reflux without dysphagia (17%), and suspected upper GI bleeding (16.3%). Colonoscopy was most often performed for surveillance of prior neoplasia (24%) and evaluation of hematochezia (19%) or positive fecal occult blood test (15%). Flexible sigmoidoscopy was most commonly performed for routine screening (40%) and evaluation of hematochezia (22%). There were significant differences between academic and nonacademic sites. CONCLUSIONS: The endoscopic database can be an important resource for future research in endoscopy by documenting current practice patterns and changes in practice over time.     

Outpatient visits for infectious diseases in the United States, 1980 through 1996

BACKGROUND: Recent studies have documented increases in infectious disease mortality and in the proportion of hospitalizations attributable to infectious diseases. To further evaluate trends in the burden of infectious diseases in the United States, we analyzed data from the National Ambulatory Medical Care Survey from 1980 through 1996. OBJECTIVE: To examine the epidemiology of and recent trends in outpatient visits for infectious diseases. METHODS: Data were from a national probability sample of patient visits to office-based physicians. Diagnoses reported by the surveyed physicians were coded to indicate whether they were infectious or noninfectious. Infectious diseases were placed into 11 mutually exclusive categories. RESULTS: During the course of the survey, infectious diseases accounted for 19.0% of visits to physicians, or an average of 129 million visits per year. The infectious disease visit rate was higher in females than in males (587 vs 461 per 1000 persons per year) and higher in non-Hispanic whites than in non-Hispanic blacks or Hispanics (538 vs 407 vs 485 per 1000 persons per year). The visit rate for infectious diseases was greatest in 0- to 4-year-olds. Upper respiratory tract infections accounted for the largest proportion of visits (38.0% of infectious disease visits), followed by otitis (15.1%) and lower respiratory tract infections (14.1%). The age-adjusted visit rate for infectious diseases increased from 462 visits per 1000 persons (17.5% of all visits) in 1980 to 575 (20.2%) in 1990. From 1990 to 1996, this rate declined to 483 per 1000 (18.1%). CONCLUSIONS: Infectious diseases are responsible for a substantial proportion of outpatient visits to physicians in the United States. Upper respiratory tract infections account for the largest proportion of these visits.     

Patterns of alcohol consumption and alcohol-impaired driving in the United States

Background:  Alcohol-related motor vehicle crashes kill approximately 17,000 Americans annually and were associated with more than $51 billion in total costs in 2000. Relatively little is known about the drinking patterns of alcohol-impaired (AI) drivers in the United States.
Methods:  2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for alcohol consumption and self-reported AI driving among U.S. adults aged ≥18 years for all states. Alcohol consumption was divided into 4 categories: binge/heavy, binge/nonheavy, nonbinge/heavy, and nonbinge/nonheavy. Binge drinking was defined as ≥5 drinks for men or ≥4 drinks for women on one or more occasions in the past month, and heavy drinking was defined as average daily consumption of >2 drinks/day (men) or >1 drink/day (women). The prevalence of AI driving was examined by drinking pattern and by demographic characteristics. Logistic regression analysis was used to assess the association between drinking patterns and AI driving.
Results:  Five percent of drinkers were engaged in AI driving during the past 30 days. Overall, 84% of AI drivers were binge drinkers and 88% of AI driving episodes involved binge drinkers. By drinking category, binge/nonheavy drinkers accounted for the largest percentage of AI drivers (49.4%), while binge/heavy drinkers accounted for the most episodes of AI driving (51.3%). The adjusted odds of AI driving were 20.1 (95% CI: 16.7, 24.3) for binge/heavy, 8.2 (6.9, 9.7) for binge/nonheavy, and 3.9 (2.4, 6.3) for nonbinge/heavy drinkers, respectively.
Conclusions:  There is a strong association between binge drinking and AI driving. Most AI drivers and almost half of all AI driving episodes involve persons who are not heavy drinkers (based on average daily consumption). Implementing effective interventions to prevent binge drinking could substantially reduce AI driving.     

Dyslipidemia Patterns among Hispanics/Latinos of Diverse Background in the United States

Background

The prevalence and determinants of dyslipidemia patterns among Hispanics/Latinos are not well known.

Methods

Lipid and lipoprotein data were used from the Hispanic Community Health Study/Study of Latinos–a population-based cohort of 16,415 US Hispanic/Latinos ages 18-74 years. National Cholesterol Education Program cutoffs were employed. Differences in demographics, lifestyle factors, and biological and acculturation characteristics were compared among those with and without dyslipidemia.

Results

Mean age was 41.1 years, and 47.9% were male. The overall prevalence of any dyslipidemia was 65.0%. The prevalence of elevated low-density lipoprotein cholesterol was 36.0%, and highest among Cubans (44.5%; P < .001). Low high-density lipoprotein cholesterol (HDL-C) was present in 41.4% and did not significantly differ across Hispanic background groups (P = .09). High triglycerides were seen in 14.8% of Hispanics/Latinos, most commonly among Central Americans (18.3%; P < .001). Elevated non-HDL-C was seen in 34.7%, with the highest prevalence among Cubans (43.3%; P < .001). Dominicans consistently had a lower prevalence of most types of dyslipidemia. In multivariate analyses, the presence of any dyslipidemia was associated with increasing age, body mass index, and low physical activity. Older age, female sex, diabetes, low physical activity, and alcohol use were associated with specific dyslipidemia types. Spanish-language preference and lower educational status were associated with higher dyslipidemia prevalence.

Conclusion

Dyslipidemia is highly prevalent among US Hispanics/Latinos; Cubans seem particularly at risk. Determinants of dyslipidemia varied across Hispanic backgrounds, with socioeconomic status and acculturation having a significant effect on dyslipidemia prevalence. This information can help guide public health measures to prevent disparities among the US Hispanic/Latino population.