The Impact of Hurricane Sandy on HIV Testing Rates: An Interrupted Time Series Analysis, January 1, 2011‒December 31, 2013.

BACKGROUND: Hurricane Sandy made landfall on the eastern coast of the United States on October 29, 2012 resulting in 117 deaths and 71.4 billion dollars in damage. Persons with undiagnosed HIV infection might experience delays in diagnosis testing, status confirmation, or access to care due to service disruption in storm-affected areas. The objective of this study is to describe the impact of Hurricane Sandy on HIV testing rates in affected areas and estimate the magnitude and duration of disruption in HIV testing associated with storm damage intensity. METHODS: Using MarketScan data from January 2011‒December 2013, this study examined weekly time series of HIV testing rates among privately insured enrollees not previously diagnosed with HIV; 95 weeks pre- and 58 weeks post-storm. Interrupted time series (ITS) analyses were estimated by storm impact rank (using FEMA's Final Impact Rank mapped to Core Based Statistical Areas) to determine the extent that Hurricane Sandy affected weekly rates of HIV testing immediately and the duration of that effect after the storm. RESULTS: HIV testing rates declined significantly across storm impact rank areas. The mean decline in rates detected ranged between -5% (95% CI: -9.3, -1.5) in low impact areas and -24% (95% CI: -28.5, -18.9) in very high impact areas. We estimated at least 9,736 (95% CI: 7,540, 11,925) testing opportunities were missed among privately insured persons following Hurricane Sandy. Testing rates returned to baseline in low impact areas by 6 weeks post event (December 9, 2012); by 15 weeks post event (February 10, 2013) in moderate impact areas; and by 17 weeks after the event (February 24, 2013) in high and very high impact areas. CONCLUSIONS: Hurricane Sandy resulted in a detectable and immediate decline in HIV testing rates across storm-affected areas. Greater storm damage was associated with greater magnitude and duration of testing disruption. Disruption of basic health services, like HIV testing and treatment, following large natural and man-made disasters is a public health concern.  Disruption in testing services availability for any length of time is detrimental to the efforts of the current HIV prevention model, where status confirmation is essential to control disease spread.

Health insurance coverage among diabetic adults from three major ethnic groups in the United States.

OBJECTIVE: The lack of adequate health insurance may result in a downward spiral of the diabetic condition, imposing an increased financial strain on family and the society as a whole. The objective of our study was to assess the insurance type and coverage among diabetic adults from three major ethnic groups. DESIGN AND SETTING: We used data of two cross-sectional national surveys to estimate insurance coverage among diabetic adults aged 20-64 years, 1988-1994 and 2003-2008. RESULTS: The prevalence of doctor-diagnosed diabetes has increased by 120%, 178% and 135% respectively among non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs), and Mexicans & other Hispanics (M&OHs) from 1988-94 to 2003-08. However, during the same period, the percentages of diabetic adults covered by health insurance declined for all three groups. In the 2003-08 period, 15%, 19% and 40% of NHWs, NHBs and M&OHs, respectively, had no insurance. Diabetic NHBs and NHWs had an equal likelihood to be covered by government-sponsored programs. However, 70% of NHWs, in contrast to 37% of NHBs, were covered by private programs exclusively. Diabetic M&OHs remained at the lowest likelihood to be covered by government-sponsored programs. The diabetic citizen's probability of being insured was more than tripled compared with the non-citizens (OR=3.40, 95%=1.42-8.14). CONCLUSION: Increasing percentages of diabetics had no insurance. Diabetic Whites were more likely to be covered by private programs than diabetic Blacks. Hispanics were the group falling through the cracks between private programs due to low income and government programs because of immigration status.

Fish consumption and severely depressed mood, findings from the first national nutrition follow-up study.

The evidence obtained from prospective studies to support the hypothesis that fish consumption may improve mental status remains limited. The current study prospectively assessed a low frequency of fish consumption as a risk factor for depressed mood. Included were 5068 adults aged 25-74 years examined in 1971-1975 as the baseline of the First National Health and Nutrition Examination Survey Follow-up Study. Frequency of eating fish at baseline was obtained using a 3-month food frequency questionnaire. Severely depressed mood (SDM) was defined as the Center for Epidemiologic Studies Depression Scale scores ≥22 or taking anti-depressants. After an average of 10.6 years of follow-up, among men (n=2039), the percentage of individuals with SDM was 11.7%. Compared with frequent consumers (more than once a week), the odds ratios (ORs) were 1.43 (95%CI=0.66-3.11) and 2.08 (1.08-4.09) respectively for the men eating fish once a week and less than once a week (p for trend=0.03). Among women (n=3029), the percentage of individuals with SDM was 17.89%. The ORs were 1 (reference), 0.91 (0.68-1.22) and 1.15 (0.83-1.59) respectively for the women eating fish more than once, once, and less than once a week. These estimates were obtained after adjustment for indicators of social deprivation and major physical diseases. The study concluded that independently from social deprivation and physical diseases, low fish consumption was a risk factor for SDM among men. Further studies are needed to confirm these findings and elucidate mechanisms for the difference between men and women.