David B. Callahan

Asthma and Serious Psychological Distress: Prevalence and Risk Factors Among US Adults, 2001-2007

BACKGROUND For millions of adults, effective control of asthma requires a regimen of care that may be compromised by psychological factors, such as anxiety and depression. This study estimated the prevalence and risk factors for serious psychological distress (SPD) and explored their relationship to health-related quality of life (HRQOL) among adults with asthma in the United States. METHODS We analyzed data from 186,738 adult respondents from the 2001-2007 US National Health Interview Survey. We calculated weighted average prevalence estimates of current asthma and SPD by demographic characteristics and health-related factors. We used logistic regression analysis to calculate odds ratios for factors that may have predicted asthma, SPD, and HRQOL. RESULTS From 2001 to 2007, the average annual prevalence of current asthma was 7.0% and the average prevalence of SPD was 3.0%. Among adults with asthma, the prevalence of SPD was 7.5% (95% CI, 7.0%-8.1%). A negative association between HRQOL and SPD was found for all adults, independent of asthma status. A similar pattern of risk factors predicted SPD and the co-occurrence of SPD and asthma, although adults with asthma who reported lower socioeconomic status, a history of smoking or alcohol use, and more comorbid chronic conditions had significantly higher odds of SPD. CONCLUSION This research suggests the importance of mental health screening for persons with asthma and the need for clinical and community-based interventions to target modifiable lifestyle factors that contribute to psychological distress and make asthma worse.

Evaluation of screening criteria to identify persons with hepatitis C virus infection among sexually transmitted disease clinic clients: Results from the San Diego viral hepatitis integration project

Background The Centers for Disease Control and Prevention estimates that 1.8% of the US population is infected with hepatitis C virus (HCV), and most are unaware of their infection. Goal The goal was to evaluate risk-based HCV screening criteria for clients attending an urban sexually transmitted disease (STD) clinic. Study Design This was a cross-sectional study of HCV prevalence among all STD clinic clients during an 8-month period (September 1999 through April 2000) in San Diego, California. Results HCV prevalence was 4.9% (165/3367). Clients who reported that they were injecting drug users (IDUs) were much more likely to be HCV-positive than other clients (51% versus 2%;P < 0.001). Selective screening of IDUs, sex partners of IDUs, and persons having received a blood transfusion before 1992 would have identified 70% of HCV-infected clients while screening only 12% of the clinics attendees. The HCV prevalence among clients with a history of a bacterial STD (in the past 5 years) and no other major risk factors was only 2.5%. Conclusion In STD clinics, integrating risk-based screening into routine clinic services is an efficient way to identify HCV-infected persons.

Asthma prevalence among US elderly by age groups: age still matters.

Objective. For over three decades, the greatest burden of asthma deaths has occurred among persons aged 65 years and older. This study analyzed the association between increasing age and asthma prevalence among age groups within the US elderly population. Methods. We analyzed aggregated data on 54,485 civilian, noninstitutionalized US adults aged 65 years and older from the 2001–2010 National Health Interview Survey (NHIS). We estimated the prevalence of current asthma, lifetime asthma, and chronic obstructive pulmonary disease (COPD) among US elderly by 5-year age groups and age stages (“young elderly” aged 65–84 years and “oldest old” aged ≥85 years). We calculated adjusted odds ratios (AOR) and 95% confidence intervals (CI) to identify asthma prevalence patterns among elderly populations. Results. From 2001 to 2010, the estimated average annual prevalence of current asthma among US elderly was 7.0%. Estimates of lifetime asthma, COPD, and co-occurring current asthma and COPD were 9.9%, 9.7%, and 3.0%, respectively. Prevalence of asthma decreased with advancing age while prevalence of COPD increased with advancing age. When controlling for study variables and significant interactions (p = .05) with COPD, the odds of reporting current asthma decreased with advancing age: 0.87 (95% CI, 0.76–1.01) for 70- to 74-year-olds; 0.76 (95% CI, 0.66–0.87) for 75- to 79-year-olds; 0.62 (95% CI, 0.51–0.75) for 80- to 84-year-olds; and 0.45 (95% CI, 0.36–0.55) for ≥85-year-olds, as compared to 65- to 69-year-olds. Conclusions. Asthma continues to affect a substantial proportion of the US elderly population. Increased diagnosis of COPD may overshadow correct diagnosis and treatment in populations with advancing age. Treatment guidelines should focus on preventable risk behaviors to increase the quality of life within this population.

Influenza Vaccination Among Adults with Asthma: Findings from the 2007 BRFSS Survey

BACKGROUND Asthma prevalence among U.S. adults is estimated to be 6.7%. People with asthma are at increased risk of complications from influenza. Influenza vaccination of adults and children with asthma is recommended by the Advisory Committee on Immunization Practices. The Healthy People 2010 Objectives call for annual influenza vaccination of at least 60% of adults aged 18-64 years with asthma and other conditions associated with an increased risk of complications from influenza. PURPOSE To assess influenza vaccination coverage among adults with asthma in the United States. METHODS Data from the 2007 Behavioral Risk Factor Surveillance System restricted to individuals interviewed during February through August were analyzed in 2008 to estimate national and state prevalence of self-reported receipt of influenza vaccination among respondents aged 18-64 years with asthma. Logistic regression provided predictive marginal vaccination coverage for each covariate, adjusted for demographic and access to care characteristics. RESULTS Among adults aged 18-64 years with asthma, influenza vaccination coverage was 39.9% (95% CI=38.3%, 41.5%) during the 2006-2007 season (coverage ranged from 26.9% [95% CI=19.8%, 35.3%] in California to 53.3% [95% CI=42.8%, 63.6%] in Tennessee). Influenza vaccination coverage was 33.9% (95% CI=31.9%, 35.9%) for adults aged 18-49 years with asthma compared to 54.7% (95% CI=52.4%, 57.0%) for adults aged 50-64 years with asthma. Among people aged 18-64 years, vaccination coverage was 28.8% among those without asthma. People with asthma who had an increased likelihood of vaccination were aged 50-64 years, female, non-Hispanic white, and had diabetes, activity limitations, health insurance, a regular healthcare provider, routine checkup in the previous year, and formerly smoked or never smoked. CONCLUSIONS Influenza vaccination coverage continues to be below the national objective of 60% for people aged 18-64 years with asthma as a high-risk condition. Increased state and national efforts are needed to improve influenza vaccination levels among this population and particularly among those aged 18-49 years.

Trends in adult current asthma prevalence and contributing risk factors in the United States by state: 2000–2009

BackgroundCurrent asthma prevalence among adults in the United States has reached historically high levels. Although national-level estimates indicate that asthma prevalence among adults increased by 33% from 2000 to 2009, state-specific temporal trends of current asthma prevalence and their contributing risk factors have not been explored.MethodsWe used 2000–2009 Behavioral Risk Factor Surveillance System data from all 50 states and the District of Columbia (D.C.) to estimate state-specific current asthma prevalence by 2-year periods (2000–2001, 2002–2003, 2004–2005, 2006–2007, 2008–2009). We fitted a series of four logistic-regression models for each state to evaluate whether there was a statistically significant linear change in the current asthma prevalence over time, accounting for sociodemographic factors, smoking status, and weight status (using body mass index as the indicator).ResultsDuring 2000–2009, current asthma prevalence increased in all 50 states and D.C., with significant increases in 46/50 (92%) states and D.C. After accounting for weight status in the model series with sociodemographic factors, and smoking status, 10 states (AR, AZ, IA, IL, KS, ME, MT, UT, WV, and WY) that had previously shown a significant increase did not show a significant increase in current asthma prevalence.ConclusionsThere was a significant increasing trend in state-specific current asthma prevalence among adults from 2000 to 2009 in most states in the United States. Obesity prevalence appears to contribute to increased current asthma prevalence in some states.

Clinical Decision Support Systems and Prevention: A Community Guide Cardiovascular Disease Systematic Review

CONTEXT Clinical decision support systems (CDSSs) can help clinicians assess cardiovascular disease (CVD) risk and manage CVD risk factors by providing tailored assessments and treatment recommendations based on individual patient data. The goal of this systematic review was to examine the effectiveness of CDSSs in improving screening for CVD risk factors, practices for CVD-related preventive care services such as clinical tests and prescribed treatments, and management of CVD risk factors. EVIDENCE ACQUISITION An existing systematic review (search period, January 1975-January 2011) of CDSSs for any condition was initially identified. Studies of CDSSs that focused on CVD prevention in that review were combined with studies identified through an updated search (January 2011-October 2012). Data analysis was conducted in 2013. EVIDENCE SYNTHESIS A total of 45 studies qualified for inclusion in the review. Improvements were seen for recommended screening and other preventive care services completed by clinicians, recommended clinical tests completed by clinicians, and recommended treatments prescribed by clinicians (median increases of 3.8, 4.0, and 2.0 percentage points, respectively). Results were inconsistent for changes in CVD risk factors such as systolic and diastolic blood pressure, total and low-density lipoprotein cholesterol, and hemoglobin A1C levels. CONCLUSIONS CDSSs are effective in improving clinician practices related to screening and other preventive care services, clinical tests, and treatments. However, more evidence is needed from implementation of CDSSs within the broad context of comprehensive service delivery aimed at reducing CVD risk and CVD-related morbidity and mortality.

A National Survey of Adult Asthma Prevalence by Urban-Rural Residence U.S. 2005

Objectives. We analyzed national data to estimate asthma prevalence among U.S. adults by urban-rural residence and to determine the relative contributions of sociodemographic and health behavior characteristics on the probability of reporting asthma. Methods. We linked the 2005 Behavioral Risk Factor Surveillance System (BRFSS) to Urban Influence Codes (UICs), categorizing respondents into four urban-rural groups: metropolitan, adjacent metropolitan, micropolitan, and remote. BRFSS collects health data from all 50 states. UICs classify respondents county as urban or rural based on population size and proximity to metropolitan areas. We calculated asthma prevalence estimates and generated odds ratios (ORs) for the probability of reporting asthma. Results. Overall asthma prevalence (7.9%; 95%CI = 7.73–8.08) was not statistically different (p = 0.28) by urban-rural residence. After adjusting for selected characteristics, adjacent metropolitan (OR = 0.96; 95%CI = 0.90–1.02) and remote (OR = 0.95; 95%CI = 0.85–1.05) residents were less likely—and micropolitan (OR = 1.04; 95%CI = 0.93–1.16) residents were more likely—to report asthma compared with metropolitan residents; but confidence intervals included null. Conclusions. Asthma prevalence is as high in rural as in urban areas. Certain demographic, behavioral, and health care characteristics unique to place of residence might affect asthma prevalence. Because these results substantially change our understanding of asthma prevalence in rural areas, further investigation is needed to determine geographic-related risk factors

Medical Care and Alcohol Use after Testing Hepatitis C Antibody Positive at STD Clinic and HIV Test Site Screening Programs

Objectives. The Centers for Disease Control and Prevention recommend screening individuals at risk for hepatitis C virus (HCV) infection. However, few published data describe outcomes of individuals with antibody to HCV (anti-HCV) identified through screening programs. The purpose of this study was to assess rates of medical evaluation and HCV treatment, change in alcohol consumption, and barriers to medical care after testing anti-HCV positive through a public screening program. Methods. Anti-HCV positive individuals identified through San Diego sexually transmitted disease (STD) clinics and an HIV test site screening program were informed of positive test results, provided education and referral, and contacted by telephone three, six, and ≥12 months later. Results. From September 1, 1999, to December 31, 2001, 411 anti-HCV positive individuals were newly identified, of whom 286 (70%) could be contacted ≥ three months after receipt of test results (median length [range] of follow-up 14 [3–35] months). Of these 286, 156 (55%) reported having received a medical evaluation, of whom 19 (12%) began HCV treatment. Of 132 who reported drinking alcohol before diagnosis, 100 (76%) reported drinking less after diagnosis. Individuals with medical insurance at diagnosis were more likely than those without insurance to obtain a medical evaluation during follow-up (75 [68%] of 111 vs. 70 [45%] of 155; p<0.001). Among those who did not obtain an evaluation, the most commonly reported reason was lack of insurance. Conclusions. Only about half of newly identified anti-HCV positive individuals received a medical evaluation, although 76% reported drinking less alcohol. Identifying ways to improve medical access for those who are anti-HCV positive could improve the effectiveness of screening programs.

Influenza A (H1N1) 2009 Monovalent Vaccination Among Adults with Asthma, U.S., 2010

BACKGROUND The 2009 pandemic influenza A (H1N1) virus (2009 H1N1) was first identified in April 2009 and quickly spread around the world. The first doses of influenza A (H1N1) 2009 monovalent vaccine (2009 H1N1 vaccine) became available in the U.S. in early October 2009. Because people with asthma are at increased risk of complications from influenza, people with asthma were included among the initial prioritized groups. PURPOSE To evaluate 2009 H1N1 vaccination coverage and identify factors independently associated with vaccination among adults with asthma in the U.S. METHODS Data from the 2009-2010 BRFSS (Behavioral Risk Factor Surveillance System) influenza supplemental survey were used; responses from March through June 2010 were analyzed to estimate vaccination levels of 2009 H1N1 vaccine among respondents aged 25-64 years with asthma. Multivariable logistic regression and predictive marginal models were performed to identify factors independently associated with vaccination. RESULTS Among adults aged 25-64 years with asthma, 25.5% (95% CI=23.9%, 27.2%) received the 2009 H1N1 vaccination. Vaccination coverage ranged from 9.9% (95% CI=6.4%, 15.1%) in Mississippi to 46.1% (95% CI=33.3%, 61.2%) in Maine. Characteristics independently associated with an increased likelihood of vaccination among adults with asthma were as follows: had a primary doctor, had other high-risk conditions, and received seasonal influenza vaccination in the 2009-2010 season. CONCLUSIONS Vaccination coverage among adults aged 25-64 years with asthma was only 25.5% and varied widely by state and demographic characteristics. National and state-specific 2009 H1N1 vaccination coverage data for adults with asthma are useful for evaluating the vaccination campaign and for planning and implementing strategies for increasing vaccination coverage in possible future pandemics.

Bacterial vaginosis in pregnancy: Diagnosis and treatment practices of physicians in San Diego, California, 1999

Background Treating symptomatic bacterial vaginosis (BV) early in pregnancy may decrease preterm birth (PTB). Understanding how physicians manage BV is important for the development of interventions. Goal The goal was to determine the extent of knowledge and behaviors of physicians related to the diagnosis, treatment, and medical effects of BV in pregnant and nonpregnant patients. Study Design This was a cross-sectional survey. Results The study group consisted of 208 physicians who provided gynecologic care, including 102 (49%) who provided care to pregnant patients. Only 65% believed that there was a strong causal association between BV and PTB. Physicians who believed that BV causes PTB were much more likely to optimally manage vaginal infections (43% versus 7%). Only 12% of physicians prescribed oral metronidazole or clindamycin during the first trimester of pregnancy to treat BV. Conclusion Physicians should be aware of the relation between symptomatic BV and PTB, seek a specific diagnosis for symptoms of vaginitis, use standard criteria to diagnose BV, and treat BV with effective regimens early in pregnancy.