- Email: [email protected]
Gestational Weight Gain and Gestational Diabetes Mellitus in Indiana Pregnancies, 2007-2011
Abstracts / Annals of Epidemiology 24 (2014) 682e702
disparities in health care and health research by: 1) assessing community health needs and concerns; 2) linking individuals to medical and social services and opportunities to participate in relevant research at UF; 3) engaging in bidirectional, health-promoting communication with and for the community; 4) increasing the community’s trust in the research enterprise through meaningful collaboration. The foundation of this model is HealthStreet’s Community Health Workers (CHWs), who perform outreach on a daily basis to work towards HealthStreet’s mission. Results: Since HealthStreet’s opening at the University of Florida (Cottler, LB PI) almost 4,000 community members have been consented, 78% of those approached, with 56% navigated to a UF study. HealthStreet has made 6,000+ referrals to services including medical care homes (1,031), and participants received 6,500+ services including blood pressure and glucose screening, HIV testing/counseling and health education. Our Community, Our Health events provide community members and researchers opportunities to discuss findings and next steps. Conclusions: HealthStreet effectively monitors individual and population health, disseminates findings to the community by geography, demography and risk factors, and links people to needed health related services. With 1 in 4 receiving a referral to needed medical care through the HealthStreet model, epidemiological surveillance data comes not at the expense of the community, but as a community service.
P63. Patterns and Causes of Hospital Readmissions in Patients with Multiple Chronic Conditions Raynard E. Washington PhD, MPH, Claudia Steiner. HHS Agency for Healthcare Research and Quality Purpose: Patients with multiple chronic conditions (MCC) account for a disproportionate share of hospital utilization and costs. As hospital readmissions are increasingly considered a measure of healthcare quality, it is important to examine the etiology of readmissions for patients with MCC to understand the implications for measurement. The objectives of this analysis were to explore patterns and causes of readmissions among patients with MCC. Methods: We used a nationally weighted sample of discharges from 21 geographically dispersed states from the Healthcare Cost and Utilization Project of adults with at least 2 chronic illnesses who were hospitalized at community hospitals during the period January through November 2010. A total of 4,779,608 adults with MCC were included in the analysis. Results: Approximately 19.68 % had 1 readmission within 30 days of discharge. Readmission rates were highest among younger adults (p<.01), males (p¼.01), patients with more comorbidities (p<.01), and longer index lengths of stay (p.<.01). The highest risk of readmission was due to chronic conditions present at the index visit, but not the principle reason for the index visit (8.1%). For several cardiovascular-related conditions, the most common causes of readmission were non-chronic conditions, most commonly, septicemia, urinary tract infections, and pneumonia. Adjusted readmission rates were highest for patients seen for hepatitis (predicted marginal risk ratio (RR)¼1.85), chronic kidney disease (RR ¼1.51) and CHF (RR¼1.41). Conclusions: Patients with MCC remain at high risk for 30 day readmissions, specifically due to co-morbid chronic conditions. Comprehensive management of all chronic illnesses during and after hospitalization is critical to improving patient outcomes.
Other Chronic Diseases P64. Gestational Weight Gain and Gestational Diabetes Mellitus in Indiana Pregnancies, 2007-2011 Gregory Budney MPH, Jenny Durica MPH, Gary Ordway MS, Linda Stemnock BSPH, Matt Kaag BS. Purpose: The percentage of Indiana pregnancies involving gestational diabetes mellitus (GDM) increased by 1.6% from 2007 to 2011. Due to statewide increases in GDM and obesity, the purpose of this study is to examine prepregnancy body mass index (BMI), recommended gestational weight gain (GWG), and associations related to GDM. Methods: Females who had a singleton birth with a recorded pre-pregnancy height and weight were identified from Indiana’s birth records 2007-2011. Pre- and post-pregnancy BMI was calculated from self-reported height and
697
weight on birth certificate records. Following Institute of Medicine’s “Weight Gain During Pregnancy: Reexamining the Guidelines” GWG was calculated and assessed to determine if recommendations were met. Analyses included bivariate analysis and logistic regression. Results: Between 2007-2011 there were a total of 412,175 females who gave birth in Indiana, 69.8% (n¼288,065) of whom did not meet GWG recommendations. Of these, 5.1% (n¼14,611) developed GDM. Between 2007-2011, those not meeting GWG recommendations were 1.08 times more likely to develop GDM regardless of pre-pregnancy BMI. Among females who did not meet GWG recommendations, those with overweight or obese pre-pregnancy BMI were 2.75 times more likely to develop GDM than females with a healthy weight or underweight pre-pregnancy BMI. This odds ratio significantly increased from 2.46 [2.25, 2.70] in 2007 to 3.16 [2.90, 3.46] in 2011. Conclusions: Between 2007-2011, those not meeting GWG recommendations were slightly more likely to develop GDM. Physicians should remain attentive to overweight or obese pregnant females as they have a higher risk of developing GDM.
P65. Female Sex Is Associated with a Lower Risk of Stroke in Patients with Heart Failure: A Nationwide Cohort Study Line Melgaard MSc, Anders Gorst-Rasmussen MSc, PhD, Lars H. Rasmussen Professor, MD, PhD, Gregory Y. Lip Professor, MD, Torben B. Larsen MD, PhD. Aalborg University Hospital Purpose: Stroke in patients with heart failure is associated with poor outcomes and increased comorbidity. Risk stratification based on readily available variables may improve clinical decision making in this patient population. This study investigated whether female sex is a risk factor of stroke in patients with heart failure in sinus rhythm. Methods: Population-based cohort study of patients diagnosed with heart failure during 1996-2012, identified by record linkage between nationwide registries. We defined our primary outcome as stroke or death and the secondary outcome as thromboembolic event. We used relative risks after 1 and 5 years to compare males with females within each of the following age groups: 50-59, 60-69, 70-79, 80-89, and 90+. Analyses took into account the competing risks of death. Results: We identified 118.762 heart failure patients, of which 57.144 (48.1%) were females. At 1- and 5- year follow-up, female sex was associated with 11% (95% CI: 0.83-0.96) and 10% (95% CI: 0.86-0.95) adjusted lower risk of stroke compared to males. The observed lower risks of stroke in females were not present in the older age groups, where the competing risk of death was substantial among males in particular. However, the relative risks of the secondary endpoint were lower in females compared to males in all age groups. Conclusions: We found an association between female sex and decreased stroke risk in HF patients which persisted after adjustment for concomitant cardiovascular risk factors. The association was attenuated with increasing age, possibly due to competing risks of death.
P66. Population-Based Estimates of Undiagnosed and Prediabetes in Canada (2007-2011) According to Various Clinical Diagnostic Guidelines Laura C. Rosella PhD, MHSc, Michael Lebenbaum MSc, Tiffany Fitzpatrick MPH, Gillian Booth MD, MSc. Public Health Ontario Purpose: To provide the first Canadian population-based estimates of preand undiagnosed type 2 diabetes (T2DM) prevalence. Methods: We combined two fasting subsamples of the Canadian Health Measures Survey restricted to non-pregnant adults aged 20 and older (N ¼ 3,494). Undiagnosed diabetes was defined as not having self-reported diabetes but having blood lipid measures which met Canadian guidelines, i.e. FPG 7.0 mmol/L or HbA1c 6.5%. Prediabetes was defined as 6.1 mmol/L FPG < 7.0 mmol/L or 6.0% HbA1c < 6.5%. All estimates were weighted using survey sampling weights. Standard errors and confidence intervals were calculated with the bootstrap method. Results: According to FPG, the prevalence of undiagnosed T2DM in Canadian adults was 1.13% [95% CI: (0.79, 1.62)], contributing to approximately 20% of total T2DM prevalence. Under the HbA1C criteria the undiagnosed prevalence rose to 3.09% [95% CI: (1.97, 4.81)]; approximately 41% of total T2DM. The HbA1c-only criteria resulted in a three-fold increase in prediabetes
disparities in health care and health research by: 1) assessing community health needs and concerns; 2) linking individuals to medical and social services and opportunities to participate in relevant research at UF; 3) engaging in bidirectional, health-promoting communication with and for the community; 4) increasing the community’s trust in the research enterprise through meaningful collaboration. The foundation of this model is HealthStreet’s Community Health Workers (CHWs), who perform outreach on a daily basis to work towards HealthStreet’s mission. Results: Since HealthStreet’s opening at the University of Florida (Cottler, LB PI) almost 4,000 community members have been consented, 78% of those approached, with 56% navigated to a UF study. HealthStreet has made 6,000+ referrals to services including medical care homes (1,031), and participants received 6,500+ services including blood pressure and glucose screening, HIV testing/counseling and health education. Our Community, Our Health events provide community members and researchers opportunities to discuss findings and next steps. Conclusions: HealthStreet effectively monitors individual and population health, disseminates findings to the community by geography, demography and risk factors, and links people to needed health related services. With 1 in 4 receiving a referral to needed medical care through the HealthStreet model, epidemiological surveillance data comes not at the expense of the community, but as a community service.
P63. Patterns and Causes of Hospital Readmissions in Patients with Multiple Chronic Conditions Raynard E. Washington PhD, MPH, Claudia Steiner. HHS Agency for Healthcare Research and Quality Purpose: Patients with multiple chronic conditions (MCC) account for a disproportionate share of hospital utilization and costs. As hospital readmissions are increasingly considered a measure of healthcare quality, it is important to examine the etiology of readmissions for patients with MCC to understand the implications for measurement. The objectives of this analysis were to explore patterns and causes of readmissions among patients with MCC. Methods: We used a nationally weighted sample of discharges from 21 geographically dispersed states from the Healthcare Cost and Utilization Project of adults with at least 2 chronic illnesses who were hospitalized at community hospitals during the period January through November 2010. A total of 4,779,608 adults with MCC were included in the analysis. Results: Approximately 19.68 % had 1 readmission within 30 days of discharge. Readmission rates were highest among younger adults (p<.01), males (p¼.01), patients with more comorbidities (p<.01), and longer index lengths of stay (p.<.01). The highest risk of readmission was due to chronic conditions present at the index visit, but not the principle reason for the index visit (8.1%). For several cardiovascular-related conditions, the most common causes of readmission were non-chronic conditions, most commonly, septicemia, urinary tract infections, and pneumonia. Adjusted readmission rates were highest for patients seen for hepatitis (predicted marginal risk ratio (RR)¼1.85), chronic kidney disease (RR ¼1.51) and CHF (RR¼1.41). Conclusions: Patients with MCC remain at high risk for 30 day readmissions, specifically due to co-morbid chronic conditions. Comprehensive management of all chronic illnesses during and after hospitalization is critical to improving patient outcomes.
Other Chronic Diseases P64. Gestational Weight Gain and Gestational Diabetes Mellitus in Indiana Pregnancies, 2007-2011 Gregory Budney MPH, Jenny Durica MPH, Gary Ordway MS, Linda Stemnock BSPH, Matt Kaag BS. Purpose: The percentage of Indiana pregnancies involving gestational diabetes mellitus (GDM) increased by 1.6% from 2007 to 2011. Due to statewide increases in GDM and obesity, the purpose of this study is to examine prepregnancy body mass index (BMI), recommended gestational weight gain (GWG), and associations related to GDM. Methods: Females who had a singleton birth with a recorded pre-pregnancy height and weight were identified from Indiana’s birth records 2007-2011. Pre- and post-pregnancy BMI was calculated from self-reported height and
697
weight on birth certificate records. Following Institute of Medicine’s “Weight Gain During Pregnancy: Reexamining the Guidelines” GWG was calculated and assessed to determine if recommendations were met. Analyses included bivariate analysis and logistic regression. Results: Between 2007-2011 there were a total of 412,175 females who gave birth in Indiana, 69.8% (n¼288,065) of whom did not meet GWG recommendations. Of these, 5.1% (n¼14,611) developed GDM. Between 2007-2011, those not meeting GWG recommendations were 1.08 times more likely to develop GDM regardless of pre-pregnancy BMI. Among females who did not meet GWG recommendations, those with overweight or obese pre-pregnancy BMI were 2.75 times more likely to develop GDM than females with a healthy weight or underweight pre-pregnancy BMI. This odds ratio significantly increased from 2.46 [2.25, 2.70] in 2007 to 3.16 [2.90, 3.46] in 2011. Conclusions: Between 2007-2011, those not meeting GWG recommendations were slightly more likely to develop GDM. Physicians should remain attentive to overweight or obese pregnant females as they have a higher risk of developing GDM.
P65. Female Sex Is Associated with a Lower Risk of Stroke in Patients with Heart Failure: A Nationwide Cohort Study Line Melgaard MSc, Anders Gorst-Rasmussen MSc, PhD, Lars H. Rasmussen Professor, MD, PhD, Gregory Y. Lip Professor, MD, Torben B. Larsen MD, PhD. Aalborg University Hospital Purpose: Stroke in patients with heart failure is associated with poor outcomes and increased comorbidity. Risk stratification based on readily available variables may improve clinical decision making in this patient population. This study investigated whether female sex is a risk factor of stroke in patients with heart failure in sinus rhythm. Methods: Population-based cohort study of patients diagnosed with heart failure during 1996-2012, identified by record linkage between nationwide registries. We defined our primary outcome as stroke or death and the secondary outcome as thromboembolic event. We used relative risks after 1 and 5 years to compare males with females within each of the following age groups: 50-59, 60-69, 70-79, 80-89, and 90+. Analyses took into account the competing risks of death. Results: We identified 118.762 heart failure patients, of which 57.144 (48.1%) were females. At 1- and 5- year follow-up, female sex was associated with 11% (95% CI: 0.83-0.96) and 10% (95% CI: 0.86-0.95) adjusted lower risk of stroke compared to males. The observed lower risks of stroke in females were not present in the older age groups, where the competing risk of death was substantial among males in particular. However, the relative risks of the secondary endpoint were lower in females compared to males in all age groups. Conclusions: We found an association between female sex and decreased stroke risk in HF patients which persisted after adjustment for concomitant cardiovascular risk factors. The association was attenuated with increasing age, possibly due to competing risks of death.
P66. Population-Based Estimates of Undiagnosed and Prediabetes in Canada (2007-2011) According to Various Clinical Diagnostic Guidelines Laura C. Rosella PhD, MHSc, Michael Lebenbaum MSc, Tiffany Fitzpatrick MPH, Gillian Booth MD, MSc. Public Health Ontario Purpose: To provide the first Canadian population-based estimates of preand undiagnosed type 2 diabetes (T2DM) prevalence. Methods: We combined two fasting subsamples of the Canadian Health Measures Survey restricted to non-pregnant adults aged 20 and older (N ¼ 3,494). Undiagnosed diabetes was defined as not having self-reported diabetes but having blood lipid measures which met Canadian guidelines, i.e. FPG 7.0 mmol/L or HbA1c 6.5%. Prediabetes was defined as 6.1 mmol/L FPG < 7.0 mmol/L or 6.0% HbA1c < 6.5%. All estimates were weighted using survey sampling weights. Standard errors and confidence intervals were calculated with the bootstrap method. Results: According to FPG, the prevalence of undiagnosed T2DM in Canadian adults was 1.13% [95% CI: (0.79, 1.62)], contributing to approximately 20% of total T2DM prevalence. Under the HbA1C criteria the undiagnosed prevalence rose to 3.09% [95% CI: (1.97, 4.81)]; approximately 41% of total T2DM. The HbA1c-only criteria resulted in a three-fold increase in prediabetes