Cell-Surface ZnT8 Antibody Prevents and Reverses Autoimmune Diabetes in Mice.

Type 1 diabetes (T1D) is an autoimmune disease in which pathogenic lymphocytes target autoantigens expressed in pancreatic islets, leading to the destruction of insulin-producing ß-cells. Zinc transporter 8 (ZnT8) is a major autoantigen abundantly present on the ß-cell surface. This unique molecular target offers the potential to shield ß-cells against autoimmune attacks in T1D. Our previous work showed that a monoclonal antibody (mAb43) against cell-surface ZnT8 could home in on pancreatic islets and prevent autoantibodies from recognizing ß-cells. This study demonstrates that mAb43 binds to exocytotic sites on the ß-cell surface, masking the antigenic exposure of ZnT8 and insulin after glucose-stimulated insulin secretion. In vivo administration of mAb43 to NOD mice selectively increased the proportion of regulatory T cells in the islet, resulting in complete and sustained protection against T1D onset as well as reversal of new-onset diabetes. The mAb43-induced self-tolerance was reversible after treatment cessation, and no adverse effects were exhibited during long-term monitoring. Our findings suggest that mAb43 masking of the antigenic exposure of ß-cells suppresses the immunological cascade from B-cell antigen presentation to T cell-mediated ß-cell destruction, providing a novel islet-targeted and antigen-specific immunotherapy to prevent and reverse clinical T1D.

Breast Cancer Population Screening Program Results in Early Detection and Reduced Treatment and Health Care Costs for Medicaid.

CONTEXT: The National Breast and Cervical Cancer Early Detection Program has increased access to screening services for low-income females since 1991; however, evaluation information from states implementing the program is sparse. This study evaluates the impact of the Missouri program, Show Me Healthy Women (SMHW), on early detection and treatment cost. OBJECTIVE: To estimate breast cancer treatment and health care services costs by stage at diagnosis among Missouri's Medicaid beneficiaries and assess the SMHW program impact. DESIGN: Analyzed Missouri Medicaid claims linked with Missouri Cancer Registry data for cases diagnosed 2008-2012 (N = 1388) to obtain unadjusted and incremental costs of female breast cancer treatment and follow-up care at 6, 12, and 24 months following diagnosis. Noncancer controls (N = 3840) were matched on age, race, and disability to determine usual health care cost. Regression analyses estimated the impact of stage at diagnosis on expenditures and incremental cost. Show Me Healthy Women participants were compared with other breast cancer patients on stage at diagnosis. A comparison of SMHW participants to themselves had they not been enrolled in the program was analyzed to determine cost savings. RESULTS: Expenditures increased by stage at diagnosis from in situ to distant with unadjusted cost at 24 months ranging from $50 245 for in situ cancers to $152 431 for distant cancers. Incremental costs increased by stage at diagnosis from 6 months at $7346, $11 859, $21 501, and $20 235 for in situ, localized, regional, and distant breast cancers, respectively, to $9728, $17 056, $38 840, and $44 409 at 24 months. A significantly higher proportion of SMHW participants were diagnosed at an early stage resulting in lower unadjusted expenditures and cost savings. CONCLUSIONS: Although breast cancer treatment costs increased by stage at diagnosis, the population screening program's significant impact on early diagnosis resulted in important cost savings over time for Medicaid.

Association of a Province-Wide Intervention With Salt Intake and Hypertension in Shandong Province, China, 2011-2016.

Importance: High salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease. Objective: To assess the association of a government-led, multisectoral, and population-based intervention with reduced salt intake and blood pressure in Shandong Province, China. Design, Setting, and Participants: This cross-sectional study used data from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) program, a 5-year intervention to reduce sodium consumption in Shandong Province, China. Two representative samples of adults (aged 18-69 years) were surveyed in 2011 (15 350 preintervention participants) and 2016 (16 490 postintervention participants) to examine changes in blood pressure, and knowledge, attitudes, and behaviors related to sodium intake. Urine samples were collected from random subsamples (2024 preintervention participants and 1675 postintervention participants) for measuring sodium and potassium excretion. Data were analyzed from January 20, 2017, to April 9, 2019. Interventions: Media campaigns, distribution of scaled salt spoons, promotion of low-sodium products in markets and restaurants, and activities to support household sodium reduction and school-based sodium reduction education. Main Outcomes and Measures: The primary outcome was change in urinary sodium excretion. Secondary outcomes were changes in potassium excretion, blood pressure, and knowledge, attitudes, and behaviors. Outcomes were adjusted for likely confounders. Means (95% CIs) and percentages were weighted. Results: Among 15 350 participants in 2011, 7683 (50.4%) were men and the mean age was 40.7 years (95% CI, 40.2-41.2 years); among 16 490 participants in 2016, 8077 (50.7%) were men and the mean age was 42.8 years (95% CI, 42.5-43.1 years). Among participants with 24-hour urine samples, 1060 (51.8%) were men and the mean age was 40.9 years (95% CI, 40.5-41.3 years) in 2011 and 836 (50.7%) were men and the mean age was 40.7 years (95% CI, 40.1-41.4 years) in 2016. The 24-hour urinary sodium excretion decreased 25% from 5338 mg per day (95% CI, 5065-5612 mg per day) in 2011 to 4013 mg per day (95% CI, 3837-4190 mg per day) in 2016 (P < .001), and potassium excretion increased 15% from 1607 mg per day (95% CI, 1511-1704 mg per day) to 1850 mg per day (95% CI, 1771-1929 mg per day) (P < .001). Adjusted mean systolic blood pressure among all participants decreased from 131.8 mm Hg (95% CI, 129.8-133.8 mm Hg) to 130.0 mm Hg (95% CI, 127.7-132.4 mm Hg) (P = .04), and diastolic blood pressure decreased from 83.9 mm Hg (95% CI, 82.6-85.1 mm Hg) to 80.8 mm Hg (95% CI, 79.4-82.1 mm Hg) (P < .001). Knowledge, attitudes, and behaviors associated with dietary sodium reduction and hypertension improved significantly. Conclusions and Relevance: The findings suggest that a government-led and population-based intervention in Shandong, China, was associated with significant decreases in dietary sodium intake and a modest reduction in blood pressure. The results of SMASH may have implications for sodium reduction and blood pressure control in other regions of China and worldwide.

Impacts of Neighborhood Characteristics on Treatment and Outcomes in Women with Ductal Carcinoma In Situ of the Breast.

Background: This study examines associations of neighborhood characteristics with treatment and outcomes of ductal carcinoma in situ (DCIS) of the breast.Methods: From the Missouri Cancer Registry, we identified 9,195 women with DCIS diagnosed between 1996 and 2011. A composite index using U.S. Census data and American Community Survey data was developed to assess census tract-level socioeconomic deprivation, and rural-urban commuting area codes were used to define rural census tracts. ORs and 95% confidence intervals (CIs) of the treatment were estimated using logistic regression. Hazard ratios (HRs) of DCIS outcomes were estimated using Cox proportional hazards regression.Results: Women in the most socioeconomically deprived census tracts were more likely than those in the least deprived to have mastectomy (OR = 1.44; 95% CI, 1.25-1.66; P trend < 0.0001), no surgery (OR = 1.54; 95% CI, 1.02-2.30; P trend = 0.04), no radiotherapy post-breast conserving surgery (OR = 1.90; 95% CI, 1.56-2.31; P trend<0.0001), delayed radiotherapy (OR = 1.26; 95% CI, 1.01-1.57; P trend = 0.02), and ipsilateral breast tumors (HR = 1.59; 95% CI, 1.07-2.38; P trend = 0.03). There was no significant difference in risk of contralateral breast tumors. Compared with urban women, rural women had significantly higher odds of underutilization of radiotherapy (OR = 1.29; 95% CI, 1.08-1.53). Rural locations were not associated with risk of ipsilateral or contralateral breast tumors.Conclusions: Neighborhood socioeconomic deprivation was associated with higher risks of suboptimal treatment and ipsilateral breast tumors. While DCIS treatment significantly varied by rural/urban locations, we did not observe any statistically significant rural-urban differences in risks of second breast tumors.Impact: Neighborhood attributes may affect treatment and outcomes of patients with DCIS. Cancer Epidemiol Biomarkers Prev; 27(11); 1298-306. ©2018 AACR.

Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race.

PURPOSE: To investigate whether treatment (surgery, radiation therapy, and endocrine therapy) contributes to racial disparities in outcomes of ductal carcinoma in situ (DCIS). PATIENTS AND METHODS: The analysis included 8184 non-Hispanic White and 954 non-Hispanic Black women diagnosed with DCIS between 1996 and 2011 and identified in the Missouri Cancer Registry. Logistic regression models were used to estimate odds ratios (ORs) of treatment for race. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of ipsilateral breast tumor (IBT) and contralateral breast tumor (CBT) for race. RESULTS: There was no significant difference between Black and White women in utilization of mastectomy (OR 1.16; 95 % CI 0.99-1.35) or endocrine therapy (OR 1.19; 95 % CI 0.94-1.51). Despite no significant difference in underutilization of radiation therapy (OR 1.14; 95 % CI 0.92-1.42), Black women had higher odds of radiation delay, defined as at least 8 weeks between surgery and radiation (OR 1.92; 95 % CI 1.55-2.37). Among 9138 patients, 184 had IBTs and 326 had CBTs. Black women had a higher risk of IBTs (HR 1.69; 95 % CI 1.15-2.50) and a comparable risk of CBTs (HR 1.19; 95 % CI 0.84-1.68), which were independent of pathological features and treatment. CONCLUSION: Racial differences in DCIS treatment and outcomes exist in Missouri. This study could not completely explain the higher risk of IBTs in Black women. Future studies should identify differences in timely initiation and completion of treatment, which may contribute to the racial difference in IBTs after DCIS.

Risk Factors, Preventive Practices, and Health Care Among Breast Cancer Survivors, United States, 2010.

INTRODUCTION: We compared behavioral risk factors and preventive measures among female breast cancer survivors, female survivors of other types of cancers, and women without a history of cancer. Survivorship health care indicators for the 2 groups of cancer survivors were compared. METHODS: Using data from the 2010 Behavioral Risk Factor Surveillance System, we calculated the proportion of women with risk factors and their engagement in preventive practices, stratified by cancer status (cancer survivors or women with no history of cancer), and compared the proportions after adjusting for sociodemographic characteristics. RESULTS: A significantly higher proportion of breast cancer survivors had mammography in the previous year (79.5%; 95% confidence interval [CI], 76.0%-83.0%) than did other cancer survivors (68.1%; 95% CI, 65.6%-70.7%) or women with no history of cancer (66.4%; 95% CI, 65.5%-67.3%). Breast cancer survivors were also more likely to have had a Papanicolaou (Pap) test within the previous 3 years than women with no history of cancer (89.4%; 95% CI, 85.9%-93.0 vs 85.1%; 95% CI, 84.4%-85.8%) and a colonoscopy within the previous 10 years (75.4%; 95% CI, 71.7%-79.0%) than women with no history of cancer (60.0%; 95% CI, 59.0%-61.0%). Current smoking was significantly lower among survivors of breast cancer (10.3%; 95% CI, 7.4%-13.2%) than other cancer survivors (20.8%; 95% CI, 18.4%-23.3%) and women with no history of cancer (18.3%; 95% CI, 17.5%-19.1%). After adjusting for sociodemographic characteristics, we found that breast cancer survivors were significantly more likely to have had mammography, a Pap test, and colonoscopy, and less likely to be current smokers. CONCLUSION: Breast cancer survivors are more likely to engage in cancer screening and less likely to be current smokers than female survivors of other types of cancer or women with no history of cancer.

High Risk Behaviors but Low Injury-Related Mortality Among Hispanic Teens in Missouri.

OBJECTIVE: Our objective was to examine racial/ethnic disparities in injury-related risk behaviors and deaths among teens in Missouri, with a focus on Hispanic people-the fastest-growing racial/ethnic group in the state. METHODS: We used data from the 2013 Missouri Youth Risk Behavior Survey, which included 1616 students in grades 9 through 12 from 32 public and charter high schools. The overall response rate was 69%. We compared the prevalence of 10 injury-related risk behaviors among racial/ethnic groups and used multivariate logistic regression models to control for respondent age and sex. Using data from the 2000-2014 Missouri death records, we also compared injury-related death rates among racial/ethnic groups of teens aged 15 to 19 years. RESULTS: Hispanic students had a significantly higher prevalence than non-Hispanic white students for 9 of 10 risk behaviors and a significantly higher prevalence than non-Hispanic black students for 6 of the 10 risk behaviors included in the study. However, Hispanic teens aged 15 to 19 years had a significantly lower death rate from suicide, homicide, and unintentional injury combined (39.8 per 100000 population, 95% confidence interval [CI], 32.2-48.5) when compared with their non-Hispanic white (54.3 per 100000 population, 95% CI, 52.3-54.6) or non-Hispanic black (94.1 per 100000 population, 95% CI, 87.9-100.3) counterparts. CONCLUSION: Injury-related risk behaviors were more prevalent among Hispanic students than non-Hispanic white or non-Hispanic black students. Further efforts are needed to understand risk behaviors among Hispanic teens to guide intervention efforts.

Missouri Community, Public Health, and Primary Care Linkage: 2011-2012 Pilot Project Results & Evaluation.

This pilot project worked to establish linkages among community-based organizations, health care providers, and public health systems. The partnerships were created to help ensure identification, referral, and follow-up for community members with uncontrolled high blood pressure or pre-hypertension to lay the groundwork for sustainable referral and health education support systems in rural communities. The evaluation shows the project helped some participants control their blood pressure and change their blood pressure management behaviors.

Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention.

Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups' questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy.

Improving Prediabetes Screenings at Rural Missouri County Health Departments.

With prediabetes criteria expanding in recent years, nurses offering prediabetes screenings require updates to stay abreast of current clinical guidelines. This study looked to improve rural Missouri health department nurses' understanding of prediabetes, improve the identification of prediabetes at participating health departments, and educate the nurses on existing prediabetes guidelines. A convenience sample of twenty-two nurses from seven rural Missouri health departments participated. Nurses completed a demographic questionnaire and a prediabetes knowledge pre-test prior to the intervention. Seven to eight weeks post-intervention, the health department nurses completed the prediabetes post-tests. A single live education session was conducted at each health department. Data from the pre- and post-tests was reviewed within three result categories. The overall, laboratory nursing knowledge, and general nursing knowledge divisions each showed statistically significant improvement with a p < 0.05. This study's post-test improvement in prediabetes knowledge replicates the usefulness of a simple, low cost educational update. Nurses improved the identification of prediabetes laboratory values on post-test data and showed an increase in overall prediabetes knowledge. A single and simple continuing education program is a useful tool for rural health nurses.

Validation of multilevel regression and poststratification methodology for small area estimation of health indicators from the behavioral risk factor surveillance system.

Small area estimation is a statistical technique used to produce reliable estimates for smaller geographic areas than those for which the original surveys were designed. Such small area estimates (SAEs) often lack rigorous external validation. In this study, we validated our multilevel regression and poststratification SAEs from 2011 Behavioral Risk Factor Surveillance System data using direct estimates from 2011 Missouri County-Level Study and American Community Survey data at both the state and county levels. Coefficients for correlation between model-based SAEs and Missouri County-Level Study direct estimates for 115 counties in Missouri were all significantly positive (0.28 for obesity and no health-care coverage, 0.40 for current smoking, 0.51 for diabetes, and 0.69 for chronic obstructive pulmonary disease). Coefficients for correlation between model-based SAEs and American Community Survey direct estimates of no health-care coverage were 0.85 at the county level (811 counties) and 0.95 at the state level. Unweighted and weighted model-based SAEs were compared with direct estimates; unweighted models performed better. External validation results suggest that multilevel regression and poststratification model-based SAEs using single-year Behavioral Risk Factor Surveillance System data are valid and could be used to characterize geographic variations in health indictors at local levels (such as counties) when high-quality local survey data are not available.

The effect of the Missouri WISEWOMAN program on control of hypertension, hypercholesterolemia, and elevated blood glucose among low-income women.

INTRODUCTION: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) public health program is designed to reduce the risk of heart disease and stroke among low-income, underinsured or uninsured women through clinical screenings, risk factor assessment, and lifestyle interventions. We assessed the effect of the Missouri WISEWOMAN program on the control of high blood pressure, total cholesterol, and blood glucose levels. METHODS: We calculated the proportion of participants (N = 1,130) with abnormal blood pressure, total cholesterol, or blood glucose levels at an initial screening visit who gained control at a follow-up visit 11 to 18 months later during a 7-year period from June 30, 2005, to June 29, 2012. We used logistic regression to identify sociodemographic characteristics and other factors associated with achieving control. RESULTS: Many WISEWOMAN participants gained control of their blood pressure (41.2%), total cholesterol (24.7%), or blood glucose levels (50.0%). After controlling for sociodemographic factors, smoking status, weight status, medication use, and number of lifestyle interventions, nondiabetic women with stage II hypertension (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [CI] = 0.21-0.60) and diabetic women with stage I (AOR = 0.54, 95% CI = 0.32-0.92) and stage II (AOR = 0.23, 95% CI = 0.07-0.77) hypertension were less likely to achieve control of their blood pressure than nondiabetic women with stage I hypertension. Women aged 45 to 64, women with less than a high school education, women who were obese in the initial visit, women who gained 7% or more of their weight, and women who did not participate in any lifestyle intervention sessions were significantly less likely to achieve total cholesterol control than their counterparts. CONCLUSION: The Missouri WISEWOMAN program helps many participants achieve control of blood pressure, total cholesterol, and blood glucose levels; the lifestyle intervention is likely to help participants control total cholesterol. More efforts are needed for women with diabetes and stage II hypertension to achieve blood pressure control.

The health and welfare of rural and urban cancer survivors in Missouri.

INTRODUCTION: An estimated 2.8 million cancer survivors reside in rural areas in the United States. We compared the risk behaviors, psychosocial factors, health outcomes, quality of life, and follow-up care of rural and urban cancer survivors in Missouri. METHODS: We used 2009-2010 Missouri Behavioral Risk Factor Surveillance System data to examine various health outcomes, behaviors, and psychosocial factors among rural and urban cancer survivors and their respective rural and urban counterparts without a cancer history. Cancer survivors also were asked about receipt of survivorship care plan components. Sociodemographic factors, access to medical care, and chronic conditions were examined as potential explanatory factors for differences among the 4 groups. RESULTS: An estimated 9.4% of rural and 7.9% of urban Missourians aged 18 years or older reported a cancer history. Rural survivors reported the highest rates of poor self-reported health, physical distress, and activity limitation; however differences between rural and urban survivors were attributable largely to sociodemographic differences. Both rural and urban cancer survivors reported more fatigue than their respective counterparts without a cancer history. Rural survivors also were less likely to meet Centers for Disease Control and Prevention recommendations for physical activity than their rural controls. The prevalence of smoking among rural survivors was higher than among urban survivors. Only 62% of rural survivors versus 78% of urban survivors reported receiving advice about cancer follow-up care. CONCLUSION: Rural cancer survivors face many health challenges. Interventions to improve quality of life and health behaviors should be adapted to meet the needs of rural cancer survivors.

The burden of chronic diseases in Missouri: progress and challenges.

Chronic diseases are the major causes of premature death, disability and loss of quality of life in Missouri. The prevalence of many chronic diseases, conditions and risk behaviors is greater in Missouri than the U.S. The medical costs for treating chronic diseases are a burden on the state's economy and will increase as the population ages. Prevention and control of chronic diseases is essential to the physical and economic health of Missourians.

Economic effect of smoke-free ordinances on 11 Missouri cities.

INTRODUCTION: The harmful effects of secondhand smoke are convincing more and more communities across the United States and the world to prohibit smoking in public places, especially in eating and drinking establishments. A 1993 Missouri state law allows smoking in designated areas in indoor public places such as restaurants and bars. Consequently, some Missouri communities have adopted local ordinances that prohibit smoking in all indoor workplaces, including restaurants and bars. We used an objective measure of economic activity, the taxable sales revenues of eating and drinking establishments, to empirically examine the economic effect of smoke-free ordinances. METHODS: We studied the economic effect of smoke-free ordinances in 11 Missouri cities using multivariate log-linear regression models with log-transformed taxable sales revenues of eating and drinking establishments as the dependent variable and the smoke-free ordinance as the independent variable, while controlling for seasonality, economic condition and unemployment. We used data from 20 quarters before the smoke-free ordinances and at least 10 quarters after the smoke-free ordinances for all cities. The null hypothesis of no effect of smoke-free ordinance on taxable sales of the eating and drinking establishments was tested. RESULTS: Eight of the 11 cities had increased taxable sales for eating and drinking establishments postordinance. The remaining 3 experienced no change. CONCLUSION: The findings of our study are consistent with findings from most published economic studies that a smoke-free ordinance does not harm a local economy.

Tobacco use among Missouri middle and high school students, 2003-2009.

Reducing tobacco use among young people is an important public health goal. This article summarizes the results of the analysis of Missouri Youth Tobacco Survey (YTS) data collected between 2003 and 2009. The YTS collects information regarding tobacco use and related issues among Missouri public middle and high school students. Downward trends in initiation of tobacco use and current cigarette smoking occurred during this period. However, increased implementation of evidence-based interventions is needed to continue the progress seen during this period.

Evaluation of the Missouri WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) breast-feeding peer counselling programme.

OBJECTIVE: To evaluate the effectiveness of the peer counselling (PC) programme on breast-feeding initiation among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Missouri, and to identify factors that facilitate breast-feeding initiation. DESIGN: We used the data from the 2006 Missouri Pregnancy Nutrition Surveillance System, Missouri Live Birth Records and the Missouri WIC programme to compare breast-feeding initiation rates between PC and non-PC agencies. We used multilevel logistic regression, with individual participants being nested within agencies, to control for individual- and agency-level characteristics. RESULTS: The breast-feeding initiation rate in PC agencies was significantly higher than in non-PC agencies among prenatal participants, but the difference was not significant among postpartum participants. After controlling for maternal sociodemographic characteristics, compared with prenatal cases in non-PC agencies, prenatal cases in PC agencies were more likely to initiate breast-feeding (OR = 1.21; 95 % CI 1.03, 1.43), whereas postpartum cases were less likely to initiate breast-feeding. Among prenatal participants in PC agencies, longer duration of prenatal WIC enrolment was associated with a higher rate of breast-feeding initiation. After adjusting for maternal sociodemographic characteristics and other agency-level characteristics, participants of PC agencies with an international board-certified lactation consultant were more likely to initiate breast-feeding than participants of PC agencies without such a consultant (OR = 1.21; 95 % CI 1.01, 1.45). CONCLUSIONS: Prenatal participation in the WIC breast-feeding PC programme (especially participation early during pregnancy) was associated with an increased rate of breast-feeding initiation in Missouri.

Health and economic burden of traumatic brain injury: Missouri, 2001-2005.

OBJECTIVE: We examined the financial and social costs resulting from traumatic brain injury (TBI) in Missouri. METHODS: We computed mortality rates from death certificates, the direct cost of TBI from hospital and emergency department (ED) visit charges, the social cost in terms of years of potential life lost (YPLL) using an abridged Missouri life table, and the indirect financial cost in terms of lost productivity due to premature death for all TBI and four major causes of TBI in Missouri. RESULTS: During 2001-2005, a mean of 1358 lives were lost due to TBI in Missouri. Four major causes-unintentional falls, motor vehicle traffic crashes, motorcycle crashes, and firearms-accounted for 88% of all TBI deaths. We estimated the annual direct medical cost of TBI at $95 million, or about $1.67 million per 100,000 Missourians. This cost increased by about 60% between 2001 and 2005. The four major causes of TBI accounted for 68% of all direct medical costs of TBI. We estimated the cost per hospitalization and ED visit at $6948 and the indirect social cost at 48,501 YPLL. During this period, the mean age of TBI fatality was 44 years. We determined the lost productivity due to TBI mortality--$1.1 billion, or about $18.8 million per 100,000 Missourians--to be three times as high for males as for females. CONCLUSIONS: The types of costs covered in this study underestimated the total cost of TBI in Missouri, as we did not include outpatient care, rehabilitation, and drug costs. Nevertheless, we found the health and economic burden from medical care and mortality related to TBI to be substantial in Missouri.

Cancer disparities between African-Americans and whites in Missouri.

Eliminating racial disparities in cancer is a key goal of national organizations and those in Missouri. The purpose of this study is to provide trends in cancer incidence (1996-2003) and mortality (1990-2005) over time with special emphasis on disparities between African-Americans and whites in Missouri. Overall changes in incidence rates suggest that by 2006 the racial disparity will be eliminated. However, African-Americans will continue to have higher mortality rates unless more aggressive interventions are implemented.