Prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001

OBJECTIVE To study the prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001. METHODS All medical claims for coronary heart disease (ICD-9 410-414), hypertension (ICD-9 401-405), congestive heart failure (ICD-9 428) and cerebrovascular accidents and transient ischemia (ICD-9:430-438.9) submitted for reimbursement purposes to an insurance company (private and public sector) in Puerto Rico in 2001 were identified. Prevalence and medical care utilization concerning cardiovascular conditions was estimated with 95% confidence. RESULTS Overall prevalence of cardiovascular conditions was 13.5% (95% CI: 11.68%-15.44%), being larger in the private sector (16.0%; 95% CI: 15.98%-16.08% vs. 11.7%; 95% CI: 11.62%-11.77%). Although in both sectors prevalence increased with age, at same age groups was two times higher in the private sector. Hypertension was the most prevalent condition (9.7; 95% CI: 8.14%-11.41%) being higher in females (10.4; 95% CI: 10.37%-10.51%) than in males (8.9; 95% CI: 8.81%-8.96%). The health service utilization (physician's office visits, emergency room visits, and hospital admissions) was higher in males. However, it varies by sectors. CONCLUSIONS Significant difference exists in the prevalence of cardiovascular conditions and health services utilization among private and public sectors in Puerto Rico. The observed differences among the private and public populations imply that there are factors such as socioeconomic status, education, lifestyles, environmental hazards in neighborhoods, and health habits that could be involved in the differences

Type 2 diabetes mellitus among youth in Puerto Rico, 2003

AIMS: To describe the clinical characteristics, and estimate the prevalence of type 2 diabetes mellitus among Puerto Rican youth, 1995-2003. METHODS: All patients aged less than 20 years with a confirmed diagnosis of type 2 diabetes were identified from pediatric endocrinologists' medical practices. Medical records of each patient were reviewed to confirm the diagnosis, classify the type of diabetes, and gather sociodemographic and clinical characteristics. From 1995 to 2003 a total of 32,444 records were reviewed. A total of 2,800 children with diabetes were identified, of which 2,702 were type 1 and 93 type 2; typel/type 2 ratio was 29:1. Frequency distributions were obtained for categorical variables, and summary measures (mean +/- standard deviation) for quantitative measure were computed. RESULTS: Mean age at first visit was 14 years. The majority of cases were females (69), for a female/ male ratio of 2.2:1. 78.5had a family history of the disease, 74.2were overweight, and 48had acanthosis nigricans. 64.5of the cases were receiving some type of hypoglycemic therapy. 18.5of the cases had severe hypertension while 17.5had cholesterol levels considered at increased risk (e[quot ]200). The overall prevalence was 13.5 per 100,000 population. CONCLUSIONS: This study is the first that describes the frequency and clinical presentation of type 2 diabetes in children and adolescents in a sample of Puerto Ricans. Further investigations must be conducted to obtain a more precise estimate of the burden of type 2 diabetes in youth and to raise awareness of this condition among health care professionals.

Health disparities between diabetic patients under private and public health coverage in Puerto Rico, 2000

OBJECTIVE: To examine health disparities between diabetic patients receiving services in private and public health sectors. METHODS: Insureds with service claims for diabetes (ICD-9 250-259) from two private insurance companies and two public health groups were selected. Personnel of the participant insurance companies were responsible for identifying medical claims that met the study inclusion criteria and providing the information in a computerized database file. RESULTS: Overall prevalence was 4.9%. Prevalence in the public sector (5.8%) was higher than that of the private sector (3.7%) (p < 0.0001). The overall prevalence among females of the public sector was nearly twice (6.3%) the prevalence in the private sector (3.3%) (p < 0.0001). The prevalence of the majority of services analyzed was larger in the public sector. However, prevalence of specific services (glucose and glycosilated hemoglobin tests) was larger in the private sector. Differences between sectors in the prevalence of complications were also observed. Prevalence and service utilization also varied by age and sex in both sectors. CONCLUSIONS: Significant difference exists in the prevalence of diabetes and health service utilization between the private and the public sector.

Prevalencia de asma y utilización de servicios médicos en asegurados de una compañía de servicios de salud en Puerto Rico, 1996-1997 / The prevalence of asthma and the utilization of medical services among those insured by a health-services company in Puerto Rico, 1996-1997

OBJECTIVE: To describe the prevalence and pattern of utilization of medical services in insured of SSS with a diagnosis of asthma during 1996 and 1997. METHODS: The medical claims of SSS insured whose main diagnosis was asthma (ICD-9 9 493-493.9) were selected for analysis. The prevalence and medical service utilization (medical visits, emergency and hospital admissions) were estimated. Differences in health service utilization by age group were analyzed by the Poisson model. RESULTS: The asthma prevalence was 14.5, being larger in patients younger than 18 years of age and in females. 54.3 of the asthmatic patients visited medical offices and the larger proportion of users was observed in the younger group (< 18 years). However, the larger proportion of users of the emergency room was observed in the 18-44 age group, while the hospital admissions was larger in the 45-64 age group. More than half (56) of the cost per service was attributed to hospital admissions while 31 was for pharmacy services. 65.9 of the insurers with asthma had prescriptions for short relief beta-antagonist. CONCLUSIONS: The prevalence of asthma in this study was high and similar to rates of the disease reported in Puerto Ricans residing in the U. S. and in other areas of the island. Similarly, the prevalence differed by age in the utilization of medical services as well as the high cost of hospital admissions. Prevalence studies using other sources as well as a standard definition of the condition may be helpful to confirm these results

Análisis de sobrevivencia de pacientes con enfermedad renal permanente en Puerto Rico 1970-1994 / Analalysis of survival of patients with end-stage renal disease in Puerto Rico, 1970-1994

To assess the survival probabilities of patients with end stage renal disease in Puerto Rico, the data from the United States Renal Data System from 1970 through 1994 was analyzed. The Kaplan Meier method was used to determine the survival rate for the following variables: diagnosis, gender, age groups, treatment modality and health regions. The analysis included 7,527 patients reported to the United States Renal Disease System of which 4,295 (57 percent) patients were reported dead. The median time of survival rate (50 percent) was 47.7 months. There was significantly lower survival rate (p = 0.0001) for diabetics compared with all the other diagnosis. Age was also a strong predictor of survival (p = 0.0001) and modality treatment (p = 0.0001). We concluded that diabetes, the elderly and the hemodialysis modality, had the lower survival rate in the puerto rican population