Nutritional Calorie Labeling and Menu Ordering Practices Among US Adults With Chronic Illnesses.

BACKGROUND: The relationship between diet and the management of chronic illnesses is well established. However, it is unknown the extent to which people with chronic illnesses pay attention to nutritional information and act upon the information obtained. We evaluated the menu ordering practices of adults with chronic illnesses. METHODS: We analyzed the 2018 Health Information National Trends Survey (HINTS 5 Cycle 2). Our analytic cohort included 3,154 respondents (weighted population size=228,464,822) who answered questions regarding a personal history of diabetes, hypertension, heart disease, and obesity. They also answered questions about their nutritional habits regarding whether they noticed caloric information at fast-food or sit-down restaurants and how that information influenced their dietary choices. RESULTS: Among respondents with these chronic illnesses, only obese patients were significantly more likely to pay attention to caloric information (OR=1.56; 95%CI: 1.06-2.31). However, noticing the calorie information was not associated with ordering less calories among all categories of respondents with chronic illnesses. CONCLUSION: US adults with chronic illnesses do not pay sufficient attention to the calorie information of their diet. Furthermore, awareness of the calorie information did not influence their dietary choices. Healthcare professionals should incorporate dietary counseling into the management of chronic illnesses of their patients.

Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015-2020.

Recurrent Clostridioides difficile infection (RCDI) causes an increased burden on the healthcare system. We calculated RCDI incidence and identified factors associated with RCDI cases in New Haven County, Connecticut, USA, during 2015-2020 by using data from population-based laboratory surveillance. A subset of C. difficile cases had complete chart reviews conducted for RCDI and potentially associated variables. RCDI was defined as a positive C. difficile specimen occurring 2-8 weeks after incident C. difficile infection. We compared cases with and without RCDI by using multiple regression. RCDI occurred in 12.0% of 4,301 chart-reviewed C. difficile cases, showing a U-shaped time trend with a sharp increase in 2020, mostly because of an increase in hospital-onset cases. Malignancy (odds ratio 1.51 [95% CI 1.11-2.07]) and antecedent nitrofurantoin use (odds ratio 2.37 [95% CI 1.23-4.58]) were medical risk factors for RCDI. The 2020 increase may reflect the impact of the COVID-19 pandemic.

Demographics and Prevalence of Risk Factors in Patients With Peripheral Arterial Disease Presenting to a Tertiary Care Center in Northern India.

Introduction Globally around 236.62 million people over 25 had the peripheral arterial occlusive disease (PAOD) in 2015, out of which 72.91 were in lower and middle-income countries. It will be a significant health problem in our country as the Indian population is aging. Our study aims to determine the demographics and prevalence risk factors in patients presenting with PAOD. Methods This prospective observational study was conducted from January 2020 to April 2021 at a tertiary care center in Northern India. A total of 275 patients with PAOD were enrolled in the study. The demographics and the prevalence of the risk factors were studied. Results Males (85.8%) were predominantly affected compared to females (14.2%). About 80.4% were smokers, of which 84.16% predominantly smoked Bidi. Around 39.3% had diabetes mellitus, 43.3% were hypertensive, and dyslipidemia was present in 17.1%. History of coronary artery disease and cerebrovascular accident was present in 22.3% and 12%, respectively. Farming was the occupation for 29.1% and 32.4% had not received formal schooling. The mean annual income was Rupees 1,56,025 (rupees 13,000 per month). Overall, the socioeconomic status was low. Conclusion The demographics and the prevalence of risk factors in patients with PAOD in Northern India differ from those in South India and the Western populations. Most of the patients were elderly males belonging to low socioeconomic status. There is a need for a central registry for vascular diseases in India to monitor the trends of the annual incidence of PAOD and to look for the prevalence of risk factors.

Association between socioeconomic level and cardiovascular risk in the Peruvian population / Asociación entre nivel socioeconómico y riesgo cardiovascular en la población peruana

ABSTRACT OBJECTIVE To determine the association between socioeconomic level and the presence of obesity, hypertension and type 2 diabetes mellitus in the Peruvian population. METHODS Secondary analysis of data from the National Demographic and Family Health Survey ( Encuesta Nacional Demográfica y de Salud Familiar , Endes) from 2018 to 2020. The outcomes were obesity, hypertension, and type 2 diabetes mellitus. The exposure variables were two indicators of socioeconomic status: educational level (< 7 years, 7-11 years, and 12+ years) and wealth index (in tertiles). Models were created using Poisson regression, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS Data from 98,846 subjects were analyzed. Mean age: 45.3 (SD: 16.0) years, and 55.5% were women. The prevalence of obesity was 26.0% (95%CI: 25.4-26.6); of hypertension, 24.9% (95%CI: 24.3-25.5); and of type 2 diabetes mellitus, 4.8% (95%CI: 4.5-5.1). In multivariate model, and compared with those with a low wealth index, those with a high wealth index had a higher prevalence of obesity (PR = 1.49; 95%CI: 1.38-1.62), hypertension (PR = 1.09; 95%CI: 1.02-1.17) and type 2 diabetes mellitus (PR = 1.72; 95%CI: 1.29-2.29). On the other hand, higher educational level was only associated with a reduction in the prevalence of obesity (PR = 0.89; 95%CI: 0.84-0.95). CONCLUSIONS There is a differential association between the wealth index, educational level and markers of noncommunicable diseases. There is evidence of a positive association between wealth index and obesity, hypertension and type 2 diabetes mellitus, whereas educational level was only negatively associated with obesity.

RESUMEN OBJETIVO Determinar la asociación entre el nivel socioeconómico y la presencia de obesidad, hipertensión y diabetes mellitus tipo 2 en la población peruana. MÉTODOS Análisis de datos secundarios de la Encuesta Nacional Demográfica y de Salud Familiar (Endes) del 2018 al 2020. Las variables dependientes fueron obesidad, hipertensión y diabetes mellitus tipo 2, y las variables independientes fueron dos indicadores de nivel socioeconómico: el nivel educativo (< 7 años, 7-11 años y 12+ años) y el índice de bienestar (en terciles). Se crearon modelos usando regresión de Poisson, reportando razones de prevalencia (RP) e intervalos de confianza al 95% (IC95%). RESULTADOS Se analizaron los datos de 98.846 sujetos, edad promedio: 45,3 (DE: 16,0) años, y 55,5% fueron mujeres. La prevalencia de obesidad fue del 26% (IC95% 25,4-26,6); la de hipertensión, 24,9% (IC95% 24,3-25,5); y la de diabetes mellitus tipo 2, 4,8% (IC95% 4,5-5,1). En modelo multivariable y comparado con los de índice de bienestar bajo, aquellos con índice de bienestar alto tenían mayor prevalencia de obesidad (RP = 1,49; IC95% 1,38-1,62), de hipertensión (RP = 1,09; IC95% 1,02-1,17) y de diabetes mellitus tipo 2 (RP = 1,72; IC95% 1,29-2,29). De otro lado, mayor nivel educativo sólo se asoció a una reducción en la prevalencia de obesidad (RP = 0,89; IC95% 0,84-0,95). CONCLUSIONES Existe asociación diferencial entre el índice de bienestar, nivel educativo y marcadores de enfermedades no transmisibles: hay evidencia de asociación positiva entre el índice de bienestar y obesidad, hipertensión y diabetes mellitus tipo 2, mientras que el nivel educativo solo estuvo asociado de forma negativa a obesidad.

Population-based Estimates for High Risk of Severe COVID-19 Disease due to Age and Underlying Health Conditions.

INTRODUCTION: COVID-19 is a viral respiratory disease, which became a global threat to public health. Specific subsets of the population are more vulnerable, namely those with chronic diseases. We aimed to estimate the share of the Portuguese population at the highest risk for complications following COVID-19 infection due to both old age and specific comorbidities. MATERIAL AND METHODS: Our sample included all people aged 65 years and above (2215 men and 3486 women) who participated in the fifth Portuguese National Health Interview Survey, conducted in 2014. In order to project the potential population at highest risk for COVID-19, we used the latest available official demographic estimates from the National Institute of Statistics - INE 2018. We used a more restrictive definition of risk combining old age criteria and the following chronic conditions as potential risk factors for COVID-19 according to the available literature: hypertension, diabetes, chronic obstructive pulmonary disease, cardio- and cerebrovascular disease. RESULTS: We estimated that 15.5% (n = 1 560 667) of the Portuguese population might be at increased risk for complications from COVID-19 because of old age and existing chronic conditions. Such estimates vary across the country (from 1.7% in Azores to 33.7% in Northern Portugal). Northern Portugal not only has the highest prevalence of selected morbidity (72.8%) within mainland Portugal, but also has the largest population at risk for COVID-19 (n = 526 607). This was followed by the Lisbon and Tagus Valley region (n = 408 564) and Central Portugal (n = 388 867). DISCUSSION: Our results should encourage authorities to continue protecting those more vulnerable to the pandemic threat, particularly on those areas of the country which are more likely to be further affected. CONCLUSION: We projected a considerable number of Portuguese people at the highest risk for severe COVID-19 disease due to both old age and pre-existing chronic conditions. Such estimates vary across the country.

Assessing two methods for estimating excess mortality of chronic diseases from aggregated data.

OBJECTIVE: To assess the numerical properties of two recently published estimation techniques for excess mortality based on aggregated data about diabetes in Germany. RESULTS: Application of the new methods to the claims data yields implausible findings for the excess mortality of type 2 diabetes in ages below 50 years of age.

Use of electronic health records from a statewide health information exchange to support public health surveillance of diabetes and hypertension.

BACKGROUND: Electronic health record (EHR) data, collected primarily for individual patient care and billing purposes, compiled in health information exchanges (HIEs) may have a secondary use for population health surveillance of noncommunicable diseases. However, data compilation across fragmented data sources into HIEs presents potential barriers and quality of data is unknown. METHODS: We compared 2015 patient data from a mid-size health system (Database A) to data from System A patients in the Utah HIE (Database B). We calculated concordance of structured data (sex and age) and unstructured data (blood pressure reading and A1C). We estimated adjusted hypertension and diabetes prevalence in each database and compared these across age groups. RESULTS: Matching resulted in 72,356 unique patients. Concordance between Database A and Database B exceeded 99% for sex and age, but was 89% for A1C results and 54% for blood pressure readings. Sensitivity, using Database A as the standard, was 57% for hypertension and 55% for diabetes. Age and sex adjusted prevalence of diabetes (8.4% vs 5.8%, Database A and B, respectively) and hypertension (14.5% vs 11.6%, respectively) differed, but this difference was consistent with parallel slopes in prevalence over age groups in both databases. CONCLUSIONS: We identified several gaps in the use of HIE data for surveillance of diabetes and hypertension. High concordance of structured data demonstrate some promise in HIEs capacity to capture patient data. Improving HIE data quality through increased use of structured variables may help make HIE data useful for population health surveillance in places with fragmented EHR systems.

New ways of estimating excess mortality of chronic diseases from aggregated data: insights from the illness-death model.

BACKGROUND: Recently, we have shown that the age-specific prevalence of a disease can be related to the transition rates in the illness-death model via a partial differential equation (PDE). The transition rates are the incidence rate, the remission rate and mortality rates from the 'Healthy' and 'Ill' states. In case of a chronic disease, we now demonstrate that the PDE can be used to estimate the excess mortality from age-specific prevalence and incidence data. For the prevalence and incidence, aggregated data are sufficient - no individual subject data are needed, which allows application of the methods in contexts of strong data protection or where data from individual subjects is not accessible. METHODS: After developing novel estimators for the excess mortality derived from the PDE, we apply them to simulated data and compare the findings with the input values of the simulation aiming to evaluate the new approach. In a practical application to claims data from 35 million men insured by the German public health insurance funds, we estimate the population-wide excess mortality of men with diagnosed type 2 diabetes. RESULTS: In the simulation study, we find that the estimation of the excess mortality is feasible from prevalence and incidence data if the prevalence is given at two points in time. The accuracy of the method decreases as the temporal difference between these two points in time increases. In our setting, the relative error was 5% and below if the temporal difference was three years or less. Application of the new method to the claims data yields plausible findings for the excess mortality of type 2 diabetes in German men. CONCLUSIONS: The described approach is useful to estimate the excess mortality of a chronic condition from aggregated age-specific incidence and prevalence data. TRIAL REGISTRATION: The article does not report the results of any health care intervention.

Recent Patterns of Multimorbidity Among Older Adults in High-Income Countries.

Population aging along with the rising burden of chronic medical conditions (CMCs) is challenging the sustainability of health care systems globally. The authors sought to characterize contemporary patterns of multimorbidity among older adults (aged ≥65 years) in high-income countries (HICs). Medline, EMBASE, CINAHL, PsycINFO, and Web of Science were searched in January 2018 for English-language articles that reported the prevalence of multimorbidity (defined as co-occurrence of ≥2 CMCs in an individual without defining an index disease) among older adults in HICs, or the proportions with ≥3 or ≥5 CMCs. Only studies that utilized data collected during January 2007-December 2017 were included. A total of 52 articles (45 studies) that reported data among >60 million older adults in 30 HICs were included. The overall prevalence of multimorbidity was 66.1% (interquartile range [IQR] 54.4-76.6). The multimorbidity prevalence increased with age as well as with the number of CMCs included in the assessment. The prevalence of ≥3 or ≥5 CMCs was 44.2% (IQR 34.0-70.3) and 12.3% (IQR 8.7-19.1), respectively. The multimorbidity prevalence was also higher among females as well as among studies using care-based data rather than self-reported data. The prevalence of hypertension, dyslipidemia, diabetes, pain disorders, depression, heart failure, cancer, and dementia among the older adults was 60.6%, 51.2%, 25.2%, 34.0%, 12.0%, 14.0%, 8.6%, and 8.4%, respectively. The available data suggest a high prevalence of multimorbidity among older adults. There is a need for increased research into understanding the causal mechanisms that underlie multimorbidity toward supporting the development of cost-effective interventions. In addition, the study results reiterate the need for preventive health care to move beyond targeting single diseases in favor of directing efforts toward reducing overall morbidity among this population.

Frailty, diabetes, and the convergence of chronic disease in an age-related condition: a population-based nationwide cross-sectional analysis of the Mexican nutrition and health survey.

AIMS: To describe the associations of frailty with diabetes mellitus and related conditions in older adults. METHODS: We conducted a cross-sectional analysis of a representative sample of older adults (n = 5379). We generated a 35-item frailty index (FI) and obtained information on diabetes and related conditions (peripheral neuropathy, lower limb amputation, diabetic coma, number of physician visits due to diabetes-related conditions, all-cause hospitalizations in the past year, years since diabetes diagnosis, and type of treatment). Logistic and Poisson regression models were used to determine the associations between frailty and diabetes and its complications. RESULTS: The mean age was 70.3 years (± 7.8); 54.7% were women. Those with an FI ≤ 0.082 composed the reference group. Multivariate analysis showed an OR of 2.32 (95% CI 1.93-2.73, p < 0.001) for the association between diabetes and frailty. People who were hospitalized for any cause during the previous year, those receiving both insulin and an oral compound to manage diabetes, and those with peripheral neuropathy showed ORs of 2.32 (95% CI 1.69-3.18, p < 0.001), 5.6 (95% CI 1.58-19.8, p = 0.008), and 2.02 (95% CI 1.42-2.86, p < 0.001), respectively, for being in the most frail group. CONCLUSIONS: People with diabetes have higher frailty scores. Furthermore, older adults with diabetes and higher burden of frailty have more diabetes-related complications.

Light-Intensity Physical Activity and All-Cause Mortality.

PURPOSE: Research demonstrates that moderate-to-vigorous physical activity (MVPA) is associated with a reduced risk of all-cause mortality. Few studies have examined the effects of light-intensity physical activity on mortality. Therefore, the purpose of this study was to examine the association between objectively measured light-intensity physical activity and all-cause mortality risk. DESIGN: Longitudinal. SETTING: National Health and Nutrition Examination Survey 2003-2006 with follow-up through December 31, 2011. SUBJECTS: Five thousand five hundred seventy-five U.S. adults. MEASURES: Participants wore an accelerometer for at least 4 days and completed questionnaires to assess sociodemographics and chronic disease information, with blood samples taken to assess biological markers. Follow-up mortality status was assessed via death certificate data from the National Death Index. ANALYSIS: Cox proportional hazard model. RESULTS: After adjusting for accelerometer-determined MVPA, age, gender, race-ethnicity, cotinine, weight status, poverty level, C-reactive protein, and comorbid illness, for every 60-minute increase in accelerometer-determined light-intensity physical activity, participants had a 16% reduced hazard of all-cause mortality (hazard ratio = .84; 95% confidence interval: .78-.91; p < .001). CONCLUSION: In this national sample of U.S. adults, light-intensity physical activity was inversely associated with all-cause mortality risk, independent of age, MVPA, and other potential confounders. In addition to MVPA, promotion of light-intensity physical activity is warranted.

Effect of the inclusion of mobile phone interviews to Vigitel / Efeito da inclusão de entrevistas por telefone celular ao Vigitel

ABSTRACT OBJECTIVE To evaluate the impact on the prevalence changes of risk factors for chronic diseases, published in the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel), after the inclusion of data from the population only with mobile phone. METHODS Our study used data from the 26 State capitals and Federal District of Brazil obtained by the National Survey on Health (PNS) and Vigitel, both held in 2013. In each capital, we added a subsample of 200 adults living in households with only mobile phones, extracted from PNS, to the Vigitel 2013 database, with approximately 1,900 households, named Vigitel dual frame. RESULTS Vigitel results showed absolute relative biases between 0.18% and 14.85%. The system underestimated the frequency of adult smokers (10.77%), whole milk consumption (52.82%), and soft drink consumption (22.22%). Additionally, it overestimated the prevalence of hypertension (25.46%). In the simulations using Vigitel dual frame, with inclusion of the sample of adults living in households with only mobile phones, the bias of estimates was reduced in five out of eight analyzed indicators, with greater effects in regions with lower rates of landline coverage. In comparing regions, we observed negative correlation (ρ = −0.91) between the percentage of indicators with presence of bias and the percentage of households with only mobile phone. CONCLUSIONS The results of this study indicate the benefits of including a subsample of 200 adults with only mobile phone on the Vigitel sample, especially in the capitals of the North and Northeast regions.

RESUMO OBJETIVO Avaliar o impacto nas mudanças das prevalências de fatores de risco de doenças crônicas, divulgadas no Vigitel, após a inclusão de dados provenientes da população com somente telefone celular. MÉTODOS O estudo utilizou os dados das capitais obtidos da Pesquisa Nacional de Saúde e do Vigitel, que foram realizados em 2013. Em cada capital, acrescentou-se uma subamostra de 200 adultos residentes em domicílios com somente celular, extraída da PNS, à base de dados do Vigitel 2013, com aproximadamente 1.900 domicílios, denominado Vigitel cadastro duplo. RESULTADOS Os resultados do Vigitel mostraram vícios relativos absolutos entre 0,18% e 14,85%. O sistema subestimou a frequência de adultos fumantes (10,77%), o consumo de leite com teor integral de gordura (52,82%) e o consumo de refrigerante (22,22%). Adicionalmente, superestimou a prevalência de hipertensão (25,46%). Nas simulações utilizando o Vigitel cadastro duplo, com inclusão da amostra de adultos residentes em domicílios com somente celular, o vício das estimativas foi reduzido em cinco de oito indicadores analisados, com maiores efeitos nas regiões com menores taxas de cobertura de telefonia fixa. Na comparação entre as regiões, observa-se correlação negativa (ρ = -0,91) entre o percentual de indicadores com presença de vício e o percentual de cobertura de domicílios com somente celular. CONCLUSÕES Os resultados do presente estudo indicam os benefícios da inclusão de uma subamostra de 200 adultos com somente celular na amostra do Vigitel, especialmente nas capitais das regiões Norte e Nordeste.

Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil / Doenças crônicas não transmissíveis e a utilização de serviços de saúde: análise da Pesquisa Nacional de Saúde no Brasil

ABSTRACT OBJECTIVE To assess whether sex, education level, and health insurance affect the use of health services among the adult Brazilian population with chronic noncommunicable diseases (NCD). METHODS Data from a cross-sectional survey were analyzed, the National Health Survey (PNS). Frequency of use of services in the population that referred at least one NCD were compared with the frequency from a population that did not report NCD, according to sex, education level, health insurance, and NCD number (1, 2, 3, 4, or more). The prevalence and prevalence ratios were calculated crude and adjusted for sex, age, region, and 95% confidence intervals. RESULTS The presence of a noncommunicable disease was associated with increase in hospitalizations in the last 12 months, in 1.7 times (95%CI 1.53–1.9). Failing to perform usual activities in the last two weeks for health reasons was 3.1 times higher in NCD carriers (95%CI 2.78–3.46); while the prevalence of medical consultation in the last 12 months was 1.26 times higher (95%CI 1.24–1.28). NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level. CONCLUSIONS NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level.

RESUMO OBJETIVO Analisar se sexo, escolaridade e posse de plano de saúde influenciam a utilização de serviços de saúde entre a população adulta brasileira portadora de doenças crônicas não transmissíveis (DCNT). MÉTODOS Foram analisados dados de inquérito transversal, a Pesquisa Nacional de Saúde (PNS). Foram comparadas as frequências de uso de serviços na população que referiu pelo menos uma DCNT, com aquelas que não relatam DCNT, segundo sexo, escolaridade, posse de plano de saúde e número de DCNT (1, 2, 3, 4 ou mais). Foram calculadas as prevalências e razões de prevalência (RP) brutas e ajustadas por sexo, idade e região e respectivos intervalos de confiança de 95%. RESULTADOS A presença de doença crônica associou-se ao aumento de internação nos últimos 12 meses, em 1,7 vezes (IC95% 1,53–1,9). Deixar de realizar atividades habituais nas duas últimas semanas por motivo de saúde foi 3,1 vezes maior em portadores de DCNT (IC95% 2,78–3,46), e a prevalência de consulta médica nos últimos 12 meses foi 1,26 vezes maior (IC95% 1,24–1,28). Portadores de DCNT utilizam mais os serviços de saúde, assim como as mulheres, pessoas com maior número de DCNT, com planos de saúde e elevada escolaridade. CONCLUSÕES Portadores de DCNT têm maior utilização de serviços de saúde, assim como as mulheres, pessoas com maior número de comorbidades, com planos de saúde e elevada escolaridade.

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort.

BACKGROUND: Incarceration is associated with increased risk of hypertension and cardiovascular disease mortality. We used data from the Veterans Aging Cohort Study (VACS) to explore the impact of incarceration on blood pressure (BP) control. METHODS: Among hypertensive VACS participants, we measured the association between self-reported recent incarceration or past (not recent) history of incarceration and BP control in the year following the survey. To analyze the association between incarceration and BP control, we used logistic regression models adjusted for sociodemographic characteristics, clinical factors (HIV status and body mass index), and behavioral factors (history of smoking, unhealthy alcohol use, illicit drug use). We explored potential mediators including post-traumatic stress disorder (PTSD), depression, primary care engagement, and adherence to antihypertensive medications. RESULTS: Among the 3515 eligible VACS participants, 2304 participants met the inclusion criteria. Of these, 163 (7 %) reported recent incarceration, and 904 (39 %) reported a past history of incarceration. Participants with recent or past history of incarceration were more likely to have uncontrolled BP than those without a history of incarceration (67 % vs. 56 % vs. 51 %, p < 0.001). In multivariable analysis, recent incarceration (adjusted odds ratio [AOR] = 1.57 95 % confidence interval [CI]: 1.09-2.26), but not a past history of incarceration (AOR = 1.08 95 % CI: 0.90-1.30), was associated with uncontrolled BP compared with those who were never incarcerated. CONCLUSIONS: Among patients with a history of hypertension, recent incarceration is associated with having uncontrolled BP following release. Interventions are needed for recently released individuals to improve hypertension outcomes.

Prevalence and correlates of diabetes mellitus in Uganda: a population-based national survey.

OBJECTIVE: We analysed fasting blood glucose (FBG) and other data collected as part of a population-based nationwide non-communicable disease risk factor survey, to estimate the prevalence of impaired fasting glycaemia (IFG) and diabetes mellitus and to identify associated factors in Uganda. METHODS: The nationwide cross-sectional survey was conducted between April and July 2014. Participants were adults aged 18-69 years. A multistage stratified sample design was used to produce a national representative sample. Fasting capillary glucose was measured to estimate glycaemia. Data were managed with WHO e-STEPs software and Epi Info. Stata(®) survey procedures were used to account for the sampling design, and sampling weights were used to account for differential probability of selection between strata. RESULTS: Of the 3689 participants, 1467 (39.8%) were males, and 2713 (73.5%) resided in the rural areas. The mean age was 35.1 years (standard deviation = 12.6) for males and 35.8 years (13.2) for females. The overall prevalence of IFG was 2.0% (95% confidence interval (CI) = 1.5-2.5%), whereas that of diabetes mellitus was 1.4% (95% CI 0.9-1.9%). The prevalence of IFG was 2.1% (95% CI 1.3-2.9%) among males and 1.9% (95% CI 1.3-2.6%) among females, whereas that of diabetes mellitus was 1.6% (95% CI 0.8-2.6%) and 1.1% (95% CI 0.6-1.7%), respectively. The prevalence of IFG was 2.6% (95% CI 1.4-3.8%) among urban and 1.9% (95% CI 1.3-2.4%) among rural residents, whereas that of diabetes mellitus was 2.7% (95% CI 1.4-4.1) and 1.0% (95% 0.5-1.6%), respectively. The majority of participants identified with hyperglycaemia (90.5% IFG and 48.9% diabetes) were not aware of their hyperglycaemic status. Factors associated with IFG were region of residence, body mass index and total cholesterol; factors associated with diabetes mellitus were age, sex, household floor finish and abdominal obesity. CONCLUSION: The prevalence of IFG and of diabetes mellitus is low in the Ugandan population, providing an opportunity for the prevention of diabetes. The majority of persons with hyperglycaemia were not aware of their hyperglycaemic status, which implies a likelihood of presenting late with complications.

Harnessing the Power of Difference: Colonialism and British Chronic Disease Research, 1940-1975.

Recent studies of post-war chronic disease epidemiology have generally focused on the histories of research in the USA and UK. Using the archival records of a major British funding body, the Colonial Medical Research Committee and its successor the Tropical Medical Research Board, this article demonstrates the advantages of bringing a post-colonial analytic to this historiography. It highlights how the administrative and medical interests in population difference at the centre of the new epidemiology came to map onto political apparatus initially created to know, reform and govern colonial subjects. Although detached from imperial aims, British medical scientists nonetheless attached value to colonial populations on the basis of British benefit and turned various sites into laboratories to extract it. This relationship did not die with the end of imperial rule. British scientists continued to pursue chronic disease epidemiology in former colonies well into the post-war period, informing debates about Britain's own public health concerns.

Clinical characteristics, complications, comorbidities and treatment patterns among patients with type 2 diabetes mellitus in a large integrated health system.

PURPOSE: To compare the prevalence of diabetes-related complications and comorbidities, clinical characteristics, glycemic control, and treatment patterns in patients with type 2 diabetes (T2D) within a large integrated healthcare system in 2008 vs 2013. METHODS: An electronic health record system was used to create a cross-sectional summary of all patients with T2D as on 1 July 2008 and 1 July 2013. Differences between the two data sets were assessed after adjusting for age, gender, race, and household income. RESULTS: In 2008 and 2013, 24 493 and 41 582 patients with T2D were identified, respectively, of which the majority were male (52.3% and 50.1%) and Caucasian (79% and 75.2%). The mean ages (years) were 64.8 and 64.3. The percentages of patients across the defined A1C categories were 64.3 and 66.7 for <7%, 21.1 and 18.8 for 7-7.9%, 7.8 and 7.5 for 8-8.9%, and 6.8 and 7.0 for ≥9% in 2008 and 2013, respectively. The most prevalent T2D-related comorbidities were hypertension (82.5% and 87.2%) and cardiovascular disease (26.9% and 22.3%) in 2008 and 2013, respectively. Thiazolidinedione and sulfonylurea use decreased, whereas metformin and dipeptidyl peptidase-4 inhibitor use increased in the 5-year period. CONCLUSIONS: Patients with T2D are characterized by a high number of comorbidities. Over 85% of the patients had an A1C<8% within our integrated health delivery system in 2008 and 2013. In 2008 and 2013, metformin therapy was the most commonly utilized antidiabetic agent, and sulfonylureas were the most commonly utilized oral antidiabetic agent in combination with metformin. As integrated health systems assume greater shared financial risk in newer payment models, achieving glycemic targets (A1C) and the management of comorbidities will become ever-more important, for preventing diabetes-related complications, as well as to ensure reimbursement for the medical care that is rendered to patients with diabetes.

Psychosocial complexity in multimorbidity: the legacy of adverse childhood experiences.

BACKGROUND: To effectively meet the health care needs of multimorbid patients, the most important psychosocial factors associated with multimorbidity must be discerned. Our aim was to examine the association between self-reported adverse childhood experiences (ACEs) and multimorbidity and the contribution of other social, behavioural and psychological factors to this relationship. METHODS: We analysed cross-sectional data from the Mitchelstown study, a population-based cohort recruited from a large primary care centre. ACE was measured by self-report using the Centre for Disease Control ACE questionnaire. Multimorbidity status was categorized as 0, 1 or ≥2 chronic diseases, which were ascertained by self-report of doctor diagnosis. Ordinal logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for multimorbidity, using ACE as the independent variable with adjustment for social (education, public health cover), behavioural (smoking, exercise, diet, body mass index) and psychological factors (anxiety/depression scores). RESULTS: Of 2047 participants, 45.3% (n = 927, 95% CI: 43.1-47.4) reported multimorbidity. ACE was reported by 28.4% (n = 248, 95% CI: 25.3-31.3%) of multimorbid participants, 21% (n = 113, 95% CI: 18.0-25.1%) of single chronic disease participants and 16% (n = 83, 95% CI: 13.2-19.7%) of those without chronic disease. The OR for multimorbidity with any history of ACE was 1.6 (95% CI: 1.4-2.0, P < 0.001). Adjusting for social, behavioural and psychological factors only marginally ameliorated this association, OR 1.4 (95% CI: 1.1-1.7, P = 0.002). CONCLUSIONS: Multimorbidity is independently associated with a history of ACEs. These findings demonstrate the psychosocial complexity associated with multimorbidity and should be used to inform health care provision in this patient cohort.

Association of physical inactivity with circulatory disease events and hospital treatment costs.

PURPOSE: Epidemiological studies of chronic disorders need to consider more responsive outcomes, particularly those that manifest themselves across a defined population over a shorter time period, to improve our ability to detect the causes of and intervene in the global epidemics of today. We explore the use of hospital episode statistics as a candidate for this role and estimate the strength of the association of circulatory disease-related events with physical inactivity, considered here as an undesirable health behavior. SETTINGS PATIENTS AND METHODS: The primary research was set in a mid-sized city in central England. Aggregation was at output area level (comprising ~300 residents); 51 of which were included. A random sample of 761 adults was selected to obtain estimates of the mean level of physical activity within each area. Circulatory disease hospital events were recorded and aggregated by output area over a 2-year period. Hierarchical linear modeling was used to establish the strength of the association between area-level physical activity and circulatory disease events. Sex, age, and reporting quarter were included as additional individual-level explanatory variables. RESULTS: Areas reporting greater activity were less likely (event rate ratio = 0.855; 95% confidence interval [CI]: 0.78-0.94) to have a circulatory disease event, as were females (0.593; 95% CI: 0.47-0.75). Areas with older residents (1.578; 95% CI: 1.5-1.66) and later reporting quarters (1.095; 95% CI: 1.04-1.15) were more likely to report circulatory disease events. CONCLUSION: This study supports the use of hospital episode statistics as an outcome measure in the epidemiology of circulatory disease and reaffirms the potential importance of physical inactivity in the disease process.