Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance

Objectives. We sought to improve public health surveillance by using a geographic analysis of emergency department (ED) visits to determine local chronic disease prevalence.Methods. Using an all-payer administrative database, we determined the proportion of unique ED patients with diabetes, hypertension, or asthma. We compared these rates to those determined by the New York City Community Health Survey. For diabetes prevalence, we also analyzed the fidelity of longitudinal estimates using logistic regression and determined disease burden within census tracts using geocoded addresses.Results. We identified 4.4 million unique New York City adults visiting an ED between 2009 and 2012. When we compared our emergency sample to survey data, rates of neighborhood diabetes, hypertension, and asthma prevalence were similar (correlation coefficient = 0.86, 0.88, and 0.77, respectively). In addition, our method demonstrated less year-to-year scatter and identified significant variation of disease burden within neighborhoods among census tracts.Conclusions. Our method for determining chronic disease prevalence correlates with a validated health survey and may have higher reliability over time and greater granularity at a local level. Our findings can improve public health surveillance by identifying local variation of disease prevalence.In its 2012 report on measures for population health, the Institute of Medicine prioritized understanding local population health to improve health care for populations with the highest need.1 Generally, health care providers have used the term “population health” when referring to patients linked to a specific health care provider or insurance group.2 However, the discipline of public health more broadly defines population health as the health of all individuals living in specific geographic regions.3To estimate disease burden, traditional methods include performing population-based telephone health surveys.4 Unless large numbers of individuals are surveyed, it is difficult to determine prevalence in small geographic areas such as census tracts, and yearly estimates have significant noise because of small sample sizes.5 Low response rates can lead to errors in estimating disease prevalence, and larger surveys can be costly and difficult to perform.6With increasing use of big data in the form of large administrative data sets with clinical data,7 there is an opportunity to create more precise measures of population health by reducing the variance associated with small sample sizes.8–10 These methods may be biased as they only track individuals who register a medical claim, which makes for a type of convenience sample. Nevertheless, a significant proportion of all individuals, regardless of insurance type, interact with the health care system, especially through emergency services. Nearly 1 in 5 individuals report having gone to an emergency department (ED) in the past year.11 Previous studies have demonstrated the promise of using emergency claims data for tracking acute illnesses; however, there is potential to extend these methods to the surveillance of chronic disease.12,13 One of the advantages of using administrative claims data is the achievement of large sample sizes without the need to conduct large surveys.14,15In this study, we have introduced a novel geographic method of public health surveillance and determined whether we could use ED administrative claims to estimate chronic disease prevalence at a local level over time. As the ED is generally a place where all individuals can access care regardless of socioeconomic or insurance status, it offers an ideal environment for public health surveillance among all types of individuals within a heterogeneous population.16     

Hypertension presenting early in pregnancy

Paraganglioma in pregnancy is an exceedingly rare and potentially life‐threatening diagnosis. It is important that the clinicians consider secondary causes when women present with hypertension in early pregnancy.     

The Association of Prehospital Intravenous Fluids and Mortality in Patients with Penetrating Trauma

Background

The optimal approach to prehospital care of trauma patients is controversial, and thought to require balancing advanced field interventions with rapid transport to definitive care.

Parechovirus Genotype 3 Outbreak among Infants,New South Wales,Australia, 2013–2014

From October 2013 through February 2014, human parechovirus genotype 3 infection was identified in 183 infants in New South Wales, Australia. Of those infants, 57% were male and 95% required hospitalization. Common signs and symptoms were fever >38°C (86%), irritability (80%), tachycardia (68%), and rash (62%). Compared with affected infants in the Northern Hemisphere, infants in New South Wales were slightly older, both sexes were affected more equally, and rash occurred with considerably higher frequency. The New South Wales syndromic surveillance system, which uses near real-time emergency department and ambulance data, was useful for monitoring the outbreak. An alert distributed to clinicians reduced unnecessary hospitalization for patients with suspected sepsis.     

An Experimental Study of the Effects of Patient Race,Sexual Orientation,and Injection Drug Use on Providers’ PrEP-Related Clinical Judgments

AIDS and Behavior - Social biases may influence providers’ judgments related to pre-exposure prophylaxis (PrEP) and patients’ consequent PrEP access. US primary and HIV care providers...     

A human antibody that inhibits factor IX/IXa function potently inhibits arterial thrombosis without increasing bleeding

10C12, a human antibody F(ab')2, which specifically binds to the gamma-carboxyglutamic acid domain of factor IX/factor IXa (F.IX/IXa), interferes with all known coagulation processes in which F.IX/IXa is involved. In a rabbit model of carotid artery injury, intravenous administration of 10C12 or heparin decreased thrombosis dose dependently. The dose that resulted in a 90% reduction of thrombus mass (ED90) was a 30-microg/kg bolus of 10C12 or a 100-U/kg bolus plus 1.0 U x kg(-1) x min(-1) infusion of heparin. Heparin, at and below the ED90, significantly prolonged coagulation times and cuticle bleeding times. In contrast, 10C12 had no effect on coagulation or bleeding times at doses up to 4 times the ED90. To further evaluate the effect of 10C12 on bleeding, it was compared with heparin in a novel model of blood loss. At the ED90 of heparin, blood loss induced by a standardized injury to the vasculature of the rabbit tibia increased to more than 2 times that of saline controls. In contrast, the dose of 10C12 required to produce a similar increase in blood loss was more than 30 times the ED90. The antithrombotic potency and relative safety of this fully human antibody suggests that it may have therapeutic value for treatment of thrombotic disorders.