Cost of care for falls in elderly population

Researchers estimated medical costs attributable to both fatal and nonfatal falls in the elderly population and found that approximately 50 billion dollars were spent in 2015. These findings are published in the Journal of the American Geriatrics Society.

Researchers utilized population data from the National Vital Statistics System (NVSS) and cost estimates from the Web-based Injury Statistics Query and Reporting System (WISQARS) for fatal falls, quasi-experimental regression analysis of data from the Medicare Current Beneficiaries Survey (MCBS) for nonfatal falls.

For nonfatal falls in adults aged 65 and older, Medicare paid approximately $28.9 billion, Medicaid $8.7 billion and private and other payers $12.0 billion. Overall medical spending for fatal falls was estimated to be $754 million.

Study authors felt that”Preventive strategies that reduce falls among older adults could lead to a substantial reduction in health care spending.”

Citation: Florence, Curtis S., Gwen Bergen, Adam Atherly, Elizabeth Burns, Judy Stevens, and Cynthia Drake. “Medical Costs of Fatal and Nonfatal Falls in Older Adults.” Journal of the American Geriatrics Society, 2018. doi:10.1111/jgs.15304.

Research funding: CDC

Adapted from press release by Wiley publications.

Association between inflammatory bowel disease and heart disease found

Researchers analyzed medical-record data from more than 17.5 million patients found that people with inflammatory bowel disease (IBD) are at increased risk for a heart attack, regardless of whether or not they have risk factors for heart disease. This research is presented at the American College of Cardiology’s 67th Annual Scientific Session.

“Younger patients had about nine times the risk of a heart attack compared to their peers in the same age group [who didn’t have IBD], and this risk continued to decline with age,” said Muhammad S. Panhwar, MD, a resident in internal medicine at Case Western Reserve University/University Hospitals Cleveland Medical Center in Cleveland and lead author of the study. “Our findings suggest that IBD should be considered an independent risk factor for heart disease.”

Inflammatory bowel disease (IBD) includes Crohn’s disease and ulcerative colitis. Per Centers for Disease Control and Prevention (CDC) data, as of 2015, an estimated three million Americans have IBD, and about 70,000 new cases are diagnosed every year.

Researchers utilized IBM Explorys, a database of de-identified data from electronic records for patients of 26 nationwide health care systems in the U.S. They then identified 211,870 patients aged 18 to 65 diagnosed with of inflammatory bowel disease (IBD) between 2014 and 2017. Researchers then looked at the rate of heart attacks in the normal population and those with inflammatory bowel disease. Compared with patients who did not have Inflammatory bowel disease, heart attacks occurred roughly twice as often in those with Inflammatory bowel disease.

Researchers also found that people with Inflammatory bowel disease (IBD) were also more likely to have diabetes, hypertension, high cholesterol, and smoking than people without inflammatory bowel disease.  After adjusting for age, race, sex and traditional heart disease risk factors, Panhwar and his colleagues found that the patients with inflammatory bowel disease had about a 23 percent higher risk of having a heart attack. Women under the age of 40 with IBD were at higher risk for a heart attack than men with IBD in the same age group. In patients over the age of 40, heart attack risk was similar for men and women with inflammatory bowel disease.

“Our study adds considerably to a growing set of literature highlighting the importance of chronic inflammation in IBD as having a role in the development of heart disease,” Panhwar said.

Adapted from press release by the American College of Cardiology.

New flu simulation map using health and social media data

Researchers at the University of Chicago have created computer simulations to predict spread of flu across the United States utilizing datasets of demographics, healthcare visits and geographic movements of 150 million people over nine years. The study is published in the journal eLife.

Simulation map of flu spread. Credit: Andrey Rzhetsky, UChicago

Researchers utilized deidentified patient data from more than 40 million families in the US using Truven MarketScan to analyze insurance claims for treatment of flu-like conditions from 2003 to 2009. To get people movement data they used 1.7 billion geolocated twitter posts. Researchers also incorporated data on “social connectivity,” which is information about how often they visit friends and neighbors, air travel, weather, vaccination rates and changes in the flu virus itself.

The study results show that seasonal flu outbreaks originate in warm, humid areas of the south and the southeastern U.S. and move northward. The team utilized newer models based on all above variables to understand what factors drive the northward spread of the flu each year. In the paper, they liken the typical outbreak to a forest fire.

The researchers were able to use these models to recreate three years of historical flu data fairly accurately.

Citation: Chattopadhyay, Ishanu, Emre Kiciman, Joshua W. Elliott, Jeffrey L. Shaman, and Andrey Rzhetsky. “Conjunction of factors triggering waves of seasonal influenza.” ELife 7 (2018). doi:10.7554/elife.30756.

Research funding: National Institutes of Health, Defense Advanced Research Projects Agency, Liz and Kent Dauten.

Adapted from press release by the University of Chicago.

Research suggests that heating coils contribute toxic metals in e-cigarette vapors

Significant amounts of toxic metals, including lead, leak from some e-cigarette heating coils and are present in the aerosols inhaled by users, according to a study from scientists at Johns Hopkins Bloomberg School of Public Health. The study is published online in Environmental Health Perspectives.

In the study, the scientists examined e-cigarette devices owned by a sample of 56 users. They found that significant numbers of the devices generated aerosols with potentially unsafe levels of lead, chromium, manganese and/or nickel. Chronic inhalation of these metals has been linked to lung, liver, immune, cardiovascular and brain damage, and even cancers.

The Food and Drug Administration has the authority to regulate e-cigarettes but is still considering how to do so. The finding that e-cigarettes expose users to what may be harmful levels of toxic metals could make this issue a focus of future FDA rules.

“It’s important for the FDA, the e-cigarette companies and vapers themselves to know that these heating coils, as currently made, seem to be leaking toxic metals–which then get into the aerosols that vapers inhale,” says study senior author Ana María Rule, PhD, MHS, an assistant scientist in the Bloomberg School’s Department of Environmental Health and Engineering.

For the new study, Rule and her colleagues, including lead author Pablo Olmedo, PhD, who was a postdoctoral researcher at the Bloomberg School at the time of his work on the study, recruited 56 daily e-cigarette users from vaping conventions and e-cigarette shops around Baltimore during the fall of 2015. Working with participants’ devices, which they brought to the researchers’ lab at the Bloomberg School, the scientists tested for the presence of 15 metals in the e-liquids in the vapers’ refilling dispensers, the e-liquids in their coil-containing e-cigarette tanks and in the generated aerosols.

Consistent with prior studies, they found minimal amounts of metals in the e-liquids within refilling dispensers, but much larger amounts of some metals in the e-liquids that had been exposed to the heating coils within e-cigarette tanks. The difference indicated that the metals almost certainly had come from the coils. Most importantly, the scientists showed that the metal contamination carried over to the aerosols produced by heating the e-liquids.

Of the metals significantly present in the aerosols, lead, chromium, nickel and manganese were the ones of most concern, as all are toxic when inhaled. The median lead concentration in the aerosols, for example, was about 15 μg/kg, or more than 25 times greater than the median level in the refill dispensers. Almost 50 percent of aerosol samples had lead concentrations higher than health-based limits defined by the Environmental Protection Agency. Similarly, median aerosol concentrations of nickel, chromium and manganese approached or exceeded safe limits.

“These were median levels only,” Rule says. “The actual levels of these metals varied greatly from sample to sample, and often were much higher than safe limits.”

E-cigarette heating coils typically are made of nickel, chromium and a few other elements, making them the most obvious sources of metal contamination, although the source of the lead remains a mystery. Precisely how metals get from the coil into the surrounding e-liquid is another mystery. “We don’t know yet whether metals are chemically leaching from the coil or vaporizing when it’s heated,” Rule says. In an earlier study of the 56 vapers, led by Angela Aherrera, MPH, a DrPH student at the Bloomberg School, the levels of nickel and chromium in urine and saliva were related to those measured in the aerosol, confirming that e-cigarette users are exposed to these metals.

The researchers did observe, however, that aerosol metal concentrations tended to be higher for e-cigarettes with more frequently changed coils–suggesting that fresher coils give off metals more readily.

The researchers also detected significant levels of arsenic, a metal-like element that can be highly toxic, in refill e-liquid and in the corresponding tank e-liquid and aerosol samples from 10 of the 56 vapers. How the arsenic got into these e-liquids is yet another mystery–and another potential focus for regulators.

Rule and her team are now planning further studies of vaping and metal exposures, with particular attention to their impacts on people. “We’ve established with this study that there are exposures to these metals, which is the first step, but we need also to determine the actual health effects,” she says.

Citation: Metal Concentrations in e-Cigarette Liquid and Aerosol Samples: The Contribution of Metallic Coils” was written by Pablo Olmedo, Walter Goessler, Stefan Tanda, Maria Grau-Perez, Stephanie Jarmul, Angela Aherrera, Rui Chen, Markus Hilpert, Joanna E. Cohen, Ana Navas-Acien, and Ana M. Rule. Environ Health Perspect; DOI:10.1289/EHP2175

Research funding: Maryland State Cigarette Restitution Fund , Alfonso Martín Escudero Foundation, American Heart Association Tobacco Regulation and Addiction Center, and National Institute of Environmental Health Sciences.

Adapted from press release by the Johns Hopkins Bloomberg School of Public Health.

Artificial intelligence algorithm to predict and prevent spread of infectious diseases

Team of researchers from USC Viterbi School of Engineering has created an algorithm that can help policymakers reduce the overall spread of disease. The algorithm is optimized to make the most of limited resources, such as advertising budgets, thus helping cash strapped public health agencies.

To create the artificial intellegence algorithm, the researchers used behavioral, demographic and epidemic disease trends data to generate a model of disease spread that captures underlying population dynamics and contact patterns between people. Using computer simulations, the researchers tested the algorithm on tuberculosis (TB) spread in India and gonorrhea in the United States. In both cases, they found the algorithm did a better job at reducing disease cases than current health outreach policies by sharing information about these diseases with individuals who might be most at risk.

The study was published in the AAAI Conference on Artificial Intelligence. The authors are Bryan Wilder, a candidate for a PhD in computer science, Milind Tambe, the Helen N. and Emmett H. Jones Professor in Engineering, a professor of computer science and industrial and systems engineering and co-founder of the USC Center for AI in Society and Sze-chuan Suen, an assistant professor in industrial and systems engineering.

“Our study shows that a sophisticated algorithm can substantially reduce disease spread overall,” says Wilder, the first author of the paper. “We can make a big difference, and even save lives, just by being a little bit smarter about how we use resources and share health information with the public.”

The algorithm also appeared to make more strategic use of resources. The team found it concentrated heavily on particular groups and did not simply allocate more budget to groups with a high prevalence of the disease. This seems to indicate that the algorithm is leveraging non-obvious patterns and taking advantage of sometimes-subtle interactions between variables that humans may not be able to pinpoint. The team’s mathematical models also take into account that people move, age, and die, reflecting more realistic population dynamics than many existing algorithms for disease control.

Adapted from press release by University of South California.

Computational model to track flu using Twitter data

An international team led by Alessandro Vespignani from Northeastern University has developed a computational model to predict the spread of the flu in real time. This unique model uses posts on Twitter in combination with key parameters of each season’s epidemic, including the incubation period of the disease, the immunization rate, how many people an individual with the virus can infect, and the viral strains present. When tested against official influenza surveillance systems, the model has been shown to accurately(70 to 90 percent) forecast the disease’s evolution up to six weeks in advance.

The paper on the novel model received a coveted Best Paper Honorable Mention award at the 2017 International World Wide Web Conference last month following its presentation.

While the paper reports results using Twitter data, the researchers note that the model can work with data from many other digital sources, too, as well as online surveys of individuals such as influenzanet, which is very popular in Europe.

“Our model is a work in progress,” emphasizes Vespignani. “We plan to add new parameters, for example, school and workplace structure.

Adapted from press release from the Northeastern University.

Price tag for cardiovascular disease to reach 1 trillion dollars by 2035

A new study projects that by 2035, cardiovascular disease, the most costly and prevalent killer, if left unchecked, will place a crushing economic and health burden on the nation’s financial and health care systems. According to the study, in the next two decades, the number of Americans with cardiovascular disease will rise to 131.2 million – 45 percent of the total U.S. population – with costs expected to reach $1.1 trillion.

The new projections are an update of those made by the association in 2011 that estimated around 100 million Americans would suffer from cardiovascular disease by 2030. In addition to the staggering human toll it takes on Americans’ lives and health, cardiovascular disease wreaks havoc on our economy.

Currently, cardiovascular disease is the costliest disease in our nation, with a price tag of $555 billion in 2016. Today’s study suggests that the economic burden of cardiovascular disease will only get worse. Specifically, the total cardiovascular disease costs across all conditions are projected to more than triple among those age 80 and more than double among those ages 65-79.

Direct medical costs related to cardiovascular disease will continue to rise, with costs expected to triple over the next 20 years for Hispanics, more than double among Blacks and be higher for women than men. Expenses associated with cardiovascular disease are expected to surpass medical cost estimates for other chronic diseases, such as diabetes and Alzheimer’s.

Indirect costs due to cardiovascular disease, or the costs related to lost productivity in the workplace and at home, are projected to be the highest for individuals age 45-64. On average, an employee with cardiovascular disease costs his or her employer nearly 60 hours and over $1,100 more in lost productivity per year than an employee without cardiovascular disease.

While white Americans face the highest indirect costs, the report stresses that Hispanics are expected to experience the largest relative increase in costs due to cardiovascular disease over the next 20 years.

To address the escalating burden highlighted in this report, the association recommends the following specific changes in federal policies: Increased funding for heart and stroke research by the National Institutes of Health Enhanced focus on prevention to improve and preserve population health from birth to old age Preservation and expansion of access to high-quality affordable health care Even though heart disease and stroke account for 23 percent and 4 percent of all deaths respectively, the NIH invests a meager 4 percent of its budget on heart disease research, a mere 1 percent on stroke research and only 2 percent on other cardiovascular disease research.

Prevention programs under the Affordable Care Act have enabled insured patients to obtain blood pressure and cholesterol screenings, smoking cessation services, behavioral counseling for obesity, as well as improved access to primary care and medications needed to help manage their diseases and reduce their risks. Retaining this emphasis on prevention and investments in it will be key to reducing health care costs moving forward. Finally, protections for patients with pre-existing conditions are vitally important for Americans who have or will develop cardiovascular disease.

“While we have made tremendous progress in fighting cardiovascular disease, recently reported death rates and these projections reinforce that now is not the time to relax,” said American Heart Association President Steven Houser, Ph.D., FAHA. “We must continue to be vigilant, because if these projections become reality, a serious health and economic crisis is on the horizon. The association welcomes the opportunity to work with Congress and the new administration to find ways to wipe out the burden of cardiovascular disease and build an improved culture of health in our country.”

Citation: Cardiovascular disease: a costly burden for America – projections through 2035. American Heart association CVD burden report. http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_491543.pdf Accessed on 2017-2-14
Adapted from press release by RTI international.

Antidepressants use associated with birth defects

A new Université de Montréal study in the British Medical Journal reveals that antidepressants prescribed to pregnant women could increase the chance of having a baby with birth defects.

The risk is 6 to 10 %, versus 3 to 5 % in women who do not take the drugs and it is high enough to merit caution in their use, especially since, in most cases, they are only marginally effective, the study says.

“In pregnancy, you’re treating the mother but you’re worried about the unborn child, and the benefit needs to outweigh the risk,” said the study’s senior author, Anick Bérard, a professor at UdeM’s Faculty of Pharmacy[AB1]  and researcher at its affiliated children’s hospital, CHU Sainte-Justine.

A well-known expert in pregnancy and depression, Bérard has previously established links between antidepressants and low birth weight, gestational hypertension, miscarriages and autism. Her new study is among the first to examine the link to birth defects among depressed women.

Every year, about 135,000 Quebec women get pregnant, and of those, about 7 % show some signs of depression, mostly mild to moderate. A much smaller percentage  (less than 1%) suffers from severe depression.

In her study, Bérard looked at 18,487 depressed women in the Quebec Pregnancy Cohort, a  longitudinal, population-based grouping of 289,688 pregnancies recorded between 1998 to 2009. Of the women studied, 3,640 – about 20 per cent – took antidepressants in the first three months.

“We only looked at the first trimester, because this is where all the organ systems are developing,” said Bérard. “At 12 weeks of gestation, the baby is formed.”

Antidepressant use during this critical time-window has the potential to interfere with serotonin intake by the fetus, which can result in malformations.

“Serotonin during early pregnancy is essential for the development of all embryonic cells, and thus any insult that disturbs the serotonin signaling process has the potential to result in a wide variety of malformations,” the study says.

For example, when Celexa (the brand name for citalopram) was taken in the first trimester, the risk of major birth defects jumped from 5 per cent to 8 per cent, Bérard found. In all, 88 cases of malformations were linked to use of the drug.

Similarly, use of Paxil (paroxetine) was associated with an increased risk of heart defects; venlafaxine (Effexor), with lung defects; and tricyclic antidepressants (such as Elavil), with increased eye, ear, face and neck defects.

Depression is on the rise across the globe and is a leading cause of death, according to the World Health Organization. Depression is particularly serious during pregnancy, and doctors – especially psychiatrists, obstetricians and other specialists – are prescribing more antidepressants than ever to expectant mothers.

Over the decade or so that Bérard studied her cohort, the proportion of expectant mothers on antidepressants in Quebec doubled, from 21 users per 1,000 pregnancies in 1998 to 43 per 1,000 in 2009.

Those using the drugs tend to be older, live alone or be on welfare; they also may have other ailments such as diabetes, hypertension and asthma, the new study shows. The women generally don’t have the financial means, leisure time or support to seek other solutions, such as exercising regularly or consulting with a psychotherapist.

“There are a multitude of ways to get mild to moderate depression treated, but you need to have the time and money and also the encouragement to take advantage of them,” Bérard said.

“Given that an increasing number of women are diagnosed with  depression during pregnancy, (the new) results have direct implications on their clinical management,” the study concludes.

“This is even more important given that the effectiveness of antidepressants during pregnancy for the treatment of the majority of cases of depression (mild to moderate depression) have been shown to be marginal.

“Hence, the need for caution with antidepressant use during pregnancy is warranted and alternative non-drug options should be considered.”

Citation: Anick Bérard, Jin-Ping Zhao and Odile Sheehy. “Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort.” BMJ Open 2017;7:e013372.
DOI: 10.1136/bmjopen-2016-013372
Research funding:  Canadian Institutes of Health Reseach (CIHR), and Fonds de la recherche du Québec – Santé (FRQ-S).
Adapted from press release by Université de Montréal.

Proton pump inhibitors linked with increased risk of infectious gastroenteritis

Research has found a link between proton pump inhibitors and an increase in the risk of infectious gastroenteritis. The study led by The Australian National University (ANU) and based on data from the Sax Institute’s 45 and Up Study, found people who take proton pump inhibitors (PPIs), had a 70 per cent increase in the risk of being admitted to hospital with infectious gastroenteritis.

Lead author Dr Yingxi Chen from the ANU National Centre for Epidemiology and Population Health said the research examined data from the study to look at cases of infectious gastroenteritis in Australians older than 45.

We found that taking PPIs increased the risk of hospitalization with infectious gastroenteritis by up to 70 per cent because they significantly reduce the amount of acid made by stomach, which increases risk of infectious gastroenteritis” Dr Chen said.

The research builds on a report by the ANU National Centre for Epidemiology and Population Health which found 15.1 million gastroenteritis cases in Australia in 2010.

“There is no doubt that PPIs are an effective treatment for reflux and heartburn. However, clinicians and the patients using them should be fully aware of the side effects when considering PPI use and dosage,” Dr Chen said.

“The elderly and those with chronic bowel problems are most at risk. These patients should be having a conversation with their doctor to ensure that they are on right dose and that these drugs are the right fit for them.”

Dr Martin McNamara, Head of Research Assets at the Sax Institute said these findings demonstrated the value of the 45 and Up Study as a national research resource.

“The 45 and Up Study is the largest ongoing study of healthy ageing in the Southern Hemisphere, allowing hundreds of Australia’s world class researchers to investigate big and complex issues and deliver answers in ways that are easily accessible to policy makers,” he said.

Citation: Yingxi Chen, Bette Liu, Kathryn Glass, Wei Du, Emily Banks & Martyn Kirk. ” Use of Proton Pump Inhibitors and the Risk of Hospitalization for Infectious Gastroenteritis.” PLoS ONE 11(12): e0168618.
DOI: 10.1371/journal.pone.0168618
Adapted from press release by Sax Institute.

Decreased mortality associated with eating red hot chili peppers

Researchers at the Larner College of Medicine at the University of Vermont, who found that consumption of hot red chili peppers is associated with a 13 percent reduction in total mortality primarily in deaths due to heart disease or stroke in a large prospective study. The study was published recently in PLoS ONE.

Chili Peppers. Wikipedia

Going back for centuries, peppers and spices have been thought to be beneficial in the treatment of diseases, but only one other study — conducted in China and published in 2015 – has previously examined chili pepper consumption and its association with mortality. This new study corroborates the earlier study’s findings.

Using National Health and Nutritional Examination Survey (NHANES) III data collected from more than 16,000 Americans who were followed for up to 23 years, medical student Mustafa Chopan ’17 and Professor of Medicine Benjamin Littenberg, M.D., examined the baseline characteristics of the participants according to hot red chili pepper consumption. They found that consumers of hot red chili peppers tended to be “younger, male, white, Mexican-American, married, and to smoke cigarettes, drink alcohol, and consume more vegetables and meats had lower HDL-cholesterol, lower income, and less education,” in comparison to participants who did not consume red chili peppers. They examined data from a median follow-up of 18.9 years and observed the number of deaths and then analyzed specific causes of death.

“Although the mechanism by which peppers could delay mortality is far from certain, Transient Receptor Potential (TRP) channels, which are primary receptors for pungent agents such as capsaicin (the principal component in chili peppers), may in part be responsible for the observed relationship,” say the study authors.

There are some possible explanations for red chili peppers’ health benefits, state Chopan and Littenberg in the study. Among them are the fact that capsaicin – the principal component in chili peppers is believed to play a role in cellular and molecular mechanisms that prevent obesity and modulate coronary blood flow, and also possesses antimicrobial properties that “may indirectly affect the host by altering the gut microbiota.”

“Because our study adds to the generalizability of previous findings, chili pepper — or even spicy food – consumption may become a dietary recommendation and/or fuel further research in the form of clinical trials,” says Chopan.

Citation: Chopan, Mustafa, and Benjamin Littenberg. “The Association of Hot Red Chili Pepper Consumption and Mortality: A Large Population-Based Cohort Study.” PloS one 12, no. 1 (2017): e0169876.
DOI: 10.1371/journal.pone.0169876
Adapted from press release by the University of Vermont.