Alan Oglesby

The components of excess mortality after hip fracture

A high excess mortality is well described after hip fracture. Deaths are in part related to comorbidity and in part due directly or indirectly to the hip fracture event itself (causally related deaths). The aim of this study was to examine the quantum and pattern of mortality following hip fracture. We studied 160,000 hip fractures in men and women aged 50 years or more, in 28.8 million person-years from the patient register of Sweden, using Poisson models applied to hip fracture patients and the general population. At all ages the risk of death was markedly increased compared with population values immediately after the event. Mortality subsequently decreased over a period of 6 months, but thereafter remained higher than that of the general population. The latter function was assumed to account for deaths related to comorbidity and the residuum assumed to be due to the hip fracture. Causally related deaths comprised 17-32% of all deaths associated with hip fracture (depending on age) and accounted for more than 1.5% of all deaths in the population aged 50 years or more. Hip fracture was a more common cause for mortality than pancreatic or stomach cancer. Thus, interventions that decreased hip fracture rate by, say, 50% would avoid 0.75% or more of all deaths.

Optimization of BMD Measurements to Identify High Risk Groups for Treatment—A Test Analysis

The aim of this study was to optimize the use of BMD measurements in case finding strategies. The use of clinical risk factors with and without BMD was explored in a random sample of the Sheffield female population ≥75 years of age. The use of clinical risk factors alone could identify women well above or well below a threshold of fracture risk. BMD assessment can be confined to a minority of women (∼20%) in whom the measurement aids in prognostication of fracture.

The association between diabetes related medical costs and glycemic control: A retrospective analysis

BackgroundThe objective of this research is to quantify the association between direct medical costs attributable to type 2 diabetes and level of glycemic control.MethodsA longitudinal analysis using a large health plan administrative database was performed. The index date was defined as the first date of diabetes diagnosis and individuals had to have at least two HbA1c values post index date in order to be included in the analyses. A total of 10,780 individuals were included in the analyses. Individuals were stratified into groups of good (N = 6,069), fair (N = 3,586), and poor (N = 1,125) glycemic control based upon mean HbA1c values across the study period. Differences between HbA1c groups were analyzed using a generalized linear model (GLM), with differences between groups tested by utilizing z-statistics. The analyses allowed a wide range of factors to affect costs.Results42.1% of those treated only with oral agents, 66.1% of those treated with oral agents and insulin, and 57.2% of those treated with insulin alone were found to have suboptimal control (defined as fair or poor) throughout the study period (average duration of follow-up was 2.95 years). Results show that direct medical costs attributable to type 2 diabetes were 16% lower for individuals with good glycemic control than for those with fair control (

Intervention thresholds for osteoporosis

1,505 vs.

Review of the cost of diabetes complications in Australia, Canada, France, Germany, Italy and Spain

1,801, p < 0.05), and 20% lower for those with good glycemic control than for those with poor control (

The health care costs of diabetic nephropathy in the United States and the United Kingdom

1,505 vs.

Patient-reported outcomes in a trial of exenatide and insulin glargine for the treatment of type 2 diabetes.

1,871, p < 0.05). Prescription drug costs were also significantly lower for individuals with good glycemic control compared to those with fair (

Short-term economic impact of body weight change among patients with type 2 diabetes treated with antidiabetic agents: analysis using claims, laboratory, and medical record data

377 vs.

Estimating the Long-Term Cost-Effectiveness of Exenatide in the United States: An Adjunctive Treatment for Type 2 Diabetes Mellitus

465, p < 0.05) or poor control (

The longitudinal link between visual acuity and health-related quality of life in patients with diabetic retinopathy

377 vs.