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Lima VD, Brumme ZL, Brumme C, Sereda P, Krajden M, Wong J, Guillemi SA, Henry B, Hogg RS, Barrios R, Montaner JSG. The Impact of Treatment as Prevention on the HIV Epidemic in British Columbia, Canada. Curr HIV/AIDS Rep 2020; 17:77-87. [PMID: 32124189 DOI: 10.1007/s11904-020-00482-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW This study proposes to describe the impact of a publicly funded Treatment as Prevention (TasP) strategy in British Columbia (BC), Canada, in decreasing the individual and public health impact of the HIV/AIDS Epidemic. RECENT FINDINGS In BC, TasP has been associated with a steady decline in HIV-related morbidity and mortality. At the same time, a demographic transition was observed among people living with HIV (PLWH), with the majority of those on antiretroviral treatment (ART) now ≥ 50 years of age, living with at least one comorbidity, and dying from age-associated comorbidities. We also documented a progressive increase in the proportion of viral load suppression as a result of ART expansion. While the pre-ART CD4 T cell count has increased steadily in recent years, there is still a large proportion of PLWH being diagnosed in later stages of HIV infection. New HIV diagnoses have been rapidly declining, however to a lesser extent among men who have sex with men (MSM), and BC is currently experiencing an increase in infectious syphilis cases in this population. These facts reinforce the effectiveness of TasP in decreasing HIV transmission, but at the same time, it highlights the need for further innovation to enhance the control of HIV and syphilis among MSM. This study supports the development of new approaches that address existing gaps in the TasP strategy in BC, and the future health needs of PLWH.
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Affiliation(s)
- Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.,Department of Medicine, Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Zabrina L Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Chanson Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.,Department of Medicine, Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Silvia A Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Bonnie Henry
- British Columbia Ministry of Health, Victoria, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.,Vancouver Coastal Health, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada. .,Department of Medicine, Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Abstract
OBJECTIVES Cirrhosis is often a consequence of substance use disorders (SUD) and can lead to significant morbidity, mortality, and hospitalizations. We aimed to determine presence and impact of SUD in recently hospitalized patients with cirrhosis, which has not been previously described. METHODS This is a retrospective study of consecutive patients with cirrhosis seen at a post-discharge hepatology clinic. The presence of clinically-recognized SUD and documented establishment of addiction treatment, as noted in routine clinical care, was determined through medical record review. Number of hospitalizations, 30-day readmissions, and all-cause mortality at 1 year were also examined. RESULTS Among 99 patients, 72% were male and the median age was 55 years. The most common etiologies of cirrhosis were alcohol-related liver disease and hepatitis C infection. Alcohol use disorder was documented in 71%. Nearly all patients with clinically-recognized SUD underwent social work evaluation during hospitalization and 65% were referred to addiction treatment. Establishment of addiction care at follow up was documented in 35%. Documented SUD was associated with greater odds of hospitalization over 1 year (adjusted odds ratio 5.77, 95% confidence interval [1.36, 24.49], P = 0.017), but not with 30-day readmissions or mortality. CONCLUSIONS Clinically-recognized SUD was common in recently hospitalized patients with cirrhosis and associated with at least 1 other hospitalization within a year. Establishment of addiction treatment was documented in only a minority of patients. Further research is needed to determine whether patients with cirrhosis and SUD experience unique barriers to addiction treatment and if integration of SUD care in hepatology settings may be beneficial.
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Golabi P, Fazel S, Otgonsuren M, Escheik C, Sayiner M, Younossi ZM. Association of Parity in Patients with Chronic Liver Disease. Ann Hepatol 2018; 17:1035-1041. [PMID: 30600295 DOI: 10.5604/01.3001.0012.7204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND AIM The impact of type of liver disease on parity rates hasn't been described. Our aim was to assess the parity rates among women with CLD. MATERIAL AND METHODS The National Health and Nutrition Examination Survey-III (1988-1994) data were used to identify adult female participants with a diagnosis of CLD. Participants were asked about their reproductive health status. Parity was defined as having at least one live birth. Hepatic ultrasound, serologic, medical examination and clinical data were available to determine the presence and type of CLD. Body mass index (kg/m2) was divided into 3 categories (< 30; 30-35; 36+). RESULTS A total of 3,502 (865 NAFLD, 737 other CLD, 1,901 control) subjects were included. Patients with NAFLD were more likely to have at least one live birth than patients with other CLD and controls (77% in NAFLD vs. 72% in controls). Multivariate analysis revealed that presence of CLD other than NAFLD (OR: 0.46 [95% CI, 0.34-0.63]) and having a college or higher degree (OR: 0.48 [95% CI, 0.34-0.68]) were negatively associated while having low income (OR: 11.06 [95% CI, 6.86-17.82]) and being African American (OR: 3.93 [95% CI, 2.59-5.98]) were positively associated with having at least one live birth. CONCLUSIONS This study revealed that patients with CLD other than NAFLD were less likely to have at least one live birth. NAFLD and obesity were associated with higher rates of live births which can potentially be explained by weight gain post live birth leading to obesity and its associated-NAFLD.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Sofie Fazel
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Munkhzul Otgonsuren
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Carey Escheik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Mehmet Sayiner
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
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Friedman EE, Dean HD, Duffus WA. Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Public Health Rep 2018; 133:392-412. [PMID: 29874147 DOI: 10.1177/0033354918774788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP. METHODS We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article). RESULTS Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%). CONCLUSIONS This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.
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Affiliation(s)
- Eleanor E Friedman
- 1 Association of Schools and Programs of Public Health/CDC Public Health Fellowship Program, Atlanta, GA, USA.,2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,3 Chicago Center for HIV Elimination and University of Chicago Department of Medicine, Chicago, IL, USA
| | - Hazel D Dean
- 4 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne A Duffus
- 2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Akhtar F, Rehman S. A Public Health Analysis on Gaps in Disease Monitoring and Opportunities for Improved Care for the Management of Hepatitis B and C. Cureus 2018; 10:e2077. [PMID: 29560290 PMCID: PMC5856414 DOI: 10.7759/cureus.2077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hepatitis B and Hepatitis C have been major disease-causing agents among humans since they were discovered in the 1960s. Both cause jaundice-like symptoms initially but their prognosis and treatment are somehow different and depend upon many demographic details, such as the age and susceptibility of the patients and any other comorbid conditions. They clinically present primarily with hepatitis and can have many adverse effects or even be life-threatening at times, if not treated properly. However, their epidemiological background and findings in terms of morbidity, mortality, and case fatality rates are different. The disease burden, impact on the healthcare system, and prevention of the two diseases are quite different. The treatment and management options along with the prevention and control measures share unique strategies for handling the two diseases. The purpose of this review is to highlight the gaps in disease monitoring and to find ways and opportunities that can lead to improved care and better management of Hepatitis B and C locally and globally. Online databases were searched and peer-reviewed articles were selected. Key issues identified were lack of education globally in resource-limited settings, leading to a decreased understanding of the potential hazards associated with needle sharing and lack of access to healthcare because of a lack of insurance. The failure of compliance with vaccination leads to an increase in mother-to-child transmission (MTCT)-related infections. Increased global travel demands a systematic program in most immigrant-receiving countries to screen for hepatitis B virus (HBV)/hepatitis c virus (HCV) infections. Delayed U.S. Food and Drug Administration (FDA) licensing for new drugs hampers the treatment of chronic Hepatitis-B (CHB) among children. With the advancement in science, an effective vaccine against HCV will definitely help in eradicating the infection.
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6
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Chirikov VV, Shaya FT, Onukwugha E, Mullins CD, dosReis S, Howell CD. Tree-based Claims Algorithm for Measuring Pretreatment Quality of Care in Medicare Disabled Hepatitis C Patients. Med Care 2017; 55:e104-e112. [PMID: 29135773 DOI: 10.1097/mlr.0000000000000405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To help broaden the use of machine-learning approaches in health services research, we provide an easy-to-follow framework on the implementation of random forests and apply it to identify quality of care (QC) patterns correlated with treatment receipt among Medicare disabled patients with hepatitis C virus (HCV). METHODS Using Medicare claims 2006-2009, we identified 1936 patients with 6 months continuous enrollment before HCV diagnosis. We ran a random forest on 14 pretreatment QC indicators, extracted the forest's representative tree, and aggregated its terminal nodes into 4 QC groups predictive of treatment. To explore determinants of differential QC receipt, we compared patient-level and county-level (linked AHRF data) characteristics across QC groups. RESULTS The strongest predictors of treatment included "liver biopsy," "HCV genotype testing," "specialist visit," "HCV viremia confirmation," and "iron overload testing." High QC [n=360, proportion treated (pt)=33.3%] was defined for patients with at least 2 from the above-mentioned metrics. Good QC patients (n=302, pt=12.3%) had either "HCV genotype testing" or "specialist visit," whereas fair QC (n=282, pt=7.1%) only had "HCV viremia confirmation." Low QC patients (n=992, pt=2.5%) had none of the selected metrics. The algorithm accuracy of predicting treatment was 70% sensitivity and 78% specificity. HIV coinfection, drug abuse, and residence in counties with higher supply of hospitals with immunization and AIDS services correlated with lower QC. CONCLUSIONS Machine-learning techniques could be useful in exploring patterns of care. Among Medicare disabled HCV patients, the receipt of more QC indicators was associated with higher treatment rates. Future research is needed to assess determinants of differential QC receipt.
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Affiliation(s)
- Viktor V Chirikov
- *University of Maryland School of Pharmacy †University of Maryland School of Medicine, Baltimore, MD ‡Howard University College of Medicine, Washington, DC
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Sanabria JR, Kombu RS, Zhang GF, Sandlers Y, Ai J, Ibarra RA, Abbas R, Goyal K, Brunengraber H. Glutathione species and metabolomic prints in subjects with liver disease as biological markers for the detection of hepatocellular carcinoma. HPB (Oxford) 2016; 18:979-990. [PMID: 28340971 PMCID: PMC5144552 DOI: 10.1016/j.hpb.2016.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/04/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of liver disease is increasing in USA. Animal models had shown glutathione species in plasma reflects liver glutathione state and it could be a surrogate for the detection of hepatocellular carcinoma (HCC). METHODS The present study aimed to translate methods to the human and to explore the role of glutathione/metabolic prints in the progression of liver dysfunction and in the detection of HCC. Treated plasma from healthy subjects (n = 20), patients with liver disease (ESLD, n = 99) and patients after transplantation (LTx, n = 7) were analyzed by GC- or LC/MS. Glutathione labeling profile was measured by isotopomer analyzes of 2H2O enriched plasma. Principal Component Analyzes (PCA) were used to determined metabolic prints. RESULTS There was a significant difference in glutathione/metabolic profiles from patients with ESLD vs healthy subjects and patients after LTx. Similar significant differences were noted on patients with ESLD when stratified by the MELD score. PCA analyses showed myristic acid, citric acid, succinic acid, l-methionine, d-threitol, fumaric acid, pipecolic acid, isoleucine, hydroxy-butyrate and glycolic, steraric and hexanoic acids were discriminative metabolites for ESLD-HCC+ vs ESLD-HCC- subject status. CONCLUSIONS Glutathione species and metabolic prints defined liver disease severity and may serve as surrogate for the detection of HCC in patients with established cirrhosis.
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Affiliation(s)
- Juan R. Sanabria
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Department of Preventive Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Department of Surgery and Research, Cancer Treatment Centers of America, Chicago, IL, USA,Department of Biostatistics, Cancer Treatment Centers of America, Chicago, IL, USA,Correspondence Juan R. Sanabria, Department of Surgery at Marshall University or Department of Proteomics and Metabolmics Core Facilities at Case Western Reserve University, Cleveland, OH, USA.Department of Surgery at Marshall University or Department of Proteomics and Metabolmics Core Facilities at Case Western Reserve UniversityClevelandOHUSA
| | - Rajan S. Kombu
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Guo-Fang Zhang
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yana Sandlers
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jizhou Ai
- Department of Surgery and Research, Cancer Treatment Centers of America, Chicago, IL, USA,Department of Biostatistics, Cancer Treatment Centers of America, Chicago, IL, USA
| | - Rafael A. Ibarra
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rime Abbas
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kush Goyal
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Henri Brunengraber
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Department of Metabolomics and Proteomics Core Facilities, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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8
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Chirikov VV, Shaya FT, Mullins CD, dosReis S, Onukwugha E, Howell CD. Determinants of quality of care and treatment initiation in Medicare disabled patients with chronic hepatitis C. Expert Rev Gastroenterol Hepatol 2016; 9:1447-62. [PMID: 26524244 DOI: 10.1586/17474124.2015.1095087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aligning with a national priority to bridge health disparities in disadvantaged populations, we explored contextual determinants of pretreatment quality of care and treatment receipt of Medicare disabled patients with hepatitis C virus (HCV) infection. METHODS We used Medicare claims (2006-2009) linked to the Area Health Resource Files. Ordinal partial proportional odds and weighted modified Poisson regressions were used to model the determinants of quality care receipt and interferon-based treatment, respectively. RESULTS We identified 1936 Medicare disabled HCV patients, of whom 10.4% were treated with peg-interferon. Despite the high comorbidity burden among HCV disabled patients, greater engagement in care correlated with greater likelihood of quality care and treatment receipt. CONCLUSION Our study highlights the need for process and linkage to care in Medicare disabled HCV patients, but future research relevant to novel interferon-free agents is needed to assess patterns of quality of care and treatment receipt in this vulnerable population.
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Affiliation(s)
- Viktor V Chirikov
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Fadia T Shaya
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA.,b 2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - C Daniel Mullins
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Susan dosReis
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Ebere Onukwugha
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Charles D Howell
- c 3 Department of Medicine, Howard University College of Medicine, 2041 Georgia Ave. Suite 5C02, Washington, DC 20060, USA
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Okafor PN, Chiejina M, de Pretis N, Talwalkar JA. Secondary analysis of large databases for hepatology research. J Hepatol 2016; 64:946-56. [PMID: 26739689 DOI: 10.1016/j.jhep.2015.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 12/15/2022]
Abstract
Secondary analysis of large datasets involves the utilization of existing data that has typically been collected for other purposes to advance scientific knowledge. This is an established methodology applied in health services research with the unique advantage of efficiently identifying relationships between predictor and outcome variables but which has been underutilized for hepatology research. Our review of 1431 abstracts published in the 2013 European Association for the Study of Liver (EASL) abstract book showed that less than 0.5% of published abstracts utilized secondary analysis of large database methodologies. This review paper describes existing large datasets that can be exploited for secondary analyses in liver disease research. It also suggests potential questions that could be addressed using these data warehouses and highlights the strengths and limitations of each dataset as described by authors that have previously used them. The overall goal is to bring these datasets to the attention of readers and ultimately encourage the consideration of secondary analysis of large database methodologies for the advancement of hepatology.
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Affiliation(s)
- Philip N Okafor
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
| | - Maria Chiejina
- Department of Internal Medicine, Good Shepard Medical Center, Longview, TX 75601, United States
| | - Nicolo de Pretis
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Medicine, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Jayant A Talwalkar
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
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10
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Wang C, Zhao P, Luo P, Liu W, Wang H, Zhao Q. Prevalence and risk factors of coronary artery disease in patients with chronic viral hepatitis. Postgrad Med 2015; 127:786-90. [PMID: 26436306 DOI: 10.1080/00325481.2015.1094366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Patients with chronic viral hepatitis usually present metabolic abnormalities and hemodynamic changes, which are known factors associated with the development of coronary artery disease (CAD). This study aims to determine the risk factors of incident CAD in these patients. METHODS We identified 193 patients who subsequently developed CAD amongst 37,840 cases diagnosed as chronic viral hepatitis from January 2007 through December 2013. RESULTS In these patients, 141 had hepatitis B virus infections and 52 had hepatitis C virus infections. There was a male preponderance (65.9%). The median age at the diagnosis of hepatitis was 51 years. In the univariate analysis, patients aged ≥ 51 years had shorter median periods from the diagnosis of hepatitis to the onset of CAD than patients aged < 51 years (50 versus 96 months, p < 0.001), and patients with hypertension had shorter median durations compared to those without hypertension (48 versus 96 months, p < 0.001). Statistical significance also existed between patients with different etiologies (p = 0.004). In the multivariate analysis by Cox regression, age at the diagnosis of hepatitis (p < 0.001; hazard ratio (HR), 1.041; 95% CI, 1.027-1.056) and hypertension (with versus without, p < 0.001; HR, 1.925; 95% CI, 1.419-2.611) were revealed. CONCLUSIONS Age at diagnosis of hepatitis and hypertension appeared to be independent risk factors of incident CAD in these patients. This topic deserves further studies.
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Affiliation(s)
- Chunya Wang
- a 1 Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University , Beijing 100029, China
| | - Pan Zhao
- b 2 Clinical Trial Center, Beijing 302 Hospital (302 Hospital of PLA) , Beijing 100039, China
| | - Ping Luo
- a 1 Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University , Beijing 100029, China
| | - Weiwei Liu
- c 3 Department of Statistics, Academy of Military Medical Science , Beijing 100850, China
| | - Hao Wang
- d 4 Medical Record Center, Beijing 302 Hospital (302 Hospital of PLA) , Beijing 100039, China
| | - Quanming Zhao
- e 5 Department of Special Medical Service, Beijing Anzhen Hospital, Capital Medical University , Beijing 100029, China
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11
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Ly KN, Speers S, Klevens RM, Barry V, Vogt TM. Measuring chronic liver disease mortality using an expanded cause of death definition and medical records in Connecticut, 2004. Hepatol Res 2015; 45:960-968. [PMID: 25319958 PMCID: PMC11005817 DOI: 10.1111/hepr.12437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/08/2014] [Accepted: 10/12/2014] [Indexed: 02/08/2023]
Abstract
AIM Chronic liver disease (CLD) is a leading cause of death and is defined based on a specific set of underlying cause-of-death codes on death certificates. This conventional approach to measuring CLD mortality underestimates the true mortality burden because it does not consider certain CLD conditions like viral hepatitis and hepatocellular carcinoma. We measured how much the conventional CLD mortality case definition will underestimate CLD mortality and described the distribution of CLD etiologies in Connecticut. METHODS We used 2004 Connecticut death certificates to estimate CLD mortality two ways. One way used the conventional definition and the other used an expanded definition that included more conditions suggestive of CLD. We compared the number of deaths identified using this expanded definition with the number identified using the conventional definition. Medical records were reviewed to confirm CLD deaths. RESULTS Connecticut had 29 314 registered deaths in 2004. Of these, 282 (1.0%) were CLD deaths identified by the conventional CLD definition while 616 (2.1%) were CLD deaths defined by the expanded definition. Medical record review confirmed that most deaths identified by the expanded definition were CLD-related (550/616); this suggested a 15.8 deaths/100 000 population mortality rate. Among deaths for which hepatitis B, hepatitis C and alcoholic liver disease were identified during medical record review, only 8.6%, 45.4% and 36.5%, respectively, had that specific cause-of-death code cited on the death certificate. CONCLUSION An expanded CLD mortality case definition that incorporates multiple causes of death and additional CLD-related conditions will better estimate CLD mortality.
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Affiliation(s)
- Kathleen N. Ly
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suzanne Speers
- Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - R. Monina Klevens
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vaughn Barry
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara M. Vogt
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Chirikov VV, Shaya FT, Howell CD. Contextual analysis of determinants of late diagnosis of hepatitis C virus infection in medicare patients. Hepatology 2015; 62:68-78. [PMID: 25754171 DOI: 10.1002/hep.27775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 03/04/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Patient- and county-level characteristics associated with advanced liver disease (ALD) at hepatitis C virus (HCV) diagnosis were examined in three Medicare cohorts: (1) elderly born before 1945; (2) disabled born 1945-1965; and (3) disabled born after 1965. We used Medicare claims (2006-2009) linked to the Area Health Resource Files. ALD was measured over the period of 6 months before to 3 months after diagnosis. Using weighted multivariate modified Poisson regression to address generalizability of findings to all Medicare patients, we modeled the association between contextual characteristics and presence of ALD at HCV diagnosis. We identified 1,746, 3,351, and 592 patients with ALD prevalence of 28.0%, 23.0%, and 15.0% for birth cohorts 1, 2, and 3. Prevalence of drug abuse increased among younger birth cohorts (4.2%, 22.6%, and 35.6%, respectively). Human immunodeficiency virus coinfection (prevalence ratio [PR] = 0.63; 95% confidence interval [CI]: 0.50-0.80; P = 0.001), dual Medicare/Medicaid eligibility (PR = 0.89; 95% CI: 0.80-0.98; P = 0.017), residence in counties with higher median household income (PR = 0.82; 95% CI: 0.71-0.95; P = 0.008), higher density of primary care providers (PR = 0.84; 95% CI: 0.73-0.98; P = 0.022), and more rural health clinics (PR = 0.90; 0.81-1.01; P = 0.081) were associated with lower ALD risk. End-stage renal disease (PR = 1.41; 95% CI: 1.21-1.63; P = 0.001), alcohol abuse (PR = 2.57; 95% CI: 2.33-2.84; P = 0.001), hepatitis B virus (PR = 1.32; 95% CI: 1.09-1.59; P = 0.004), and Midwest residence (PR = 1.22; 95% CI: 1.05-1.41; P = 0.010) were associated with higher ALD risk. Living in rural counties with high screening capacity was protective in the elderly, but associated with higher ALD risk among the disabled born 1945-1965. CONCLUSIONS ALD prevalence patterns were complex and were modified by race, elderly/disability status, and the extent of health care access and screening capacity in the county of residence. These study results help inform treatment strategies for HCV in the context of coordinated models of care.
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Affiliation(s)
- Viktor V Chirikov
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Fadia T Shaya
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.,University of Maryland School of Medicine, Baltimore, MD
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Valery PC, Powell E, Moses N, Volk ML, McPhail SM, Clark PJ, Martin J. Systematic review: unmet supportive care needs in people diagnosed with chronic liver disease. BMJ Open 2015; 5:e007451. [PMID: 25854973 PMCID: PMC4390721 DOI: 10.1136/bmjopen-2014-007451] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE People with chronic liver disease, particularly those with decompensated cirrhosis, experience several potentially debilitating complications that can have a significant impact on activities of daily living and quality of life. These impairments combined with the associated complex treatment mean that they are faced with specific and high levels of supportive care needs. We aimed to review reported perspectives, experiences and concerns of people with chronic liver disease worldwide. This information is necessary to guide development of policies around supportive needs screening tools and to enable prioritisation of support services for these patients. DESIGN Systematic searches of PubMed, MEDLINE, CINAHL and PsycINFO from the earliest records until 19 September 2014. Data were extracted using standardised forms. A qualitative, descriptive approach was utilised to analyse and synthesise data. RESULTS The initial search yielded 2598 reports: 26 studies reporting supportive care needs among patients with chronic liver disease were included, but few of them were patient-reported needs, none used a validated liver disease-specific supportive care need assessment instrument, and only three included patients with cirrhosis. Five key domains of supportive care needs were identified: informational or educational (eg, educational material, educational sessions), practical (eg, daily living), physical (eg, controlling pruritus and fatigue), patient care and support (eg, support groups), and psychological (eg, anxiety, sadness). CONCLUSIONS While several key domains of supportive care needs were identified, most studies included hepatitis patients. There is a paucity of literature describing the supportive care needs of the chronic liver disease population likely to have the most needs--namely those with cirrhosis. Assessing the supportive care needs of people with chronic liver disease have potential utility in clinical practice for facilitating timely referrals to support services.
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Affiliation(s)
- Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Powell
- Centre for Liver Disease Research, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Neta Moses
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael L Volk
- Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Paul J Clark
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jennifer Martin
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
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Shapshak P, Sinnott JT, Somboonwit C, Kuhn JH. Surveillance for Hepatitis C. GLOBAL VIROLOGY I - IDENTIFYING AND INVESTIGATING VIRAL DISEASES 2015. [PMCID: PMC7120481 DOI: 10.1007/978-1-4939-2410-3_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hepatitis C is a global public health problem. Globally, an estimated 170 million persons (3 % of the world’s population) have been infected with the hepatitis C virus, and an estimated 350,000 persons die annually from complications of chronic hepatitis C. Furthermore, an increasing trend in hepatitis C mortality in the USA was observed over the last decade; in 2007, mortality associated with hepatitis C surpassed mortality associated with HIV. As the hepatitis C epidemic continues, it is increasingly important to accurately measure hepatitis C-related morbidity and mortality in order to inform public health programs and policies and prioritize and evaluate prevention efforts. This chapter provides an overview of hepatitis C surveillance and methods used in the USA with some examples from other countries.
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Affiliation(s)
- Paul Shapshak
- Division of Infectious Diseases and International Medicine, USF Morsani College of Medicine, Tampa, Florida USA
| | - John T. Sinnott
- Infectious Diseases and International He, USF Morsani College of Medicine, Tampa, Florida USA
| | - Charurut Somboonwit
- Division of Infectious Diseases and Inte, USF Morsani College of Medicine, Tampa, Florida USA
| | - Jens H. Kuhn
- C.W. Bill Young Center for Biodefense & Emerging Infectious Diseases, NIH-NIAID Div. Clinical Research, Frederick, Maryland USA
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15
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Chirikov VV, Shaya FT, Howell CD. Association between interferon use and reduced metabolic and vascular complications among patients with hepatitis C. Expert Rev Gastroenterol Hepatol 2014; 8:973-83. [PMID: 25109401 DOI: 10.1586/17474124.2014.945911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined whether interferon treatment is associated with reduced metabolic/vascular complications in hepatitis C virus patients. The study had historical prospective cohort design using Maryland Medicaid administrative data (2006-2009). The end point was the incidence rate of mild, severe and combined mild/severe events from the Diabetes Complications Severity Index (DCSI). Interferon-treated and -untreated hepatitis C virus patients were matched on baseline covariates. Using multivariate counting process Cox regressions, we modeled the association between interferon receipt of at least 24 weeks and DCSI events incidence rate. Treated whites had similar rate of mild DCSI events, significantly 64% (p < 0.01) lower rate of severe DCSI events, and overall 29% (p = 0.14) lower rate of mild/severe DCSI events, compared with untreated whites. Compared with untreated blacks, treated blacks had a similar rate of DSCI events. Future studies should confirm our findings and should include important clinical variables such as viral genotype, virologic count and achieving sustained virologic response.
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Affiliation(s)
- Viktor V Chirikov
- University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
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