Ehud Kokia

Diabetes and risk of incident cancer: a large population-based cohort study in Israel

Type 2 diabetes mellitus has been associated with an increased risk of a variety of cancers in observational studies, but few have reported the relationship between diabetes and cancer risk in men and women separately. The main goal of this retrospective cohort study was to evaluate the sex-specific risk of incident overall and site-specific cancer among people with DM compared with those without, who had no reported history of cancer at the start of the follow-up in January 2000. During an average of 8xa0years of follow-up (SDxa0=xa02.5), we documented 1,639 and 7,945 incident cases of cancer among 16,721 people with DM and 83,874 free of DM, respectively. In women, DM was associated with an adjusted hazard ratio of 1.96 (95% CI: 1.53–2.50) and 1.41 (95% CI: 1.20–1.66) for cancers of genital organs and digestive organs, respectively. A significantly reduced HR was observed for skin cancer (0.38; 95% CI: 0.22–0.66). In men with DM, there was no significant increase in overall risk of cancer. DM was related with a 47% reduction in the risk of prostate cancer. These findings suggest that the nature of the association between DM and cancer depends on sex and specific cancer site.

The risk of overt diabetes mellitus among women with gestational diabetes: a population-based study.

Diabet. Med. 27, 779–785 (2010)

Increased warfarin doses and decreased international normalized ratio response after nationwide generic switching

Our objective was to examine possible changes in the effectiveness of warfarin after a nationwide generic substitution of formulations in 1998.

The use of an automated patient registry to manage and monitor cardiovascular conditions and related outcomes in a large health organization

BACKGROUNDnThe present study describes a computerized registry of cardiovascular disease patients in a large health maintenance organization in Israel. The registry is aimed to be used by health professionals to identify cardiovascular disease patients and to follow the courses of their illnesses and risk factors.nnnMETHODSnIn 1998, the registry was initiated using advanced information technology that integrated personal computerized community and hospital records, data from laboratory tests, dispensed medications, physiological signals, radiological images, and reports from investigations and procedures.nnnRESULTSnBetween 1998 and 2007, the number of patients with cardiovascular diseases that were identified by the registry has increased from 34,144 to 80,339. During this period, the age-adjusted prevalence rates have risen from 3.7% to 5.1% and from 1.9% to 2.6%, among men and women, respectively. The percentage of ischemic heart disease patients who reached target LDL was doubled, from 21% in 2000 to 50% in 2006. The average stay in hospital declined from 11.7 to 8.6 days. Primary myocardial infarction rates declined 33% and 54% in men aged 54-65 and women aged 65-74 years, respectively.nnnCONCLUSIONSnThe present study provides, for the first time in Israel, data on selected quality of care and clinical outcomes using a large, population-based registry of cardiovascular disease patients. It demonstrates a significant improvement in the adherence with LDL tests and achieving target LDL levels and a subsequent decline in incidence of myocardial infarction within ten years since its establishment.

Persistence with Statins and Incident Cataract: A Population-Based Historical Cohort Study

PURPOSEnIn recent years, there is a growing body of evidence suggesting that statins may have anti-inflammatory effects; consequently, it was hypothesized that statins may have a preventive effect against cataract.nnnMETHODSnThe study was carried out on a retrospective cohort of 180,291 new statin users in a large health organization in Israel. Study participants were followed between 1998 and 2007 for incident cataract or cataract extraction.nnnRESULTSnDuring the study period 27,301 cataracts were diagnosed and 6,976 cataract extractions were performed among study participants. Persistence with statins was associated significantly (P < 0.001) with a reduced risk of cataract in men and women aged 45 to 74. Men aged 45-54 with a high (>80%) proportion of follow-up days covered with statins had an adjusted hazard ratio of 0.62 (95% confidence interval: 0.54-0.72), compared with patients with low persistence with statins. In elderly patients, no relationship or a positive relationship was observed.nnnCONCLUSIONSnPersistent statin use was significantly protective for the incidence of cataract in men and women under 75 years of age.

Disparities in diabetes care: role of the patient's socio-demographic characteristics

BackgroundThe commitment to promoting equity in health is derived from the notion that all human beings have the right to the best attainable health. However, disparities in health care are well-documented. The objectives were to explore disparities in diabetes prevalence, care and control among diabetic patients. The study was conducted by Maccabi Healthcare Services (MHS), an Israeli HMO (health care plan).MethodsRetrospective study. The dependent variables were diabetes prevalence, uptake of follow-up examinations, and disease control. The independent variables were socio-economic rank (SER), ethnicity (Arab vs non Arab), supplementary voluntary health insurance (SVHI), and immigration from Former Soviet Union (FSU) countries. Chi Square and Logistic Regression Models were estimated.ResultsWe analyzed 74,953 diabetes patients. Diabetes was more prevalent in males, lower SER patients, Arabs, immigrants and owners of SVHI. Optimal follow up was more frequent among females, lower SERs patients, non Arabs, immigrants and SVHI owners. Patients who were female, had higher SERs, non Arabs, immigrants and SVHI owners achieved better control of the disease. The multivariate analysis revealed significant associations between optimal follow up and age, gender (males), SER (Ranks 1-10), Arabs and SVHI (OR 1.02, 0.95, 1.15, 0.85 and 1.31, respectively); poor diabetes control (HbA1C > 9 gr%) was significantly associated with age, gender (males), Arabs, immigrants, SER (Ranks1-10) and SVHI (OR 0.96, 1.26, 1.38, 0.72, 1.37 and 0.57, respectively); significant associations with LDL control (< 100 gr%) were revealed for age, gender (males) and SVHI (OR 1.02, 1.30 and 1.44, respectively).ConclusionDisparities in diabetes prevalence, care and control were revealed according to population sub-group. MHS has recently established a comprehensive strategy and action plan, aimed to reduce disparities among members of low socioeconomic rank and Arab ethnicity, sub-groups identified in our study as being at risk for less favorable health outcomes.

Long-term trends in hepatitis A incidence following the inclusion of Hepatitis A vaccine in the routine nationwide immunization program.

Summary.u2002 For many years hepatitis A was one of the most common vaccine preventable diseases in Israel. In 1999, Israel became the first country to introduce an inactivated hepatitis A vaccine into its national childhood vaccination program. The objectives of the present study were to study trends in disease incidence after the implementation of the new vaccination policy and to assess vaccination coverage among children and adults in Israel. We used the databases of the second largest HMO in Israel (1.7 million members) to identify patients who had evidence of hepatitis A in 1998 and 2007 and to collect information on all subjects who received at least one dose of hepatitis A vaccine during the study period. Hepatitis A vaccination coverage in children <5u2003years and 5–14u2003years of age increased from 9% and 15% in 1998 to 89% and 68% in 2007, respectively. During this period the annual incidence of hepatitis A dropped from 142.4 per to 7.6 per 100u2003000. The most prominent reduction in the age‐specific annual incidence rates was calculated in children <5u2003years from 239.4 per 100u2003000 in 1998 to 2.2 per 100u2003000 in 2007 and from 310.3 per 100u2003000 to 3.0 per 100u2003000 in children aged 5–14u2003years. In endemic areas, vaccination of infants and children against hepatitis A can greatly reduce the total burden of the disease.

The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: Analysis of large sub populations

BackgroundPopulations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer.The objectiveTo explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer.MethodsThe study was conducted by Maccabi Healthcare Services, an Israeli HMO (health plan) providing healthcare services to 1.9 million members. Utilization of breast cancer (BC) and colorectal cancer (CC) screening were analyzed by socio-economic ranks (SERs), ethnicity (Arab vs non-Arab), immigration status and ownership of voluntarily supplemental health insurance (VSHI).ResultsData on 157,928 and 303,330 adults, eligible for BC and CC screening, respectively, were analyzed. Those having lower SER, Arabs, immigrants from Former Soviet Union countries and non-owners of VSHI performed fewer cancer screening examinations compared with those having higher SER, non-Arabs, veterans and owners of VSHI (p < 0.001). Logistic regression model for BC Screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab and having a lower SER. The model for CC screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. The model estimated for BC and CC screening among females revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant.ConclusionPatients from low socio-economic backgrounds, Arabs, immigrants and those who do not own supplemental insurance do fewer tests for early detection of cancer. These sub-populations should be considered priority populations for targeted intervention programs and improved resource allocation.

Potential impact and cost-effectiveness analysis of rotavirus vaccination of children in Israel

BACKGROUNDnRotavirus is a common cause of acute gastroenteritis in children under 5 years of age. Two effective vaccines against rotavirus gastroenteritis were recently licensed in many countries throughout the world. The study aimed to investigate the cost effectiveness of vaccinating an Israeli birth cohort of 143 500 children.nnnMETHODSnThe cost-effectiveness analysis was determined using a decision analytical model, based on evidence-based estimates of the medical burden of rotavirus gastroenteritis in Israel.nnnRESULTSnAccording to our model, a routine rotavirus immunization program using Rotarix and RotaTeq would prevent 17,801 and 13,288 office visits and 645 and 535 hospitalizations every year, respectively. When direct healthcare costs and societal costs are taken into account, the incremental cost-effectiveness ratio per gained QALY for Rotarix and RotaTeq are

Database evaluation of the effects of long-term rosiglitazone treatment on cardiovascular outcomes in patients with type 2 diabetes.

10,995 and