Inequalities in US Life Expectancy by Area Unemployment Level, 1990-2010

This study examined the association between unemployment and life expectancy in the United States during 1990-2010. 

Census-based unemployment rates were linked to US county-level mortality data. Life expectancies were calculated by age, sex, race, and unemployment level during 1990-2010. Differences in life expectancy were decomposed by age and cause of death. 

Life expectancy was consistently lower in areas with higher unemployment rates. In 2006-2010, those in areas with high unemployment rates (≥9%) had a life expectancy of 76.9 years, compared with 80.7 years for those in areas with low unemployment rates (<3%). The association between unemployment and life expectancy was stronger for men than for women. 

Life expectancy ranged from 69.9 years among black men in high unemployment areas to 90.0 years among Asian/Pacific Islander women in low unemployment areas. Disparities persisted over time. In 1990-1992, life expectancy was 4.7 years shorter in high unemployment than in low unemployment areas. In 2006-2010, the life expectancy difference between the lowest and highest unemployment areas decreased to 3.8 years. Heart disease, cancer, homicide, unintentional injuries, diabetes, HIV/AIDS, and liver cirrhosis contributed most to the lower life expectancy in high unemployment areas. High unemployment areas recorded larger gains in life expectancy than low unemployment areas, contributing to the narrowing gap during 1990-2010.

Below:  Life expectancy at birth by sex and area unemployment level, United States, 1990–2010

Below:  Survivorship by age, race, and unemployment level, United States, 1990–2010

Below:  Conditional probability of survival between ages of 25 and 64 years by unemployment level, United States, 1990–2010

Full article at:   http://goo.gl/FI27Gt

By:  Singh GK1, Siahpush M2.

• 1US Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, USA.
• 2Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE 68198-4365, USA.
• Scientifica (Cairo). 2016;2016:8290435. doi: 10.1155/2016/8290435. Epub 2016 Mar 17. 

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Poorly Controlled HIV Infection: An Independent Risk Factor for Liver Fibrosis

BACKGROUND:

Liver disease is a major cause of mortality among HIV-infected persons. There is limited information about the extent to which HIV disease severity impacts liver disease progression.

METHODS:

We determined the incidence and predictors of advanced hepatic fibrosis measured by the FIB-4 index (≥3.25) in a large diverse population of HIV-infected patients without significant liver disease at baseline (FIB-4<1.45) in care between January 2000 and March 2014. We used Cox proportional hazards analysis to examine factors associated with progression to FIB-4 ≥3.25.

RESULTS:

Among 14,198 HIV-infected patients, HCV coinfection (adjusted hazard ratio [aHR] 1.9, 95% CI 1.6-2.1), HBV coinfection (aHR 1.5, 95% CI 1.2-1.8), alcohol use disorder (aHR 1.4, 95% CI 1.2-1.6) and diabetes (aHR 1.9, 95% CI 1.6-2.3) were associated with progression to advanced fibrosis in multivariable analysis. In addition, patients at each lower level of time-varying CD4 count had a significantly greater risk of progression, with a nearly 7-fold higher risk in those with CD4 <100 cells/mm (aHR 6.9, 95% CI 5.8-8.3) compared with CD4 ≥500 cells/mm. An increasing gradient of risk was also observed among patients with higher time-varying HIV viral load (VL), with the greatest risk noted with VL ≥100,000 copies/ml (aHR 2.6, 95% CI 2.2-3.1) compared with VL <500 copies/ml.

CONCLUSION:

Lower CD4 count and higher HIV VL were significantly associated with progression to advanced hepatic fibrosis in a dose-dependent manner, independent of the risk associated with traditional factors: HCV or HBV coinfection, alcohol, and diabetes. Our findings suggest that early treatment of HIV infection could mitigate liver disease.

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By:  Kim HN1, Nance R, Van Rompaey S, Delaney JC, Crane HM, Cachay ER, Geng E, Boswell SL, Rodriguez B, Eron J, Saag M, Moore RD, Kitahata MM.

• 1Department of Medicine, University of Washington 
• 2 Department of Epidemiology, University of Washington 
• 3 Department of Medicine, University of California San Diego 
• 4 Department of Medicine, University of California San Francisco 
• 5 Fenway Health, Boston MA 
• 6 Department of Medicine, Case Western University 
• 7 Department of Medicine, University of North Carolina Chapel Hill 
• 8 Department of Medicine, University of Alabama, Birmingham 
• 9 Department of Medicine, Johns Hopkins University.
• J Acquir Immune Defic Syndr. 2016 Mar 16. 

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Prevalence Of & Factors Associated with Prediabetes & Diabetes among HIV-Infected Adults in Cameroon

BACKGROUND:

HIV and certain antiretrovirals (ARVs) are associated with diabetes. Few studies have examined the prevalence of and factors associated with diabetes amongst HIV-infected individuals on combination antiretroviral therapy (cART) in sub-Saharan Africa; some report prevalence estimates between 3.5-26.5% for diabetes in Cameroon and 20.2-43.5% for prediabetes in sub-Saharan Africa.

METHODS:

In a cross-sectional study, HIV-infected individuals (16-65 years old) were screened for diabetes using haemoglobin A_1C (HbA_1C ). We further categorized HbA_1C as normoglycemia (HbA_1C <5.7%), prediabetes (HbA_1C 5.7-6.4%), or diabetes (HbA_1C  ≥6.5%). Dysglycemia was defined as HbA_1C ≥5.7%. Logistic regression modeling was used to assess factors associated with having dysglycemia. .

RESULTS:

Of 500 participants, 363 (72.6%) were female. Median age was 42.5 years [Interquartile Range (IQR):36.5-49.5]. Nineteen (3.8%) were diabetic, and 170 (34%) were prediabetic. One hundred nine (22%) had a CD4+ count <200 cells/mm³ , and 464 (93%) had received >28 days of antiretroviral therapy (ART) at time of screening. Median abdominal circumference for women was 79.5 cm (IQR: 75.5-85.3) and for men, 86.5 cm (IQR: 81.7-90.5). Adjusting for age, sex, socio-economic status, CD4 cell count, being on cART >28 days, BMI, hypertension, history of hypertension, abdominal circumference, and duration of HIV infection, larger abdominal circumference was associated with higher prevalence of prediabetes or diabetes [adjusted Odds Ratio (aOR)=1.07, 95% Confidence Interval (CI):1.03-1.11], while being on cART (aOR=0.46, CI:0.22-0.99) was associated with lower prevalence.

CONCLUSIONS:

There was a high prevalence of Cameroonian HIV-infected adults with dysglycemia. Larger abdominal circumference was associated with higher prevalence, while cART was associated with lower prevalence.

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By:  Rhee JY1, Bahtila TD2, Palmer D2, Tih PM2, Aberg JA3, LeRoith D4, Jao J5.

• 1Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• 2Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
• 3Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• 4Department of Medicine, Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• 5Department of Medicine, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 
• Diabetes Metab Res Rev. 2016 Feb 17. doi: 10.1002/dmrr.2792

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Metabolics - CROI 2016 Treatment Update - Video

Breaking the Taboo: Illicit Drug Use among Adolescents with Type 1 Diabetes Mellitus

Background. 

The aim of the study was to explore the prevalence of illicit drug use in a group of Polish adolescents with type 1 diabetes (DM1) in comparison with a national cohort of their healthy peers. 

Methods. 

Two hundred and nine adolescents with DM1, aged 15-18 years, were studied in 2013 with an anonymous questionnaire prepared for the European School Survey Project on Alcohol and Other Drugs (ESPAD). The control group was a representative sample of 12114 students at the same age who took part in ESPAD in 2011. Metabolic control was regarded as good if self-reported HbA1c was <8% or poor if HbA1c was ≥8%. 

Results. 

Lifetime prevalence of illicit drug use was lower among adolescents with DM1 than in the control group [58 (28%) versus 5524 (46%), p = 10(-5)]. Cannabis preparations were the most frequently used substances [38 (18.3%) versus 3976 (33.1%), p = 10(-5)], followed by tranquilizers, sedatives, and amphetamine. Lifetime and last 12-month use of cannabis were associated with poorer glycemic control (HbA1c ≥ 8%), p < 0.01 and 0.02, respectively. 

Conclusions. 

Adolescents with DM1 report using illicit drugs to a lesser extent than their healthy peers. The use of cannabis is associated with a poorer metabolic control in teens with DM1.

Below:  The proportion of patients who tried or did not try marijuana, according to HbA1c levels, p = 0.03; response rate to that question was 189/209.

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By:  Hogendorf AM1, Fendler W1, Sieroslawski J2, Bobeff K3, Wegrewicz K3, Malewska KI3, Przudzik MW3, Szmigiero-Kawko M4, Sztangierska B4, Mysliwiec M4,Szadkowska A1, Mlynarski W1.

• 1Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland.
• 2Department of Studies on Alcoholism and Other Dependencies, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland.
• 3Students' Scientific Circle at the Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland.
• 4Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland.
• J Diabetes Res. 2016;2016:4153278. doi: 10.1155/2016/4153278. Epub 2015 Dec 29. 

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Contraceptive Use in Women with Hypertension & Diabetes: Cross-Sectional Study in Northwest Ethiopia

Purpose

Women with diabetes and hypertension are at increased risk of pregnancy complications, including those from surgical delivery and their offspring are at risk for congenital anomalies. Thus, diabetic and hypertensive women of reproductive age are advised to use valid contraceptive methods for reducing unwanted pregnancy and its complications. However, contraceptive use among these segments of the population had not been previously assessed in Ethiopia. Hence, the aim of this study was to assess contraceptive use and associated factors among diabetic and hypertensive women of reproductive age on chronic follow-up care at University of Gondar and Felege Hiwot Hospitals.

Methods

Hospital-based cross-sectional study was conducted from April to May 2012 among diabetic and hypertensive women on follow-up at the chronic illness care center. The sample size calculated was 403. Structured and pretested questionnaire was used for data collection. Data were collected using interview supplemented by chart review. The data were entered using EPI info Version 2000 and analyzed using SPSS Version 16. Frequencies, proportion, and summary statistics were used to describe the study population in relation to relevant variables. Both bivariate and multivariate analyses were run to see the association of each independent variable with contraceptive practice.

Results

A total of 392 married women on chronic follow-up care were interviewed making the response rate of 93.3%. The contraceptive prevalence rate was found to be 53.8%. Factors such as age 25–34 years (adjusted odds ratio, AOR [95% confidence interval, CI] =3.60 [1.05–12.36]), (AOR [95% CI] =2.29 [1.15–4.53]), having middle- and high-level incomes (AOR [95% CI] =2.12 [1.19–3.77]), (AOR [95% CI] =5.03 [2.19–11.54]), receiving provider counseling (AOR [95% CI] =9.02 [4.40–18.49]), and controlled disease condition (AOR [95% CI] =4.13 [2.35–7.28]) were significantly associated with contraceptive practice.

Conclusion

The contraceptive utilization of women on diabetes and hypertension follow-up care was found to be low. Hence, strengthening counseling and education about family planning and controlling their medical conditions would help increase the contraceptive uptake of women on chronic follow-up.

Full article at:   http://goo.gl/tg64gS

By:   Tensae Tadesse Mekonnen,1 Solomon Meseret Woldeyohannes,2 and Tegbar Yigzaw3

¹Department of Midwifery, Tseda Health Science College, University of Gondar, Gondar, Ethiopia

²Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia

³Jhpiego-Ethiopia, Addis Ababa, Ethiopia

Correspondence: Tensae Tadesse Mekonnen, Department of Midwifery, Tseda Health Science College, PO Box 102, Gondar, Ethiopia, Tel/fax +251 5 8111 6221, Email moc.liamg@edatzamla

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Liver Fibrosis in HIV Patients Receiving a Modern cART: Which Factors Play a Role?

Liver-related death in human immunodeficiency virus (HIV)-infected individuals is about 10 times higher compared with the general population, and the prevalence of significant liver fibrosis in those with HIV approaches 15%. 

The present study aimed to assess risk factors for development of hepatic fibrosis in HIV patients receiving a modern combination anti-retroviral therapy (cART).This cross-sectional prospective study included 432 HIV patients, of which 68 (16%) patients were anti-hepatitis C virus (HCV) positive and 23 (5%) were HBsAg positive.Health trajectory including clinical characteristics and liver fibrosis stage assessed by transient elastography were collected at inclusion. Liver stiffness values >7.1 kPa were considered as significant fibrosis, while values >12.5 kPa were defined as severe fibrosis. Logistic regression and Cox regression uni- and multivariate analyses were performed to identify independent factors associated with liver fibrosis.

Significant liver fibrosis was detected in 10% of HIV mono-infected, in 37% of HCV co-infected patients, and in 18% of hepatitis B virus co-infected patients. The presence of diabetes mellitus (odds ratio [OR] = 4.6) and FIB4 score (OR = 2.4) were independently associated with presence of significant fibrosis in the whole cohort. Similarly, diabetes mellitus (OR = 5.4), adiposity (OR = 4.6), and the FIB4 score (OR = 3.3) were independently associated with significant fibrosis in HIV mono-infected patients. Importantly, cumulative cART duration protected, whereas persistent HIV viral replication promoted the development of significant liver fibrosis along the duration of HIV infection.

Our findings strongly indicate that besides known risk factors like metabolic disorders, HIV may also have a direct effect on fibrogenesis. Successful cART leading to complete suppression of HIV replication might protect from development of liver fibrosis.

Below:  FIGURE 1. (A) Distribution of fibrosis among subgroups. (B–D) Association between LS and HIV duration, time naive, and DM. (E–H) Association between LS and BMI, DM, HIV duration, and time naive in HIV mono-infected patients compared with coinfected patients. Data are presented as mean ± SEM. BMI = body mass index, DM = diabetes mellitus, HIV = human immunodeficiency virus, LS = liver stiffness, SEM = standard error of the mean.

Full article at:   http://goo.gl/1el3nx

By:   Mohr R1, Schierwagen R, Schwarze-Zander C, Boesecke C, Wasmuth JC, Trebicka J, Rockstroh JK.

• 1From the Department of Medicine I, University Hospital Bonn, Bonn, Germany (RM, RS, CS-Z, CB, J-CW, JT, JKR); German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany (RM, CS-Z, CB, J-CW, JKR); and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark (JT). 

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The Impact of Medication-Focused Workshops in a Diabetes Educational Program in Jail: A Pilot Study

Background 

Correctional institutions have unique circumstances offering care and the opportunity to adopt healthy behaviours for populations suffering from chronic diseases such as diabetes. In view of their expertise on medication, pharmacists can contribute to multidisciplinary educational health programmes in prisons. 

Objective 

To assess the effectiveness of a pharmacist led diabetes medication-related workshops. Method Pharmacists led workshops about patients' empowerment in their treatment within the educational program. On a prospective observational study basis, the impact was assessed in terms of relevance, learning outcomes and achievement transfer using the Kirkpatrick training assessment method. Hb1Ac was measured as glycemic control outcome. 

Results 

Fifteen patients involved in the workshops showed a significant decrease in HbA1c compared to the control group (-1.18 ± 0.52 vs. +0.26 ± 0.28 %; p < 0.001).

Relevance:

All participants were satisfied and ready to join other sessions.

Learning Outcomes:

(LO) Postworkshop scores were significantly improved (LO1: 4.2 ± 0.9 vs. 2.2 ± 1.4; LO2: 4.5 ± 0.9 vs. 2.6 ± 1.3; p < 0.05). Decrease in HbA1c was correlated to increase in LO2's scores. (Y = 0.946 - 1.134X; R = -0.692; p < 0.05). Achievement transfer: Key points from all LOs were reported. In case studies, 70 % of participants adopted healthy strategies (LO3). Conclusion These results highlight the positive impact of the workshops and the additive value of pharmacists' involvement within the educational program in jail.

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By:   Davoust S1, Ghaleb V2, Guillon S2, Amirat-Combralier V1, Bartoli C2, Hache G3.

• 1Penitentiary Center of Marseille, Pharmacy, 239 Chemin de Morgiou, Marseille, France.
• 2Penitentiary Center of Marseille, Medical Unit, 239 Chemin de Morgiou, Marseille, France.
• 3Penitentiary Center of Marseille, Pharmacy, 239 Chemin de Morgiou, Marseille, France. guillaume.hache@univ-amu.fr. 

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