Sundar S. Shrestha

Estimating the Burden of 2009 Pandemic Influenza A (H1N1) in the United States (April 2009–April 2010)

To calculate the burden of 2009 pandemic influenza A (pH1N1) in the United States, we extrapolated from the Centers for Disease Control and Preventions Emerging Infections Program laboratory-confirmed hospitalizations across the entire United States, and then corrected for underreporting. From 12 April 2009 to 10 April 2010, we estimate that approximately 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (195,086-402,719), and 12,469 deaths (8868-18,306) occurred in the United States due to pH1N1. Eighty-seven percent of deaths occurred in those under 65 years of age with children and working adults having risks of hospitalization and death 4 to 7 times and 8 to 12 times greater, respectively, than estimates of impact due to seasonal influenza covering the years 1976-2001. In our study, adults 65 years of age or older were found to have rates of hospitalization and death that were up to 75% and 81%, respectively, lower than seasonal influenza. These results confirm the necessity of a concerted public health response to pH1N1.

Effects of Vaccine Program against Pandemic Influenza A(H1N1) Virus, United States, 2009–2010

Vaccination likely prevented 700,000–1,500,000 clinical cases, 4,000–10,000 hospitalizations, and 200–500 deaths.

Medical Expenditures Associated With Diabetes Acute Complications in Privately Insured U.S. Youth

OBJECTIVE To estimate medical expenditures attributable to diabetes ketoacidosis (DKA) and severe hypoglycemia among privately insured insulin-treated U.S. youth with diabetes. RESEARCH DESIGN AND METHODS We analyzed the insurance claims of 7,556 youth, age ≤19 years, with insulin-treated diabetes. The youth were continuously enrolled in fee-for-service health plans, and claims were obtained from the 2007 U.S. MarketScan Commercial Claims and Encounter database. We used regression models to estimate total medical expenditures and their subcomponents: outpatient, inpatient, and drug expenditures. The excess expenditures associated with DKA and severe hypoglycemia were estimated as the difference between predicted medical expenditures for youth who did/did not experience either DKA or severe hypoglycemia. RESULTS For youth with and without DKA, respectively, predicted mean annual total medical expenditures were

The Economic Burden of Vision Loss and Eye Disorders among the United States Population Younger than 40 Years

14,236 and

Medical Expenditures Associated With Diabetes Among Privately Insured U.S. Youth in 2007

8,398 (an excess of

Eye Care Use Among a High-Risk Diabetic Population Seen in a Public Hospital's Clinics

5,837 for those with DKA). The excess was statistically greater for those with one or more episodes of DKA (

Changes Over Time in High Out-of-Pocket Health-Care Burden in U.S. Adults With Diabetes, 2001–2011

8,455) than among those with only one episode (

Spatial Clusters of County-Level Diagnosed Diabetes and Associated RiskFactors in the United States

3,554). Predicted mean annual total medical expenditures were

Changes in diagnosed diabetes, obesity, and physical inactivity prevalence in US counties, 2004-2012

12,850 and

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

8,970 for youth with and without severe hypoglycemia, respectively (an excess of