Maria C. Mejia de Grubb

Additive effects of Pre‐pregnancy body mass index and gestational diabetes on health outcomes and costs

Pre‐pregnancy obesity and gestational diabetes mellitus (GDM) are increasingly prevalent independent risk factors for maternal and infant morbidities. However, there is a paucity of information on their joint effects on health outcomes and healthcare costs.

Demographic and Geographic Variations in Breast Cancer Mortality among U.S. Hispanics

This paper examines demographic and geographic differences in breast cancer mortality (1999 to 2009) between U.S. Hispanic and non-Hispanic women from different racial groups. Data were publically available from the U.S. Centers for Disease Control and Prevention (CDC). Four racial groups are included: American Indian/Alaska Natives, Asian/Pacific Islanders, Blacks/African Americans, and Whites. Age-adjusted rates were obtained for women ages 35–64 and 65 years and older. Hispanic mortality was generally lower than non-Hispanic mortality regardless of age, race, Census Region, State, or county. The lone exception was Hispanic Asian/Pacific Islanders residing in Hawaii. Despite generally lower rates, there was considerable variation in Hispanic breast cancer mortality within the country. Poverty, percentage of renters, and educational attainment were important explanatory factors. Analytic epidemiologic studies might explain social, cultural, and other reasons for the observed geographic variations. Such studies, in turn, could support a stronger theoretical basis for public health policy.

Clostridium difficile infection in patients hospitalized with type 2 diabetes mellitus and its impact on morbidity, mortality, and the costs of inpatient care

AIMS Type 2 diabetes mellitus (T2DM) is often complicated by infections leading to hospitalization, increased morbidity, and mortality. Not much is known about the impact of Clostridium difficile infection (CDI) on health outcomes in hospitalized patients with T2DM. We estimated the prevalence and temporal trends of CDI; evaluated the associations between CDI and in-hospital mortality, length of stay (LOS), and the costs of inpatient care; and compared the impact of CDI with that of other infections commonly seen in patients with T2DM. METHODS We conducted a cross-sectional analysis using data from the Nationwide Inpatient Sample among patients ⩾18years with T2DM and generalized linear regression was used to analyze associations and jointpoint regression for trends. RESULTS The prevalence of CDI was 6.8 per 1000 hospital discharges. Patients with T2DM and CDI had increased odds of in-hospital mortality (OR, 3.63; 95% CI 3.16, 4.17). The adjusted mean LOS was higher in patients with CDI than without CDI (11.9 vs. 4.7days). That translated to average hospital costs of

Multimorbidity is associated with increased rates of depression in patients hospitalized with diabetes mellitus in the United States

23,000 and

National trends of hepatitis B and C during pregnancy across sociodemographic, behavioral, and clinical factors, United States, 1998–2011

9100 for patients with and without CDI, respectively. The adjusted risk of mortality in patients who had CDI alone (OR 3.75; 95% CI 3.18, 4.41) was similar to patients who had CDI in addition to other common infections (OR 3.25; 95% CI 2.58, 4.10). CONCLUSION CDI is independently associated with poorer health outcomes in patients with T2DM. We recommend close surveillance for CDI in hospitalized patients and further studies to determine the cost effectiveness of screening for CDI among patients with T2DM.

theoretical and Methodological Issues in Research Related to Value-based Approaches in Healthcare

AIMS Information on the burden and risk factors for diabetes-depression comorbidity in the US is sparse. We used data from the largest all-payer, nationally-representative inpatient database in the US to estimate the prevalence, temporal trends, and risk factors for comorbid depression among adult diabetic inpatients. METHODS We conducted a retrospective analysis using the 2002-2014 Nationwide Inpatient Sample databases. Depression and other comorbidities were identified using ICD-9-CM codes. Logistic regression was used to investigate the association between patient characteristics and depression. RESULTS The rate of depression among patients with type 2 diabetes increased from 7.6% in 2002 to 15.4% in 2014, while for type 1 diabetes the rate increased from 8.7% in 2002 to 19.6% in 2014. The highest rates of depression were observed among females, non-Hispanic whites, younger patients, and patients with five or more chronic comorbidities. CONCLUSIONS The prevalence of comorbid depression among diabetic inpatients in the US is increasing rapidly. Although some portion of this increase could be explained by the rising prevalence of multimorbidity, increased awareness and likelihood of diagnosis of comorbid depression by physicians and better documentation as a result of the increased adoption of electronic health records likely contributed to this trend.

Diet and Obesity Issues in the Underserved

Currently, data examining nationally representative prevalence and trends of HBV or HCV among specific subgroups of pregnant women in the US are unavailable. We conducted a cross‐sectional analysis of hospitalizations for liveborn singleton deliveries from 1998 to 2011 using data from the Nationwide Inpatient Sample. After identifying deliveries with HBV, HCV, and HIV infection during pregnancy, survey logistic regression was used to identify risk factors. Temporal trends were analyzed using joinpoint regression. The rates of HBV and HCV were 85.8 and 118.6 per 100,000 deliveries, respectively; however, there was substantial variation across maternal and hospital factors. The HBV rate increased from 57.8 in 1998 to 105.0 in 2011, resulting in an annual increase of 5.5% (95% CI: 3.8–7.3). The HCV rate increased fivefold, from 42.0 in 1998 to over 210 in 2011. These trends were observed for nearly every population subgroup. However, we did observe differences in the degree to which hepatitis during pregnancy was becoming more prevalent. The increasing national trend in the prevalence of hepatitis among pregnant women was particularly concerning among already high‐risk groups. This underscores the need for coordinated approaches—encompassing culturally‐appropriate health education/risk‐reduction programs, and increased vaccination and screening efforts—championed by health providers. J. Med. Virol. 89:1025–1032, 2017.

Primary and secondary prevention of colorectal cancer: An evidence-based review

Theoretical and Methodological Issues in Research Related to Value-Based Approaches in Healthcare William Mkanta;Madhuri Katta;Karthika Basireddy;Gary English;Maria Mejia de Grubb; Journal of Healthcare Management

Patient satisfaction and its potential impact on refugee integration into the healthcare system

The goal of this article is to inform new directions for addressing inequalities associated with obesity by reviewing current issues about diet and obesity among socioeconomically vulnerable and underserved populations. It highlights recent interventions in selected high-risk populations, as well as gaps in the knowledge base. It identifies future directions in policy and programmatic interventions to expand the role of primary care providers, with an emphasis on those aimed at preventing obesity and promoting healthy weight.

An Examination of the Likelihood of Home Discharge After General Hospitalizations Among Medicaid Recipients

Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well established that CRC mortality rates have decreased in the past several decades, adoption of routine screening continues to lag behind screening for other common cancers such as cervical and breast cancer. The decrease in overall rates has been attributed, in part, to improved primary and secondary prevention efforts, including smoking prevention and cessation programs, nutritional counseling, and the use of evidence-based screening protocols, as well as access to better treatment. Despite the increased screening rates, it is estimated that at least one-third of eligible people do not receive appropriate screening. The objective of this review is to describe the current epidemiology of CRC and to demonstrate effective primary and secondary prevention strategies for the primary care provider.