1
|
Tomic D, Morton JI, Chen L, Salim A, Gregg EW, Pavkov ME, Arffman M, Balicer R, Baviera M, Boersma-van Dam E, Brinks R, Carstensen B, Chan JCN, Cheng YJ, Fosse-Edorh S, Fuentes S, Gardiner H, Gulseth HL, Gurevicius R, Ha KH, Hoyer A, Jermendy G, Kautzky-Willer A, Keskimäki I, Kim DJ, Kiss Z, Klimek P, Leventer-Roberts M, Lin CY, Lopez-Doriga Ruiz P, Luk AOY, Ma S, Mata-Cases M, Mauricio D, McGurnaghan S, Imamura T, Paul SK, Peeters A, Pildava S, Porath A, Robitaille C, Roncaglioni MC, Sugiyama T, Wang KL, Wild SH, Yekutiel N, Shaw JE, Magliano DJ. Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study. Lancet Diabetes Endocrinol 2022; 10:795-803. [PMID: 36183736 PMCID: PMC10988609 DOI: 10.1016/s2213-8587(22)00252-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. METHODS For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20-100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005-19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. FINDINGS Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6-17·0) for Scottish women to 59·6% (58·5-60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017-18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2-59·3) for men and 64·1 years (64·0-64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013-14 in Lithuania (43·7 years [42·7-44·6]) for men and in 2010-11 in Latvia (54·2 years [53·4-54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010-11 to 2015-16 and in the USA from 2009-10 to 2014-15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015-16) to 12·9 years (Israel Clalit Health Services; 2015-16) for 20-year-old men and from 3·1 years (Finland; 2011-12) to 11·2 years (Israel Clalit Health Services; 2010-11 and 2015-16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009-10 and 2014-15 for 20-year-old men (a decrease of 2·7 years). INTERPRETATION Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. FUNDING US Centers for Disease Control and Prevention and Diabetes Australia.
Collapse
Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Jedidiah I Morton
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Lei Chen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Agus Salim
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, Australia
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Martti Arffman
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Elise Boersma-van Dam
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany; Institute for Medical Biometry and Epidemiology, University Witten/Herdecke, Witten, Germany
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Yiling J Cheng
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Sonsoles Fuentes
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Hélène Gardiner
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Hanne L Gulseth
- Department for Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School EWL, Bielefeld University, Bielefeld, Germany
| | - György Jermendy
- Third Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Alexandra Kautzky-Willer
- Department of Medicine III, Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; Gender Institute, Gars am Kamp, Austria
| | - Ilmo Keskimäki
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland; Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- Second Department of Medicine and Nephrological Center, University of Pécs, Pécs, Hungary
| | - Peter Klimek
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria; Complexity Science Hub Vienna, Vienna, Austria
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Stefan Ma
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Dídac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain; Department of Endocrinology, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Sanjoy K Paul
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
| | - Cynthia Robitaille
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan; Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan; Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
2
|
Magliano DJ, Chen L, Carstensen B, Gregg EW, Pavkov ME, Salim A, Andes LJ, Balicer R, Baviera M, Chan JCN, Cheng YJ, Gardiner H, Gulseth HL, Gurevicius R, Ha KH, Jermendy G, Kim DJ, Kiss Z, Leventer-Roberts M, Lin CY, Luk AOY, Ma S, Mata-Cases M, Mauricio D, Nichols GA, Pildava S, Porath A, Read SH, Robitaille C, Roncaglioni MC, Lopez-Doriga Ruiz P, Wang KL, Wild SH, Yekutiel N, Shaw JE. Trends in all-cause mortality among people with diagnosed diabetes in high-income settings: a multicountry analysis of aggregate data. Lancet Diabetes Endocrinol 2022; 10:112-119. [PMID: 35026157 DOI: 10.1016/s2213-8587(21)00327-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes. METHODS In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdictions (in six data sources in Asia, eight in Europe, one from Australia, and four from North America) for the period from Jan 1, 1995, to Dec 31, 2016, (or a subset of this period) on all-cause mortality in people with diagnosed total or type 2 diabetes. We collected data from administrative sources, health insurance records, registries, and a health survey. We estimated excess mortality using the standardised mortality ratio (SMR). FINDINGS In our dataset, there were approximately 21 million deaths during 0·5 billion person-years of follow-up among people with diagnosed diabetes. 17 of 19 data sources showed decreases in the age-standardised and sex-standardised mortality in people with diabetes, among which the annual percentage change in mortality ranged from -0·5% (95% CI -0·7 to -0·3) in Hungary to -4·2% (-4·3 to -4·1) in Hong Kong. The largest decreases in mortality were observed in east and southeast Asia, with a change of -4·2% (95% CI -4·3 to -4·1) in Hong Kong, -4·0% (-4·8 to -3·2) in South Korea, -3·5% (-4·0 to -3·0) in Taiwan, and -3·6% (-4·2 to -2·9) in Singapore. The annual estimated change in SMR between people with and without diabetes ranged from -3·0% (95% CI -3·0 to -2·9; US Medicare) to 1·6% (1·4 to 1·7; Lombardy, Italy). Among the 17 data sources with decreasing mortality among people with diabetes, we found a significant SMR increase in five data sources, no significant SMR change in four data sources, and a significant SMR decrease in eight data sources. INTERPRETATION All-cause mortality in diabetes has decreased in most of the high-income countries we assessed. In eight of 19 data sources analysed, mortality decreased more rapidly in people with diabetes than in those without diabetes. Further longevity gains will require continued improvement in prevention and management of diabetes. FUNDING US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
Collapse
Affiliation(s)
- Dianna J Magliano
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lei Chen
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Agus Salim
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Yiling J Cheng
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Helene Gardiner
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Hanne L Gulseth
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - György Jermendy
- 3rd Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Departments of Pediatrics and Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Stefan Ma
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Gregory A Nichols
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health, Ben Gurion University, Beer-Sheva, Israel
| | | | - Cynthia Robitaille
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, Latrobe University, Melbourne, VIC, Australia
| |
Collapse
|
3
|
Magliano DJ, Chen L, Islam RM, Carstensen B, Gregg EW, Pavkov ME, Andes LJ, Balicer R, Baviera M, Boersma-van Dam E, Booth GL, Chan JCN, Chua YX, Fosse-Edorh S, Fuentes S, Gulseth HL, Gurevicius R, Ha KH, Hird TR, Jermendy G, Khalangot MD, Kim DJ, Kiss Z, Kravchenko VI, Leventer-Roberts M, Lin CY, Luk AOY, Mata-Cases M, Mauricio D, Nichols GA, Nielen MM, Pang D, Paul SK, Pelletier C, Pildava S, Porath A, Read SH, Roncaglioni MC, Lopez-Doriga Ruiz P, Shestakova M, Vikulova O, Wang KL, Wild SH, Yekutiel N, Shaw JE. Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings. Lancet Diabetes Endocrinol 2021; 9:203-211. [PMID: 33636102 PMCID: PMC10984526 DOI: 10.1016/s2213-8587(20)30402-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time. METHODS In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time. FINDINGS Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions. INTERPRETATION The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources. FUNDING US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
Collapse
Affiliation(s)
- Dianna J Magliano
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lei Chen
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Rakibul M Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Elise Boersma-van Dam
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yi Xian Chua
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Sonsoles Fuentes
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Hanne L Gulseth
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Thomas R Hird
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - György Jermendy
- 3rd Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Mykola D Khalangot
- Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences, Kyiv, Ukraine; Endocrinology Department, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | - Victor I Kravchenko
- Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences, Kyiv, Ukraine
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Department of Pediatrics and Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; DAP-Cat Group, Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; DAP-Cat Group, Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Gregory A Nichols
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Mark M Nielen
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Deanette Pang
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine Pelletier
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health, Ben Gurion University, Beer-Sheva, Israel
| | | | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Olga Vikulova
- Diabetes Institute, Endocrinology Research Center, Moscow, Russia
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, Latrobe University, Bundoora, VIC, Australia
| |
Collapse
|
4
|
Hamel C, Corace K, Hersi M, Rice D, Willows M, Macpherson P, Sproule B, Flores-Aranda J, Garber G, Esmaeilisaraji L, Skidmore B, Porath A, Ortiz Nunez R, Hutton B. Psychosocial and pharmacologic interventions for methamphetamine addiction: protocol for a scoping review of the literature. Syst Rev 2020; 9:245. [PMID: 33099314 PMCID: PMC7585172 DOI: 10.1186/s13643-020-01499-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/04/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Methamphetamine use and harms are rising rapidly. Management of patients with methamphetamine use disorder (MUD) and problematic methamphetamine use (PMU) is challenging, with no clearly established best approach; both psychosocial and pharmacologic interventions have been described. Furthermore, given the diversity of individuals that use methamphetamines, there is a need to assess evidence for treatments for subgroups including youths; gay, bisexual, and other men who have sex with men; individuals with mental health comorbidities; and individuals in correction services. Establishing awareness of the messages regarding treatment from recent clinical practice guidelines (CPG) in the field is also of value. The first study objective will be to establish a greater understanding of the methods, populations, and findings of controlled studies for psychosocial and pharmacologic treatments for MUD and PMU. Investigation of this information can help establish the potential for advanced syntheses of the evidence (such as network meta-analysis) to compare therapies for this condition and to identify gaps related to key populations where more primary research is needed. Summarizing the recommendations regarding treatment of MUD/PMU from recent CPGs and systematic reviews will be an important secondary objective. METHODS A scoping review will be performed. Using the OVID platform, MEDLINE, Embase, PsycINFO, and relevant Cochrane databases from EBM Reviews will be searched (from databases' inception onwards). Eligibility criteria will include individuals described as having MUD or PMU, with designs of interest including randomized trials, non-randomized trials, and controlled cohort studies with three or more months of follow-up; systematic reviews and CPGs will also be sought. Two reviewers (with support from automation tools) will independently screen all citations, full-text articles, and chart data. Different approaches to handling and summarizing the data will be implemented for each type of study design. Tables and graphics will be used to map evidence sources and identify evidence gaps. DISCUSSION This research will enhance awareness of evidence addressing the effects of psychosocial and pharmacologic interventions for MUD/PMU overall and in sub-populations, both in terms of recent CPGs/reviews and primary studies; inspection of the latter will also help establish the feasibility of future syntheses to compare treatments, such as network meta-analysis. SYSTEMATIC REVIEW PROTOCOL REGISTRATION: Open Science Framework ( https://osf.io/9wy8p ).
Collapse
Affiliation(s)
- C Hamel
- Center for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201b, Ottawa, Ontario, K1H 8 L6, Canada
| | - K Corace
- Center for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201b, Ottawa, Ontario, K1H 8 L6, Canada.,Substance Use and Concurrent Disorders Program, The Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - M Hersi
- Center for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201b, Ottawa, Ontario, K1H 8 L6, Canada
| | - D Rice
- Center for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201b, Ottawa, Ontario, K1H 8 L6, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - M Willows
- Substance Use and Concurrent Disorders Program, The Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - P Macpherson
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - B Sproule
- Department of Pharmacy, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - G Garber
- Center for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201b, Ottawa, Ontario, K1H 8 L6, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - L Esmaeilisaraji
- Center for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201b, Ottawa, Ontario, K1H 8 L6, Canada
| | - B Skidmore
- Center for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201b, Ottawa, Ontario, K1H 8 L6, Canada
| | - A Porath
- Canadian Center on Substance Use and Addiction, Ottawa, ON, Canada
| | | | - B Hutton
- Center for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201b, Ottawa, Ontario, K1H 8 L6, Canada. .,Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada. .,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
5
|
Triki N, Ash N, Porath A, Birnbaum Y, Greenberg D, Hammerman A. Risk sharing or risk shifting? On the development of patient access schemes in the process of updating the national list of health services in Israel. Expert Rev Pharmacoecon Outcomes Res 2019; 19:749-753. [PMID: 31825682 DOI: 10.1080/14737167.2019.1702525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Agreements between payers and pharmaceutical/medical device companies are widely implemented to address financial and clinical uncertainties. We analyzed the main characteristics of these agreements in Israel from 2011-2018.Research design and methods: We reviewed all agreements implemented during the study period. Information regarding the type of agreement, therapeutic indications, its time frame and the total budget involved are presented.Results: A total of 56 agreements were signed since 2011, of which 53 (95%) were financial-based and 50 (89%) referred to pharmaceuticals. The annual number of agreements increased from one in 2011 to 21 in 2018. The main therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), and cardiovascular (7%). The proportion of the annual budget allocated subject to these agreements increased accordingly from 3% in 2011 to 73% in 2018. The majority (63%) of the agreements were signed for 5 years, 9% were shorter-term and 20% have no time-limit. In 14 (44%) of the financial-based agreements implemented through 2017, the actual utilization exceeded the pre-specified threshold and the companies reimbursed the health-plans accordingly.Conclusions: The number of agreements and the allocated budget subject to these agreements increased substantially in recent years. Most agreements are financial-based that, in many cases, shifted the short-term financial risk from health-plans to the industry.
Collapse
Affiliation(s)
- Noa Triki
- Department of Health Technology Policy, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Nachman Ash
- Medical Division, Maccabi Healthcare Services, Tel-Aviv, Israel.,The Department of Health Systems Management, Ariel University, Ariel, Israel
| | - Avi Porath
- Department of Public Health, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yair Birnbaum
- Clalit Health Services Headquarters, Tel-Aviv, Israel
| | - Dan Greenberg
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Ariel Hammerman
- Department of Pharmaceutical Technology Assessment, Clalit Health Services Headquarters, Tel-Aviv, Israel
| |
Collapse
|
6
|
Abstract
IMPORTANCE Previous studies have suggested that Holocaust survivors may experience different chronic comorbidities more often than the general population. However, the mortality hazard among these individuals has not been addressed. OBJECTIVE To assess the overall mortality rate and comorbidities of a cohort of Holocaust survivors compared with an age-matched control group. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included all Holocaust survivors insured by Maccabi Healthcare Services in Israel who were born between 1911 and 1945 in Europe and control individuals born in Israel during the same years and insured by the same service. Data were collected from January 1, 1998, through December 31, 2017. OUTCOMES AND MEASURES Rates of morbidities and mortality rates adjusted for sex, socioeconomic status, and body mass index using logistic regression, Cox regression, and Kaplan-Meier analysis. RESULTS The 38 597 Holocaust survivors included 22 627 women (58.6%) and had a mean (SD) age of 81.7 (5.4) years, and the 34 931 individuals in the control group included 18 615 women (53.3%) and had a mean (SD) age of 77.7 (5.3) years. The Holocaust survivors had higher rates than control individuals of reported hypertension (32 038 [83.0%] vs 23 285 [66.7]), obesity (12 838 [33.3%] vs 9254 [26.5]), chronic kidney disease (11 929 [30.9%] vs 6927 [19.8]), cancer (11 369 [29.5%] vs 9721 [27.8]), dementia (6389 [16.6%] vs 3355 [9.6]), ischemic heart disease, nonmyocardial infarction (5729 [14.8%] vs 4135 [11.8]), myocardial infarction (3641 [9.4%] vs 2723 [7.8]), and osteoporotic fractures among women (6429 [28.4%] vs 4120 [22.1]). In contrast, the overall mortality rate was lower among Holocaust survivors (25.3%) compared with the control group (41.1%). After adjustment for confounders, mean age at death was significantly higher in the survivor group compared with the control group. CONCLUSIONS AND RELEVANCE The findings showed higher rates of comorbidities and lower mortality among Holocaust survivors, which may be associated with a combination of improved health literacy and unique resilience characteristics among Holocaust survivors. More research is needed to explore the biologic and psychosocial basis for these results.
Collapse
Affiliation(s)
- Naama Fund
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Nachman Ash
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Faculty of Medicine, Ariel University, Ariel, Israel
| | - Avi Porath
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology, Ben Gurion University of the Negev, Beersheba, Israel
| | - Varda Shalev
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Pediatrics, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Koren
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Faculty of Medicine, Ariel University, Ariel, Israel
- Department of Epidemiology, Ben Gurion University of the Negev, Beersheba, Israel
- Department of Pediatrics, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, Western University, London, Ontario, Canada
| |
Collapse
|
7
|
Porath A, Arbelle JE, Fund N, Cohen A, Mosseri M. Statin Therapy: Diabetes Mellitus Risk and Cardiovascular Benefit in Primary Prevention. Isr Med Assoc J 2018; 20:480-485. [PMID: 30084572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The salutary effects of statin therapy in patients with cardiovascular disease (CVD) are well established. Although generally considered safe, statin therapy has been reported to contribute to induction of diabetes mellitus (DM). OBJECTIVES To assess the risk-benefit of statin therapy, prescribed for the prevention of CVD, in the development of DM. METHODS In a population-based real-life study, the incidence of DM and CVD were assessed retrospectively among 265,414 subjects aged 40-70 years, 17.9% of whom were treated with statins. Outcomes were evaluated according to retrospectively determined baseline 10 year cardiovascular (CV) mortality risks as defined by the European Systematic COronary Risk Evaluation, statin dose-intensity regimen, and level of drug adherence. RESULTS From 2010 to 2014, 5157 (1.9%) new cases of CVD and 11,637 (4.4%) of DM were observed. Low-intensity statin therapy with over 50% adherence was associated with increased DM incidence in patients at low or intermediate baseline CV risk, but not in patients at high CV risk. In patients at low CV risk, no CV protective benefit was obtained. The number needed to harm (NNH; incident DM) for low-intensity dose regimens with above 50% adherence was 40. In patients at intermediate and high CV risk, the number needed to treat was 125 and 29; NNH was 50 and 200, respectively. CONCLUSIONS Prescribing low-dose statins for primary prevention of CVD is beneficial in patients at high risk and may be detrimental in patients at low CV risk. In patients with intermediate CV risk, our data support current recommendations of individualizing treatment decisions.
Collapse
Affiliation(s)
- Avi Porath
- Department of Health Services Research, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Jonathan Eli Arbelle
- Department of Health Services Research, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Naama Fund
- Department of Health Services Research, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Asaf Cohen
- Department of Health Services Research, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Morris Mosseri
- Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Davidovitch M, Koren G, Fund N, Shrem M, Porath A. Challenges in defining the rates of ADHD diagnosis and treatment: trends over the last decade. BMC Pediatr 2017; 17:218. [PMID: 29284437 PMCID: PMC5747128 DOI: 10.1186/s12887-017-0971-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/13/2017] [Indexed: 01/25/2023] Open
Abstract
Background There is a global trend of large increases in the prevalence and incidence of Attention Deficit Hyperactivity Disorder (ADHD). This study aimed to address potential causes of these major changes. Methods The authors used a large cohort to analyze data employing patients’ electronic medical records, with physicians’ diagnosis of ADHD, including records of medication purchases. Results The prevalence of ADHD diagnoses rose twofold from 6.8% to 14.4% between 2005 and 2014 (p < 0.001), while the ratio of males to females with ADHD decreased from 2.94 in 2005 to 1.86 in 2014 (p < 0.001). The incidence increased, peaking in 2011 before declining in 2014. ADHD medication usage by children and adolescents was 3.57% in 2005 and 8.51% by 2014 (p < 0.001). Conclusions We report a dramatic increase in the rate of ADHD diagnoses. One of the leading factors to which we attribute this increase is the physicians’ and parents’ changed attitude towards diagnosing attention/hyperactivity problems, with more parents appear to consider ADHD diagnosis and treatment as a means to improve their child’s academic achievements, commonly with the aid of medications. This change in attitude may also be associated with the dramatic increase in female ADHD diagnosis prevalence.
Collapse
Affiliation(s)
- Michael Davidovitch
- Department of Child Development, Medical Division, Maccabi Healthcare Services, 27 Hamered St., 6812509, Tel Aviv, Israel.
| | - Gideon Koren
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel.,Western University, Ontario, Canada
| | - Naama Fund
- Department of Health Services Research, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Maayan Shrem
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Avi Porath
- Chief Physician Office, Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Epidemiology, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
9
|
Porath A, Irony A, Borobick AS, Nasser S, Malachi A, Fund N, Kaufman G. Maccabi proactive Telecare Center for chronic conditions - the care of frail elderly patients. Isr J Health Policy Res 2017; 6:68. [PMID: 29228992 PMCID: PMC5724333 DOI: 10.1186/s13584-017-0192-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/23/2017] [Indexed: 12/04/2022] Open
Abstract
Background In 2012, Maccabi Healthcare Services founded Maccabi Telecare Center (MTC), a multi-disciplinary healthcare service providing telemedical care to complex chronic patients. The current paper describes the establishment and operation of the MTC center, from the identification of the need for the service, through the design of its solution elements, to outcomes in several areas of care. We analyze the effects of the program on elderly frail patients, a growing population with complex and costly needs. Methods Observational quasi-experimental analyses using propensity score matching was used to assess the effect of MTC’s operation on utilization outcomes including direct costs. Results Results for frail elderly patients with complex chronic conditions show significant reductions in hospitalization days and hospitalization costs. MTC interventions also entailed lower overall average monthly costs in frail patients. Conclusion We conclude that a proactive telehealth service for complex chronic patients using education, empowerment to self-management, and coordination of care is a cost-effective means of improving quality care and health outcomes in frail elderly patients. Electronic supplementary material The online version of this article (10.1186/s13584-017-0192-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Avi Porath
- Maccabi Healthcare Services, 27 Hamered Street, 6812509, Tel Aviv, Israel. .,Public Health Department, Faculty of health, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Angela Irony
- Maccabi Healthcare Services, 27 Hamered Street, 6812509, Tel Aviv, Israel
| | | | - Shuruk Nasser
- Maccabi Healthcare Services, 27 Hamered Street, 6812509, Tel Aviv, Israel
| | - Ateret Malachi
- Maccabi Healthcare Services, 27 Hamered Street, 6812509, Tel Aviv, Israel
| | - Naama Fund
- Maccabi Healthcare Services, 27 Hamered Street, 6812509, Tel Aviv, Israel
| | - Galit Kaufman
- Maccabi Healthcare Services, 27 Hamered Street, 6812509, Tel Aviv, Israel
| |
Collapse
|
10
|
Wilf-Miron R, Kuint J, Peled R, Cohen A, Porath A. Utilization of ultrasonography to detect developmental dysplasia of the hip: when reality turns selective screening into universal use. BMC Pediatr 2017; 17:136. [PMID: 28583152 PMCID: PMC5460553 DOI: 10.1186/s12887-017-0882-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 05/08/2017] [Indexed: 12/19/2022] Open
Abstract
Background Developmental dysplasia of the hip (DDH) occurs in 3–5 of 1000 live births and is associated with known risk factors. In most countries, formal practice for early detection of DDH entails the combination of risk factor identification and physical examination of the hip, while the golden standard diagnostic instrument is hip ultrasonography (US). This practice is commonly referred to as selective screening. Infants with positive US findings are treated with a Pavlik harness, a dynamic abduction splint. The objective of our study was to evaluate hip US utilization patterns in Maccabi Healthcare Services (MHS), a large health plan. Methods Study population: All MHS members, born between June 2011 and October 2014, who underwent at least one US before the age of 15 months. Study variables: Practice specialty and number of enrolled infants. Positive US result was defined as referral to an abduction splint. Cost was based on Ministry of Health price list. Chi square and correlation coefficients were employed in the statistical analysis. Results Of the 115,918 infants born during the study period, 67,491 underwent at least one hip US. Of these, 60.6% were female, mean age at performance: 2.2 months. Of those who underwent US, 625 (0.93%) were treated with a Pavlik harness: 0.24% of the male infants and 1.60% of the female infants (p < 0.001). Analysis of physician practice characteristics revealed that referral to US was significantly higher among pediatricians as compared with general practitioners (60% and 35%, respectively). Practice volume had no influence on referral rate. Direct medical costs of the 107 hip US examinations performed that led to detection of one positive case (treated by Pavlik): US$10,000. Conclusions Current pattern of hip US utilization for early detection of DDH resembles universal screening more closely than selective screening. This can inform policy decisions as to whether a stricter selective screening or a formal move to universal screening is appropriate in Israel.
Collapse
Affiliation(s)
- Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel. .,The School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jacob Kuint
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Healthcare Services, Tel Aviv, Israel
| | - Ronit Peled
- Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Asaf Cohen
- Maccabi institute for Health Services Research, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Avi Porath
- Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Maccabi institute for Health Services Research, Maccabi Healthcare Services, Tel Aviv, Israel
| |
Collapse
|
11
|
Porath A, Fund N, Maor Y. Costs of Managing Patients with Diabetes in a Large Health Maintenance Organization in Israel: A Retrospective Cohort Study. Diabetes Ther 2017; 8:167-176. [PMID: 27853980 PMCID: PMC5306111 DOI: 10.1007/s13300-016-0212-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the direct costs of patients with diabetes ensured in a large health maintenance organization, Maccabi Health Services (MHS), in order to compare the medical costs of these patients to the medical costs of other patients insured by MHS and to assess the impact of poorly controlled diabetes on medical costs. METHODS A retrospective analysis of patients insured in MHS during 2012 was performed. Data were extracted automatically from the electronic database. A glycated hemoglobin (HbA1c) level of >9% (75 mmol/mol) was considered to define poorly controlled diabetes, and that of <7% (53 mmol/mol) and <8% (64 mmol/mol) to define controlled diabetes for patients aged <75 and ≥75 years, respectively. Multivariate analysis analyses were done to assess factors affecting cost. RESULTS Data on a total of 99,017 patients with diabetes were obtained from the MHS database for 2012. Of these, 54% were male and 72% were aged 45-75 years. The median annual cost of treating diabetes was 4420 cost units (CU), with hospitalization accounting for 56% of the total costs. The median annual cost per patient in the age groups 35-44 and 75-84 years was 2836 CU and 7033 CU, respectively. Differences between costs for patients with diabetes and those for patients without diabetes was 85% for the age group 45-54 years but only 24% for the age group 75-84 years. Medical costs increased similarly with age for patients with controlled diabetes and those with poorly controlled diabetes costs, as did additional co-morbidities. Costs were significantly impacted by kidney disease. The costs for patients with an HbA1c level of 8.0-8.99% (64-74 mmol/mol) and 9.0-9.99% (75-85 mmol/mol) were 5722 and 5700 CU, respectively. In a multivariate analysis the factors affecting all patients' costs were HbA1C level, male gender, chronic diseases, complications of diabetes, disease duration, and stage of kidney function. CONCLUSIONS The direct medical costs of patients with diabetes were significantly higher than those of patients without diabetes. The main drivers of these higher costs were hospitalizations and renal function. In poorly controlled patients the effect of HbA1c on costs was limited. These findings suggest that it is cost effective to identify patients with diabetes early in the course of the disease. FUNDING The work was sponsored by internal funds of the authors. Article processing charges for this study was funded by Novo Nordisk.
Collapse
Affiliation(s)
- Avi Porath
- Maccabi Healthcare Services, Tel Aviv, Israel
- Epidemiology Department, Faculty of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Naama Fund
- Department of Health Services Research and Health Economics at Chief Physician Office of Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yasmin Maor
- Infectious Disease Unit, Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel.
| |
Collapse
|
12
|
Peled R, Porath A, Wilf-Miron R. Improving the quality of primary care by allocating performance-based targets, in a diverse insured population. BMC Health Serv Res 2016; 16:668. [PMID: 27871283 PMCID: PMC5117594 DOI: 10.1186/s12913-016-1920-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/11/2016] [Indexed: 11/30/2022] Open
Abstract
Background Primary Care Health organizations, operating under universal coverage and a regulated package of benefits, compete mainly over quality of care. Monitoring, primary care clinical performance, has been repeatedly proven effective in improving the quality of care. In 2004, Maccabi Healthcare Services (MHS), the second largest Israeli HMO, launched its Performance Measurement System (PMS) based on clinical quality indicators. A unique module was built in the PMS to adjust for case mix while tailoring targets to the local units. This article presents the concept and formulas developed to adjust targets to the units’ current performance, and analyze change in clinical indicators over a six year period, between sub-population groups. Methods Six process and intermediate outcome indicators, representing screening for breast and colorectal cancer and care for patients with diabetes and cardiovascular disease, were selected and analyzed for change over time (2003–2009) in overall performance, as well as the difference between the lowest and the highest socio-economic ranks (SERs) and Arab and non-Arab members. Results MHS demonstrated a significant improvement in the selected indicators over the years. Performance of members from low SERs and Arabs improved to a greater extent, as compared to members from high ranks and non-Arabs, respectively. Conclusion The performance measurement system, with its module for tailoring of units' targets, served as a managerial vehicle for bridging existing gaps by allocating more resources to lower performing units. This concept was proven effective in improving performance while reducing disparities between diverse population groups.
Collapse
Affiliation(s)
- Ronit Peled
- Department Health Systems Management, Faculty Health Sciences, Ben Gurion University of the Negev, Beer Sheva, 65321, Israel. .,Peres Academy Center, Rehovot, Israel.
| | - Avi Porath
- Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.,The Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel
| | - Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel.,The School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
13
|
Kol S, Yellin LB, Segal Y, Porath A. In Vitro fertilization (IVF) treatments in Maccabi Healthcare Services 2007-2014. Isr J Health Policy Res 2016; 5:14. [PMID: 27064651 PMCID: PMC4826545 DOI: 10.1186/s13584-016-0072-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Israel reports the world's highest IVF cycles per capita. However, clinical outcome data of these treatments are scarce. In a previous publication, we summarized IVF results among Maccabi Healthcare Services members for the years 2007-2010. The main findings included an increase in mean patients' age over the period studied, a 50 % increase in cycle numbers during this time, and a decrease in success rate (live birth) from 18.8 % in 2007 to 14.8 % in 2010. The purpose of the current publication is to summarize IVF outcome for the years 2011-2014, and to explore possible changes in the trends we reported previously. METHODS IVF and live births data were collected from Maccabi Healthcare Services' fertility treatments registry. Analyses were conducted by treatment year and patients' age at the initiation of treatment cycles. Autologous cycles, were included (ovum donation cycles and frozen-thaw cycles were excluded). A successful cycle was defined if a live birth was recorded within 10 months of its initiation. RESULTS In accordance with previous data for the years 2007-2010, mean patients' age continued to rise (from 36.2 in 2011 to 37.1 in 2014). In contrast to previous years, during which a continued increase in treatment cycles was recorded, we found that treatment number decreased from a peak of 9,751 in 2011 to 8,623 in 2014. Contrary to that trend, the number of patients over 40 years of age increased from 3,204 in 2011 to 3,648 in 2014. Success rate fluctuated between 14.4 % in 2014 to 16.4 % in 2013. The majority (78 %) of treatment cycles were conducted in four private medical centers. CONCLUSIONS The decrease in treatment cycles in recent years notwithstanding, Israel is still leading the world with IVF treatments relative to population. Success rate is relatively low compared to international data. Given the steady increase in patients' mean age, and particularly, the increase in patients over 40 years of age, we maintain that the low success rate reflects a growing number of treatments that a priori have a low chance of success.
Collapse
Affiliation(s)
- Shahar Kol
- Maccabi Healthcare Services, Tel Aviv, Israel
| | - Lucia Bergovoy Yellin
- Department of Health Services Research at Chief Physician Office of Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Avi Porath
- Maccabi Healthcare Services, Tel Aviv, Israel
| |
Collapse
|
14
|
Shames J, Weitzman S, Nechemya Y, Porath A. Association of Atrial Fibrillation and Stroke: Analysis of Maccabi Health Services Cardiovascular Database. Isr Med Assoc J 2015; 17:486-491. [PMID: 26394490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Stroke is a leading cause of death and disability worldwide. The risk factors for stroke overlap those for cardiovascular disease. Atrial fibrillation (AF) is a particularly strong risk factor and is common, particularly in the elderly. Maccabi Healthcare Services (MHS) has maintained a vascular registry of clinical information for over 100,000 members, among them patients with heart disease and stroke. OBJECTIVES To determine the prevalence of stroke in MHS, and whether the association of AF and stroke, along with other risk factors, in the Maccabi population is similar to that in published studies. METHODS Data on stroke and AF patients aged 45 and older were collected from the database for the year 2010, including age, previous transient ischemic attack (TIA), body mass index (BMI), prior myocardial infarction (MI), diabetes, hypertension, anticoagulation and dyslipidemia. A cross-sectional analysis was used to estimate stroke prevalence by AF status. A case-control analysis was also performed comparing a sample of stroke and non-stroke patients. This permitted estimation of the strength of associations for atrial fibrillation and various other combinations of risk factors with stroke. RESULTS Stroke prevalence ranged from 3.5 (females, age 45-54 years) to 74.1 (males, age 85+) per thousand in non-AF members, and from 29 (males, age 45-54) to 165 (males, age 85+) per thousand for patients with AF. AF patients had significantly more strokes than non-AF patients in all age groups. Stroke prevalence increased with age and was significantly higher in males. Multivariable analysis revealed that male gender, increasing age, AF, hypertension, diabetes, and history of TIA were highly significant risk factors for stroke. In addition, for males, dyslipidemia and prior Ml were moderately strong risk factors. CONCLUSIONS Analysis of the MHS vascular database yielded useful information on stroke prevalence and association of known risk factors with stroke, which is consistent with the epidemiological literature elsewhere. Further analysis of health fund data could potentially provide useful information in the future.
Collapse
|
15
|
Wilf-Miron R, Bolotin A, Gordon N, Porath A, Peled R. The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a "business case" for quality of diabetes care--a time series study. BMC Endocr Disord 2014; 14:92. [PMID: 25434420 PMCID: PMC4265437 DOI: 10.1186/1472-6823-14-92] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/19/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In primary health care systems where member's turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered.The objectives of this study were: (1) to investigate the relationship between improvement in selected measures of diabetes (type 2) care and patients' health outcomes; and (2) to estimate the association between improvement in performance and direct medical costs. METHODS A time series study with three quality indicators - Hemoglobin A1c (HbA1c) testing, HbA1C and LDL- cholesterol (LDL-C) control - which were analyzed in patients with diabetes, insured by a large health fund. Health outcomes measures used: hospitalization days, Emergency Department (ED) visits and mortality. Poisson, GEE and Cox regression models were employed. Covariates: age, gender and socio-economic rank. RESULTS 96,553 adult (age >18) patients with diabetes were analyzed. The performance of the study indicators, significantly and steadily improved during the study period (2003-2009). Poor HbA1C (>9%) and inappropriate LDL-C control (>100 mg/dl) were significantly associated with number of hospitalization days. ED visits did not achieve statistical significance. Improvement in HbA1C control was associated with an annual average of 2% reduction in hospitalization days, leading to substantial reduction in tertiary costs. The Hazard ratio for mortality, associated with poor HbA1C and LDL-C, control was 1.78 and 1.17, respectively. CONCLUSION Our study demonstrates the effect of continuous improvement in quality care indicators, on health outcomes and resource utilization, among patients with diabetes. These findings support the business case for quality, especially in healthcare systems with relatively low enrollee turnover, where providers, in the long term, could "harvest" their investments in improving quality.
Collapse
Affiliation(s)
- Rachel Wilf-Miron
- />The Gertner Institute for Epidemiology and Health Policy Research, Ramat, Gan, Israel
- />The School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arkadi Bolotin
- />Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nesia Gordon
- />Central Administration, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Avi Porath
- />Maccabi Institute for Health Research, Tel Aviv, Israel
- />Epidemiology Department, Ben Gurion University of the Nege, Beer Sheva, Israel
| | - Ronit Peled
- />Department of Health Systems Management, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
16
|
Arbelle JE, Chodick G, Goldstein A, Porath A. Multiple chronic disorders - health care system's modern challenge in the Maccabi Health Care System. Isr J Health Policy Res 2014; 3:29. [PMID: 25206971 PMCID: PMC4158396 DOI: 10.1186/2045-4015-3-29] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 08/24/2014] [Indexed: 11/25/2022] Open
Abstract
Background One of the major challenges health care systems face in modern time is treating chronic disorders. In recent years, the increasing occurrence of multiple chronic disorders (MCC) in single individuals has compounded the complexity of health care. In 2008, it was estimated that worldwide as many as one quarter of the population between the ages of sixty five to sixty nine suffered from two or more chronic conditions and this prevalence rose with age. Clinical guidelines provide guidance for management of single disorders, but not for MCC. The aim of the present study was the study of the prevalence, distribution and impact of MCC in a large Israeli health system. Methods We performed a cross-sectional study of MCC in the Maccabi Healthcare System (MHS), Israel’s second largest healthcare service, providing care for approximately two million people. Data regarding chronic conditions was collected through electronic medical records and organizational records, as was demographic and socioeconomic data. Age and sex specific data were compared with previously published data from Scotland. Results Two thirds of the population had two or more chronic disorders. This is significantly higher than previously published rates. A correlation between patient age and number of chronic disorders was found, as was a correlation between number of chronic disorders and low socioeconomic status, with the exception of children due to a high prevalence of learning disabilities, asthma, and visual disturbances. Discussion MCC is very prevalent in the MHS population, increases with age, and except for children is more prevalent in lower socioeconomic classes, possibly due to the a combination of the structure of the Israeli universal insurance and requirements of the ministry of education for exemptions and benefits. A higher than previously reported prevalence of MCC may be due to the longtime use of use of integrated electronic medical records. Conclusions To effectively deal with MCC health care systems must devise strategies, including but not limited to, information technologies that enable shared teamwork based on clinical guidelines which address the problem of multiple, as opposed to single chronic disorders in patients.
Collapse
Affiliation(s)
- Jonathan E Arbelle
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel ; Faculty of Medicine, Ben-Gurion University, Beer Sheva, Israel
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel ; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Alex Goldstein
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Avi Porath
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel ; Faculty of Medicine, Ben-Gurion University, Beer Sheva, Israel
| |
Collapse
|
17
|
Siegelmann-Danieli N, Silverman B, Zick A, Beit-Or A, Katzir I, Porath A. The impact of the Oncotype DX Recurrence Score on treatment decisions and clinical outcomes in patients with early breast cancer: the Maccabi Healthcare Services experience with a unified testing policy. Ecancermedicalscience 2013; 7:380. [PMID: 24386009 PMCID: PMC3869476 DOI: 10.3332/ecancer.2013.380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Indexed: 12/05/2022] Open
Abstract
The Oncotype DX Recurrence Score is a validated prognosticator in oestrogen receptor positive (ER+) breast cancer. Our retrospective analysis of a prospectively defined cohort summarises the clinical implications associated with Oncotype DX testing according to the Maccabi Healthcare Services (MHS) policy. The MHS eligibility criteria for testing included ER+ N0/pN1mic invasive tumours, discussion of test implications with an oncologist, ductal carcinoma 0.6–1 cm Grade 2–3, HER2 negative ductal carcinomas with 1.1–4.0 cm Grade 1–2, or lobular carcinoma. Large (> 1 cm) Grade 3 tumours could have grade reassessed. We linked Recurrence Score results with patients’ information and used chi-squared tests to assess the associations thereof. Between January 2008 and December 2011, tests were performed on 751 patients (MHS-eligible, 713); 54%, 38%, and 8% of patients had low, intermediate, and high Recurrence Score results, respectively. Recurrence Score distribution varied significantly with age (P = 0.002), with increasing Recurrence Score values with decreasing age. The proportion of patients with high Recurrence Score results varied by grade/size combination and histology, occurring in 32% of small (≤ 1 cm) Grade 3 and 3% of larger (1.1–4 cm) Grade 1 ductal tumours and only in 2% of lobular carcinomas. Chemotherapy was administered to 1%, 13%, and 61% of patients with low, intermediate, and high Recurrence Score results, respectively (P < 0.0001), but only to 2% of intermediate score patients ≥ 65 years. Luteinising-hormone-releasing hormone agonists with tamoxifen were used in 27% of low Recurrence Score patients ≤ 50 years. With a median follow-up of 26 months, no systemic recurrences were documented, whereas four patients exhibited locoregional recurrences. In summary, in this low-to-moderate risk patient population, testing identified 46% of patients as intermediate/high risk. Treatment decisions were influenced by Recurrence Score results and patients’ age. The current MHS policy seems to achieve the goal of promoting chemotherapy use according to the test results in a prespecified patient population.
Collapse
Affiliation(s)
| | - Barbara Silverman
- Maccabi Healthcare Services, 27 Hamered Street, Tel Aviv 68125, Israel
| | - Aviad Zick
- Hadassah Medical Center, Ein Kerem, Jerusalem 91120, Israel
| | - Anat Beit-Or
- Maccabi Healthcare Services, 27 Hamered Street, Tel Aviv 68125, Israel
| | - Itzhak Katzir
- Maccabi Healthcare Services, 27 Hamered Street, Tel Aviv 68125, Israel
| | - Avi Porath
- Maccabi Healthcare Services, 27 Hamered Street, Tel Aviv 68125, Israel
| |
Collapse
|
18
|
Ducrocq G, Bhatt DL, Labreuche J, Corbalan R, Porath A, Gao R, Panchenko E, Liau CS, Ikeda Y, Goto S, Amarenco P, Steg PG. Geographic differences in outcomes in outpatients with established atherothrombotic disease: results from the REACH Registry. Eur J Prev Cardiol 2013; 21:1509-16. [DOI: 10.1177/2047487313501278] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- G Ducrocq
- Université Paris-Diderot, Sorbonne Paris Cité, France; AP-HP, Hopital Bichat - Paris, France; INSERM U-698, France
| | - DL Bhatt
- VA Boston Healthcare System, Brigham and Women’s Hospital, Harvard Medical School, USA
| | - J Labreuche
- Université Paris-Diderot, Sorbonne Paris Cité, France; AP-HP, Hopital Bichat - Paris, France; INSERM U-698, France
| | - R Corbalan
- Pontificia Universidad Católica de Chile, Chile
| | - A Porath
- Department of Epidemiology, Ben-Gurion University of the Negev, Israel
| | - R Gao
- Cardiovascular Institute & Fuwai Hospital, People's Republic of China
| | - E Panchenko
- Cardiology Research Center, Russian Federation, Russia
| | - CS Liau
- National Taiwan University Hospital, Taiwan
| | - Y Ikeda
- Kokura Memorial Hospital, Japan
| | | | - P Amarenco
- Université Paris-Diderot, Sorbonne Paris Cité, France; AP-HP, Hopital Bichat - Paris, France; INSERM U-698, France
| | - PG Steg
- Université Paris-Diderot, Sorbonne Paris Cité, France; AP-HP, Hopital Bichat - Paris, France; INSERM U-698, France
| |
Collapse
|
19
|
Udell JA, Steg PG, Scirica BM, Eagle KA, Ohman EM, Goto S, Alsheikh-Ali AA, Porath A, Corbalan R, Umez-Eronini AA, Hoffman EB, Wilson PWF, Bhatt DL. Metabolic syndrome, diabetes mellitus, or both and cardiovascular risk in outpatients with or at risk for atherothrombosis. Eur J Prev Cardiol 2013; 21:1531-40. [PMID: 23918840 DOI: 10.1177/2047487313500541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of metabolic syndrome (MetS), diabetes mellitus (DM), and their coexistence is increasing but whether MetS increases cardiovascular risk beyond component risk factors is controversial. DESIGN We compared the risk of cardiovascular death, myocardial infarction, or stroke among patients with MetS, newly detected DM, established DM, or coexistent MetS and DM in the global REduction of Atherothrombosis for Continued Health (REACH) registry. METHODS Outpatients with or at risk for atherothrombosis were recruited between 1 December 2003 and 31 December 2004 and followed up to 4 years for cardiovascular events. Risk was compared in patients with or without MetS or DM after adjustment for age, sex, risk factors, vascular disease, fasting blood glucose, therapy, and region. RESULTS Among 44,548 REACH participants, 17,887 (40%) were without MetS or DM; 6459 had MetS (15%); 12,059 had established DM (27%); 7503 had both (17%); and 640 had newly detected DM (1%). Presence of MetS was not associated with higher cardiovascular events (12.6%, adjusted HR 0.98, 95% CI 0.89-1.08). In addition, once DM was evident, patients with coexistent MetS had similar increased risk (16.1%, adjusted HR 1.33, 95% CI 1.21-1.47) as DM alone (16.7%, adjusted HR 1.36, 95% CI 1.24-1.48). Newly detected DM was associated with increased cardiovascular risk (18.5%, adjusted HR 1.26, 95% CI 1.02-1.57), similar to longstanding DM. MetS was associated with incident DM (adjusted OR 1.94). CONCLUSIONS In the REACH registry, presence of newly detected DM but not metabolic syndrome was associated with an increased risk of cardiovascular events.
Collapse
Affiliation(s)
- Jacob A Udell
- Women's College Hospital, University of Toronto, Toronto, Canada
| | - Ph Gabriel Steg
- Université Paris-Diderot, DHU Fire, AP-HP and INSERM U-698, Paris, France
| | | | - Kim A Eagle
- University of Michigan Cardiovascular Center, Ann Arbor, MI, USA
| | | | - Shinya Goto
- Tokai University School of Medicine, Isehara, Japan
| | - Alawi A Alsheikh-Ali
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates Tufts University School of Medicine, Boston, MA, USA
| | - Avi Porath
- Ben-Gurion University of the Negev, Israel
| | - Ramon Corbalan
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Elaine B Hoffman
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter W F Wilson
- Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
20
|
Shalev V, Goldshtein I, Porath A, Weitzman D, Shemer J, Chodick G. Continuation of statin therapy and primary prevention of nonfatal cardiovascular events. Am J Cardiol 2012; 110:1779-86. [PMID: 23021514 DOI: 10.1016/j.amjcard.2012.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/08/2012] [Accepted: 08/08/2012] [Indexed: 11/25/2022]
Abstract
Although the beneficial effect of statins in secondary prevention of cardiac events is well established, their effectiveness in primary prevention is questionable when most evidence derives from randomized controlled trials and not "real-life" data. To evaluate the association between persistent use of statins and risk of acute nonfatal cardiovascular events in primary prevention patients in community settings, we retrospectively analyzed a cohort of 171,535 adults 45 to 75 years old with no indication of cardiovascular disease who began statin therapy from 1998 to 2009 in a large health maintenance organization in Israel. Persistence with statins was measured by the proportion of days covered with dispensed prescriptions of statins during the follow-up period. Main outcome measurements were occurrence of myocardial infarction or performance of a cardiac revascularization procedure. Incidence of acute cardiovascular events during the follow-up period (993,519 person-years) was 10.22 per 1,000 person-years. Persistence with statins was associated with a lower risk of incident cardiac events (p for trend <0.01). The most persistent users (covered with statins for ≥80% of their follow-up time) had a hazard ratio of 0.58 (95% confidence interval 0.55 to 0.62) compared to nonpersistent users (proportion of days covered <20%). Similar results were found when analyses were limited to patients with >5 years of follow-up. Treatment with high efficacy statins was associated with a lower risk of cardiac events. In conclusion, our large and unselected community-based study supports the results of randomized controlled trials regarding the beneficial effect of statins in the primary prevention of acute cardiac events.
Collapse
|
21
|
Abstract
Introduction Studies have suggested that statins may inhibit tumor cell growth and possibly prevent carcinogenesis. The objective of this study was to investigate the association between persistent statin use and the risk of primary cancer in adults. Methods This retrospective study was conducted by using the computerized data sets of a large health maintenance organization (HMO) in Israel. The study population was 202,648 enrollees aged 21 or older who purchased at least 1 pack of statin medication from 1998 to 2006. The follow-up period was from the date of first statin dispensation (index date) to the date of first cancer diagnosis, death, leaving the HMO, or September 1, 2007, whichever occurred first. Persistence was measured by calculating the mean proportion of follow-up days covered (PDC) with statins by dividing the quantity of statin dispensed by the total follow-up time. Results During the study period, 8,662 incident cancers were reported. In a multivariable model, the highest cancer risk was calculated among nonpersistent statin users. A strong negative association between persistence with statin therapy and cancer risk was calculated for hematopoietic malignancies, where patients covered with statins in 86% or more of the follow-up time had a 31% (95% confidence interval, 0.55-0.88) lower risk than patients in the lowest persistence level (≤12%) . Conclusion Our study demonstrated that persistent use of statins is associated with a lower overall cancer risk and particularly the risk of incident hematopoietic malignancies. In light of widespread statin consumption and increases in cancer incidence, the association between statins and cancer incidence may be relevant for cancer prevention.
Collapse
Affiliation(s)
- Miriam Lutski
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | | |
Collapse
|
22
|
Nevzorov R, Porath A, Henkin Y, Kobal SL, Jotkowitz A, Novack V. Effect of beta blocker therapy on survival of patients with heart failure and preserved systolic function following hospitalization with acute decompensated heart failure. Eur J Intern Med 2012; 23:374-8. [PMID: 22560389 DOI: 10.1016/j.ejim.2012.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 01/15/2012] [Accepted: 01/30/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND The importance of heart failure with preserved ejection fraction is being increasingly recognized. However, there is a paucity of data about effective treatment for this condition. The present study investigated the impact of beta blocker therapy for 3 months before admission on the two-year survival of patients with heart failure and preserved systolic function hospitalized due to decompensated heart failure. METHODS We performed a retrospective cohort analysis of 345 consecutive patients with heart failure with preserved systolic function older than 18 years hospitalized due to decompensated heart failure. Two groups of patients were compared: those who received beta blockers within 3 months before admission (BB) and those who did not (NBB). The primary outcome was two year all cause mortality (maximal follow-up available in all subjects). To adjust for a potential misbalance between BB and NBB groups in baseline characteristics, a propensity score for beta blocker therapy was incorporated into the survival model. RESULTS 154 patients (44.6%) received beta blockers prior to admission. Overall two year mortality rate in the BB group was 50% vs. 62.8% in the NBB group, log-rank test p = 0.016. Beta blockers showed protective effect on two-year survival after adjustment for comorbidities and propensity score (hazard ratio [HR], 0.69; 95% CI 0.47-0.99). CONCLUSIONS Therapy with beta blockers may have protective effect on survival of patients with heart failure with preserved systolic function.
Collapse
Affiliation(s)
- Roman Nevzorov
- Department of Cardiology, Tel Aviv University's Sackler Medical School, Rabin Medical Center, Petah Tikva, Israel.
| | | | | | | | | | | |
Collapse
|
23
|
Venkitachalam L, Wang K, Porath A, Corbalan R, Hirsch AT, Cohen DJ, Smith SC, Ohman EM, Steg PG, Bhatt DL, Magnuson EA. Global variation in the prevalence of elevated cholesterol in outpatients with established vascular disease or 3 cardiovascular risk factors according to national indices of economic development and health system performance. Circulation 2012; 125:1858-69. [PMID: 22492667 DOI: 10.1161/circulationaha.111.064378] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated serum cholesterol accounts for a considerable proportion of cardiovascular disease worldwide. An understanding of the relationship between country-level economic and health system factors and elevated cholesterol may provide insight for prioritization of cardiovascular prevention programs. METHODS AND RESULTS Using hierarchical models, we examined the relationship between elevated total cholesterol (>200 mg/dL) in 53 570 outpatients from 36 countries, and tertiles of several country-level indices: (1) gross national income, (2) total expenditure on health as percentage of gross domestic product, (3) government expenditure on health as percentage of total expenditure on health, (4) out-of-pocket expenditures as percentage of private expenditure on health, and the World Health Organization indices of (5) Health System Achievement and (6) Performance/Efficiency. Overall, 38% of outpatients had total cholesterol >200 mg/dL (>5.18 mmol/L), and 9.3% of the total variability in elevated cholesterol was at the country level; this proportion was higher for patients with (12.1%) versus without (7.4%) history of hyperlipidemia. Among patients with history of hyperlipidemia, countries in the highest tertile of gross national income or World Health Organization Health System Achievement had lower odds of elevated cholesterol than lower tertiles (P<0.001, for both). Countries in the highest tertile of out-of-pocket health expenditures had higher odds of elevated cholesterol than those in the lowest tertile (P<0.001). No significant associations were found for patients without history of hyperlipidemia. CONCLUSIONS Global variations in the prevalence of elevated cholesterol among patients with history of hyperlipidemia are associated with country-level economic development and health system indices. These results support the need for strengthening efforts toward effective cardiovascular disease prevention and control and may provide insight for health policy setting at the national level.
Collapse
|
24
|
Hemo B, Endevelt R, Porath A, Stampfer MJ, Shai I. Adherence to weight loss medications; post-marketing study from HMO pharmacy data of one million individuals. Diabetes Res Clin Pract 2011; 94:269-75. [PMID: 21907442 DOI: 10.1016/j.diabres.2011.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 08/14/2011] [Accepted: 08/18/2011] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Post-marketing data on weight-loss medications in free living population are a necessary adjunct to data from clinical trials. MATERIALS AND METHODS We conducted a population-based analysis of first-time medication users based on HMO pharmacy purchasing data serving > one million adults. RESULTS During 5 years, usage of orlistat and sibutramine more than doubled and rates were higher during the months May-Aug. As compared to non-users (n = 1,038,828), annual weight-loss drug users (n = 7175) had higher women proportion, body-mass-index (BMI), bariatric surgery history, and usage of diabetes, depression, and cardiovascular medications (p < 0.001 for all). Among users, men had higher BMI (34.4 kg/m(2) vs. 32.5 kg/m(2)), prevalence of diabetes (25.4% vs. 10.7%) and heart disease (14.2% vs. 3.5%) than women. Mean duration of purchasing weight-loss medications was 2.1 months for orlistat and 2.9 months for sibutramine. Fewer than 2% completed 12 months of weight-loss medication therapy. Among the 25% who continued to purchase at least 4 months, BMI (sub-group analysis) reduced from 33.02 kg/m(2) to 32.04 kg/m(2) (p < 0.001). In a multivariate model, long-term adherence (≥ 4 months) to weight-loss medications was associated with use of sibutramine vs. orlistat (OR = 2.08; 95%CI: 1.76-2.45), and prevalence of diabetes (OR = 1.20; 95%CI: 1.01-1.25). Age, gender, and baseline BMI were not associated with long-term adherence. CONCLUSIONS Usage of weight-loss drugs is higher among diabetes patients. However, the poor adherence to therapy is substantially below levels reported in clinical trials.
Collapse
Affiliation(s)
- Beatriz Hemo
- Research and Evaluation Unit, Maccabi Healthcare Services, Tel-Aviv, Israel
| | | | | | | | | |
Collapse
|
25
|
Rosen B, Pawlson LG, Nissenholtz R, Benbassat J, Porath A, Chassin MR, Landon BE. What the United States could learn from Israel about improving the quality of health care. Health Aff (Millwood) 2011; 30:764-72. [PMID: 21471499 DOI: 10.1377/hlthaff.2011.0061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 1999 Israel began to implement a system for monitoring quality of care in its health plans. That system was based largely on a similar system in the United States that, until recently, was associated with steady improvements in performance. However, in recent years health plan quality in the United States appears to have reached a plateau. In contrast, health plans in Israel have continued to show improvements on many of the same measures. Between 2005 and 2007 they achieved a gain of 6.7 percent in nine measures of primary care quality, while US performance on these measures declined. These gains were achieved, in part, through intense cooperation among health plans and physicians. Israel is a much smaller country and differs greatly from the United States in how it finances health care. Nonetheless, we suggest that the Israeli experience could help the United States accelerate the move toward quality improvement-for example, through increased coordination among US employers, health plans, physicians, and physician groups.
Collapse
Affiliation(s)
- Bruce Rosen
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel.
| | | | | | | | | | | | | |
Collapse
|
26
|
Heymann AD, Gross R, Tabenkin H, Porter B, Porath A. Factors associated with hypertensive patients' compliance with recommended lifestyle behaviors. Isr Med Assoc J 2011; 13:553-557. [PMID: 21991716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND A crucial element in controlling blood pressure is non-pharmaceutical treatment. However, only a few studies specifically address the question of hypertensive patients' compliance with physicians' recommendations for a healthy lifestyle. OBJECTIVES To explore factors associated with hypertensive patients' compliance with lifestyle recommendations regarding physical activity, smoking cessation and proper diet. METHODS We performed a secondary data analysis of a representative sample of 1125 hypertensive patients in Israel's two largest health funds. Data were collected in 2002-2003 by telephone interviews using structured questionnaires. The response rate was 77%. Bivariate and multivariate analysis was conducted. RESULTS About half of the hypertensive patients reported doing regular exercise and adhering to a special diet; 13% were smokers. About half reported receiving counseling on smoking cessation and diet and a third on physical exercise. A quarter reported receiving explanations regarding self-measurement of blood pressure and signs of deterioration. Multivariate analysis revealed that patients' beliefs about hypertension management, their knowledge on hypertension and its management, and physician counseling on a healthy lifestyle and self-care, have an independent effect on compliance with recommended lifestyle behaviors. CONCLUSIONS The low counseling rates suggest that there may be a need to improve physicians' counseling skills so that they will be more confident and effective in delivering this service to their patients. A model based on educating both physicians and patients may contribute to improving the care of hypertensive patients.
Collapse
Affiliation(s)
- Anthony D Heymann
- Department of Community Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.
| | | | | | | | | |
Collapse
|
27
|
Wilf-Miron R, Peled R, Yaari E, Vainer A, Porath A, Kokia E. The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: analysis of large sub populations. BMC Cancer 2011; 11:376. [PMID: 21867544 PMCID: PMC3176246 DOI: 10.1186/1471-2407-11-376] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 08/25/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Populations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer. THE OBJECTIVE To explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer. METHODS The study was conducted by Maccabi Healthcare Services, an Israeli HMO (health plan) providing healthcare services to 1.9 million members. Utilization of breast cancer (BC) and colorectal cancer (CC) screening were analyzed by socio-economic ranks (SERs), ethnicity (Arab vs non-Arab), immigration status and ownership of voluntarily supplemental health insurance (VSHI). RESULTS Data on 157,928 and 303,330 adults, eligible for BC and CC screening, respectively, were analyzed. Those having lower SER, Arabs, immigrants from Former Soviet Union countries and non-owners of VSHI performed fewer cancer screening examinations compared with those having higher SER, non-Arabs, veterans and owners of VSHI (p < 0.001). Logistic regression model for BC Screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab and having a lower SER. The model for CC screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. The model estimated for BC and CC screening among females revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. CONCLUSION Patients from low socio-economic backgrounds, Arabs, immigrants and those who do not own supplemental insurance do fewer tests for early detection of cancer. These sub-populations should be considered priority populations for targeted intervention programs and improved resource allocation.
Collapse
Affiliation(s)
- Rachel Wilf-Miron
- Quality Management in Health Care, Maccabi Healthcare Services, Tel-Aviv, Israel
- Faculty of Management, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Peled
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Einat Yaari
- Quality Management in Health Care, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Anna Vainer
- Quality Management in Health Care, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Avi Porath
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- Central Management, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Ehud Kokia
- Faculty of Management, Tel-Aviv University, Tel-Aviv, Israel
- Central Management, Maccabi Healthcare Services, Tel-Aviv, Israel
| |
Collapse
|
28
|
Sella T, Chodick G, Barchana M, Heymann AD, Porath A, Kokia E, Shalev V. Gestational diabetes and risk of incident primary cancer: a large historical cohort study in Israel. Cancer Causes Control 2011; 22:1513-20. [PMID: 21847538 DOI: 10.1007/s10552-011-9825-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/29/2011] [Indexed: 01/20/2023]
Abstract
PURPOSE Gestational diabetes mellitus (GDM), a state of glucose intolerance associated with pregnancy, is increasing in prevalence. Data regarding the cancer risk associated with GDM are sparse and limited to cancers of the breast and pancreas. This study was conducted to examine the risk of incident overall and site-specific malignancies associated with prior GDM in a historical cohort of women in a large health maintenance organization in Israel. METHODS All pregnant women aged 15-50 years who underwent 50-g glucose challenge tests between 13 March 1995 and 27 May 2009, without history of malignancy, diabetes, and infertility, were included. Clinical and demographic parameters at index date including age, socioeconomic level, BMI, and parity were collected. Diagnosis of gestational diabetes was based on the 100-g oral glucose tolerance test using Carpenter and Coustan criteria. Cancer diagnoses were obtained from the Israel Cancer Register through linkage data. RESULTS Among the 185,315 women who had undergone glucose challenge during the study period, 11,264 (6.1%) were diagnosed with GDM. During a total follow-up period of 1.05 million person-years (mean = 5.19 ± 3.9, median = 4.3), 2,034 incident cases of cancer were identified. GDM was associated with a hazard ratio (HR) of 7.06 (95% CI: 1.69-29.45) for pancreatic cancer (nine cases) and a HR of 1.70 (95% CI: 0.97-2.99) for hematological malignancies (177 cases). The association between GDM and hematological malignancies was limited to women with 5 or more years of follow-up (HR = 4.53; 95% CI: 1.81-11.31). CONCLUSION GDM is associated with an increased risk of pancreatic cancer and hematologic malignancies.
Collapse
Affiliation(s)
- Tal Sella
- Medical Division, Maccabi Healthcare Services, 27 Ha'Mered Street, Tel Aviv, Israel.
| | | | | | | | | | | | | |
Collapse
|
29
|
Sella T, Chodick G, Barchana M, Heymann AD, Porath A, Kokia E, Shalev V. Gestational diabetes and risk of incident primary cancer: A large population-based cohort study in Israel. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
30
|
Alsheikh-Ali AA, Al-Mahmeed WA, Porath A, Khalil I, Mahmoud H, Bhatt DL, Steg PG. Prevalence and treatment of cardiovascular risk factors in outpatients with atherothrombosis in the Middle East. Heart Asia 2011; 3:77-81. [PMID: 27325999 DOI: 10.1136/ha.2010.003145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 07/11/2011] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To characterise the risk-factor profile and treatment gaps among patients with, or at risk for, cardiovascular disease in the Middle East. DESIGN Secondary analysis of a prospective observational study. SETTING International multicentre study (Reduction of Atherothrombosis for Continued Health). PATIENTS Stable outpatients with established cardiovascular disease or at least three risk factors for atherothrombosis. The present analysis was based on 840 patients from the Middle East. INTERVENTION Observational study without a study-specific intervention. MAIN OUTCOME MEASURES A treatment gap was defined as at least one of the following: current cigarette smoking, total cholesterol ≥200 mg/dl, serum glucose ≥126 mg/dl or blood pressure of ≥140/90. RESULTS The majority of Middle Eastern patients had hypertension (80.2%), more than half had a history of diabetes mellitus (52.3%), and a third had hypercholesterolaemia (34.1%). There was a high prevalence of obesity (38.6%), and nearly half the patients were former or current smokers (46%). β-Blockers and angiotensin-converting enzyme inhibitors were the most commonly prescribed antihypertensives (61.1% and 57.5%, respectively). Antiplatelet therapy (most commonly aspirin) and lipid-lowering drugs (most commonly a statin) were used in most patients (90.7% and 85.2%, respectively). Three-quarters of the participants (75.6%) had at least one uncontrolled risk factor. CONCLUSION Patients with atherothrombosis in the Middle East have a high prevalence of risk factors including alarming rates of diabetes mellitus and obesity. At least one risk factor is uncontrolled in the majority of patients, presenting a pressing need for improving the care of such patients in the Middle East.
Collapse
Affiliation(s)
- Alawi A Alsheikh-Ali
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Institute for Clinical Research and Health Policy Studies and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Wael A Al-Mahmeed
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Avi Porath
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Ismail Khalil
- Division of Vascular Surgery & Wound Care Center, Department of Surgery, American University of Beirut, Beirut, Lebanon
| | - Hisham Mahmoud
- Medical Affairs, Sanofi-aventis Gulf Office, Dubai, United Arab Emirates
| | - Deepak L Bhatt
- VA Boston Healthcare System and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - P Gabriel Steg
- INSERM U-698, Université Paris 7 and AP-HP, Paris, France
| |
Collapse
|
31
|
Roussel R, Travert F, Pasquet B, Wilson PWF, Smith SC, Goto S, Ravaud P, Marre M, Porath A, Bhatt DL, Steg PG. Metformin use and mortality among patients with diabetes and atherothrombosis. ACTA ACUST UNITED AC 2010; 170:1892-9. [PMID: 21098347 DOI: 10.1001/archinternmed.2010.409] [Citation(s) in RCA: 256] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Metformin is recommended in type 2 diabetes mellitus because it reduced mortality among overweight participants in the United Kingdom Prospective Diabetes Study when used mainly as a means of primary prevention. However, metformin is often not considered in patients with cardiovascular conditions because of concerns about its safety. METHODS We assessed whether metformin use was associated with a difference in mortality among patients with atherothrombosis. The study sample comprised 19 691 patients having diabetes with established atherothrombosis participating in the Reduction of Atherothrombosis for Continued Health (REACH) Registry between December 1, 2003, and December 31, 2004, treated with or without metformin. Multivariable adjustment and propensity score were used to account for baseline differences. The main outcome measure was 2-year mortality. RESULTS The mortality rates were 6.3% (95% confidence interval [CI], 5.2%-7.4%) with metformin and 9.8% 8.4%-11.2%) without metformin; the adjusted hazard ratio (HR) was 0.76 (0.65-0.89; P < .001). Association with lower mortality was consistent among subgroups, noticeably in patients with a history of congestive heart failure (HR, 0.69; 95% CI, 0.54-0.90; P = .006), patients older than 65 years (0.77; 0.62-0.95; P = .02), and patients with an estimated creatinine clearance of 30 to 60 mL/min/1.73 m(2) (0.64; 95% CI, 0.48-0.86; P = .003) (to convert creatinine clearance to mL/s/m(2), multiply by 0.0167). CONCLUSIONS Metformin use may decrease mortality among patients with diabetes when used as a means of secondary prevention, including subsets of patients in whom metformin use is not now recommended. Metformin use should be tested prospectively in this population to confirm its effect on survival.
Collapse
Affiliation(s)
- Ronan Roussel
- INSERM, Department of Diabetology, Bichat Hospital, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Rosen B, Porath A, Pawlson LG, Chassin MR, Benbassat J. Adherence to standards of care by health maintenance organizations in Israel and the USA. Int J Qual Health Care 2010; 23:15-25. [PMID: 21084320 DOI: 10.1093/intqhc/mzq065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The health-care systems in the USA and Israel differ in organization, financing and expenditure levels. However, managed care organizations play an important role in both countries, and a comparison of the performance of their community-based health plans could inform policymakers about ways to improve the quality of care. OBJECTIVE To compare the adherence to standards of care in Israel and in the USA. STUDY DESIGN An observational study comparing trends in performance using data from reports of the National Quality Measures Program in Israel and of the National Committee for Quality Assurance in the USA. RESULTS Differences in specifications preclude a comparison between most measures in the two reports. However, the comparison of 11 similar measures in the 2007 reports indicates that performance was higher in the USA by 10 or more percentage points on four measures (flu immunization, medication for asthma, screening for colorectal cancer and monitoring for diabetic nephropathy). Performance was higher in Israel on three measures in patients with diabetes (blood pressure, low-density lipoprotein (LDL) cholesterol and glycemic control), and similar on the remaining four measures. Between 2005 and 2007, quality of care improved in both countries. However, improvement was slower in the USA than in Israel. CONCLUSIONS In comparison with the USA, Israel achieves comparable health maintenance organization (HMO) quality on several primary care indicators and more rapid quality improvement, despite its substantially lower level of expenditure. Considering the differences between the two countries in settings and populations, further research is needed to assess the causes, generalizability and policy implications of these findings.
Collapse
Affiliation(s)
- Bruce Rosen
- Smokler Center for Health Policy Research, Myers-JDC Brookdale Institute, Jerusalem, Israel.
| | | | | | | | | |
Collapse
|
33
|
Chodick G, Amital H, Shalem Y, Kokia E, Heymann AD, Porath A, Shalev V. Persistence with statins and onset of rheumatoid arthritis: a population-based cohort study. PLoS Med 2010; 7:e1000336. [PMID: 20838658 PMCID: PMC2935457 DOI: 10.1371/journal.pmed.1000336] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 07/28/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The beneficial effects of statins in rheumatoid arthritis (RA) have been suggested previously, but it is unclear whether statins may prevent its development. The aim of this retrospective cohort study was to explore whether persistent use of statins is associated with onset of RA. METHODS AND FINDINGS The computerized medical databases of a large health organization in Israel were used to identify diagnosed RA cases among adults who began statin therapy between 1998 and 2007. Persistence with statins was assessed by calculating the mean proportion of follow-up days covered (PDC) with statins for every study participant. To assess the possible effects of healthy user bias, we also examined the risk of osteoarthritis (OA), a common degenerative joint disease that is unlikely to be affected by use of statins. A total of 211,627 and 193,770 individuals were eligible for the RA and OA cohort analyses, respectively. During the study follow-up period, there were 2,578 incident RA cases (3.07 per 1,000 person-years) and 17,878 incident OA cases (24.34 per 1,000 person-years). The crude incidence density rate of RA among nonpersistent patients (PDC level of <20%) was 51% higher (3.89 per 1,000 person-years) compared to highly persistent patients who were covered with statins for at least 80% of the follow-up period. After adjustment for potential confounders, highly persistent patients had a hazard ratio of 0.58 (95% confidence interval 0.52-0.65) for RA compared with nonpersistent patients. Larger differences were observed in younger patients and in patients initiating treatment with high efficacy statins. In the OA cohort analysis, high persistence with statins was associated only with a modest decrement in risk ratio (hazard ratio = 0.85; 0.81-0.88) compared to nonadherent patients. CONCLUSIONS The present study demonstrates an association between persistence with statin therapy and reduced risk of developing RA. The relationship between continuation of statin use and OA onset was weak and limited to patients with short-term follow-up.
Collapse
|
34
|
Nevzorov R, Shleyfer E, Gourevitch A, Jotkowitz A, Porath A, Barski L. Campylobacter-associated myopericarditis with ventricular arrhythmia in a young hypothyroid patient. Isr Med Assoc J 2010; 12:505-506. [PMID: 21337822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Roman Nevzorov
- Department of Medicine F, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
AIMS To determine the incidence of postpartum diabetes mellitus in the years following a diagnosis of gestational diabetes mellitus (GDM) and to determine whether the severity of GDM, represented by the magnitude of the deviation of diagnostic tests from the normal values or requirement for medications, is associated with the development of diabetes. METHODS A retrospective cohort study was performed among 185 416 pregnant women who had glucose challenge test or 3 h oral glucose tolerance test (OGTT) in a large health maintenance organization in Israel. Subsequent diagnosis of diabetes was ascertained by using an automated patient registry. RESULTS A total of 11 270 subjects were diagnosed with GDM, comprising 6.07% of the cohort. During a total follow-up period of 1 049 334 person-years there were 1067 (16.9 per 1000 person-years) and 1125 (1.1 per 1000 person-years) diagnoses of postpartum diabetes among GDM and non-GDM women, respectively. The cumulative risk of incident diabetes in GDM patients with up to 10 years of follow-up was 15.7%, compared with 1% among the non-GDM population. Gestational diabetes mellitus was associated with nearly an eightfold higher risk of postpartum diabetes after adjusting for important confounders, such as socioeconomic status and body mass index. Among women with a history of GDM, the number of abnormal OGTT values and use of insulin were associated with a substantially higher risk for developing diabetes. CONCLUSIONS Three or four abnormal OGTT values and GDM requiring insulin or oral hypoglycaemic medications are important predictors of postpartum diabetes risk in women with a history of GDM.
Collapse
Affiliation(s)
- G Chodick
- Medical Division, Maccabi Healthcare Services, 27 Ha'Mered Street, Tel Aviv, Israel.
| | | | | | | | | | | | | |
Collapse
|
36
|
Wilf-Miron R, Tov OS, Lewinhoff I, Yaari E, Avitzour M, Viner A, Porath A, Kokia E. [Equity promotion in Maccabi Healthcare Services: from the Equality Report to an organizational action plan]. Harefuah 2010; 149:210-264. [PMID: 20812491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Maccabi Healthcare Services (MHS), the second largest HMO in Israel, has chosen to implement a multi-annual strategy to promote equality and equity in healthcare. Within the strategy's framework, MHS will maintain an ongoing process of studying the variability of its members characteristics for the purpose of adjusting service provision and improving health outcomes. MHS has recently published its first Equality Report, dedicated to defining the observed associations between its members demographic and socioeconomic characteristics and their health measures. The report identifies those sub-groups belonging to Israel's geographic and social peripheries that require focused interventions. Based on the report's recommendations, MHS has decided to designate promotion of equality as its strategic objective, a filter through which every policy decision will be reviewed. In addition it was decided to: 1. develop an organizational methodology to produce an index to assess reductions in disparities over time; 2. adjust MHS services to member's ethnic and cultural needs; 3. strengthen perceptions of community orientation based in primary care; 4. target resources to "social peripheries", beginning in 2010; 5. improve service accessibility and availability in geographically peripheral areas; 6. reduce economic barriers to healthcare. This article details the disparities as analyzed in the report in addition to the specific policy decisions made in their wake.
Collapse
Affiliation(s)
- Rachel Wilf-Miron
- Quality Management Department, Maccabi Healthcare Services, Tei Aviv, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Chodick G, Heymann AD, Rosenmann L, Green MS, Flash S, Porath A, Kokia E, Shalev V. Diabetes and risk of incident cancer: a large population-based cohort study in Israel. Cancer Causes Control 2010; 21:879-87. [PMID: 20148361 DOI: 10.1007/s10552-010-9515-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 01/22/2010] [Indexed: 12/22/2022]
Abstract
Type 2 diabetes mellitus has been associated with an increased risk of a variety of cancers in observational studies, but few have reported the relationship between diabetes and cancer risk in men and women separately. The main goal of this retrospective cohort study was to evaluate the sex-specific risk of incident overall and site-specific cancer among people with DM compared with those without, who had no reported history of cancer at the start of the follow-up in January 2000. During an average of 8 years of follow-up (SD = 2.5), we documented 1,639 and 7,945 incident cases of cancer among 16,721 people with DM and 83,874 free of DM, respectively. In women, DM was associated with an adjusted hazard ratio of 1.96 (95% CI: 1.53-2.50) and 1.41 (95% CI: 1.20-1.66) for cancers of genital organs and digestive organs, respectively. A significantly reduced HR was observed for skin cancer (0.38; 95% CI: 0.22-0.66). In men with DM, there was no significant increase in overall risk of cancer. DM was related with a 47% reduction in the risk of prostate cancer. These findings suggest that the nature of the association between DM and cancer depends on sex and specific cancer site.
Collapse
Affiliation(s)
- Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, 27 Ha'Mered Street, Tel Aviv, 68125, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Shotan A, Garty M, Blondhein DS, Meisel SR, Lewis BS, Shochat M, Grossman E, Porath A, Boyko V, Zimlichman R, Caspi A, Gottlieb S. Atrial fibrillation and long-term prognosis in patients hospitalized for heart failure: results from heart failure survey in Israel (HFSIS). Eur Heart J 2009; 31:309-17. [PMID: 19837682 DOI: 10.1093/eurheartj/ehp422] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Atrial fibrillation (AF) and heart failure (HF) commonly coexist, and each adversely affects the other. The aim of the study was to prospectively evaluate the impact of AF and its subtypes on management, and early and long-term outcome of hospitalized HF patients. METHODS AND RESULTS Data were prospectively collected on HF patients hospitalized in all public hospitals in Israel as part of a national survey (HFSIS). Atrial fibrillation patients were subdivided into intermittent and chronic AF subgroups. During March-April 2003, we enrolled 4102 HF patients, of whom 1360 (33.2%) had AF [600 (44.1%) intermittent, 562 (41.3%) chronic]. Patients with AF were older (76.9 +/- 10.5 vs. 71.7 +/- 12.6 years, P = 0.0001), males, with preserved LV systolic function. Crude mortality rates for AF patients were progressively and consistently higher during hospitalization and during the 4-year follow-up period, especially in the chronic AF group (P = 0.0001). After covariate adjustment, AF was associated with increased 1-year mortality [HR 1.19, 95% CI (1.03-1.36)]. CONCLUSION AF was present in a third of hospitalized HF patients, and identified a population with increased mortality risk, largely due to co-morbidities.
Collapse
Affiliation(s)
- Avraham Shotan
- Heart Institute, Hillel Yaffe Medical Center, Hadera 38100, Israel.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Nevzorov R, Novack V, Henkin Y, Kobal SL, Jotkowitz A, Porath A. Discrepancy between results of randomized control studies and retrospective analysis: the case of statin therapy effect on one-year mortality in patients with decompensated heart failure. Eur J Intern Med 2009; 20:494-8. [PMID: 19712852 DOI: 10.1016/j.ejim.2009.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 12/28/2008] [Accepted: 03/04/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND In view of the recent reports on a lack of protective effect of statin therapy on clinical outcomes in patients with heart failure, the present study investigated the impact of statin therapy before admission on one-year survival of patients hospitalized due to decompensated heart failure in two groups of patients; with and without ischemic heart disease. METHODS We performed a retrospective cohort analysis of 887 consecutive patients older than 18 years hospitalized with decompensated heart failure between 11/December 2001 and 06/June 2005. Two groups of patients were compared: those who received statins within 3 months before the admission (S) and those who did not (NS). The primary outcome was one-year all-cause mortality. To adjust for a potential misbalance between S and NS groups in baseline characteristics, a propensity score for statin therapy was incorporated into the survival model. RESULTS Two hundred eighty-one patients (31.7%) received statins prior to admission. Patients with ischemic heart disease (IHD) (656/887 subjects, 74%) had higher rate of S therapy as compared to the rest 36.3% vs. 18.6%, p<0.001. Overall one-year mortality rate in the S group was 21% vs. 31.8% in the NS group, p<0.001. In the subgroup of patients with IHD, statins were protective after adjustment for comorbidities and propensity score (hazard ratio [HR], 0.66; 95% CI 0.4-0.97), but in patients with non-ischemic HF statin therapy was not associated with a protective effect (HR 0.77; 95% CI 0.38-1.6). CONCLUSIONS In our study statins' protective effect on one-year survival in HF patients is restricted to patients with IHD. This stands in disagreement with the results of the randomized trials showing no effect of statin therapy. Statin use may be a marker of better health care and despite an extensive adjustment for baseline characteristics, unaccounted bias inherent to retrospective studies may explain the discrepancy in the results.
Collapse
Affiliation(s)
- Roman Nevzorov
- Department of Internal Medicine F, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | | | | | | | | |
Collapse
|
40
|
Dagan E, Novack V, Porath A. Adverse outcomes in patients with community acquired pneumonia discharged with clinical instability from Internal Medicine Department. ACTA ACUST UNITED AC 2009; 38:860-6. [PMID: 17008229 DOI: 10.1080/00365540600684397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There are well established admission criteria for patients suffering from community-acquired pneumonia, yet the clinical tool for decision to discharge the hospitalized patient is lacking. Continuous pressure to reduce hospital expenditures can lead to a premature discharge of unstable patients. The current study assessed the impact of clinical instability at discharge on short-term outcomes. Demographic data, background disease, laboratory tests results and PORT score were assessed prospectively. On the last day of the hospitalization 7 physiological parameters of instability were evaluated. 60 d composite mortality and readmission rate was a primary outcome measure. Of the 373 patients, 22% were discharged with 1 or more instabilities, of whom 26.8% reached primary outcome within 60 d, compared to 8.2% of patients with no instabilities. 60 d death rate was 2.1% in the former group, compared to 14.6% in the unstable patients (p<0.001). Instability on discharge remained a significant prognosticator of adverse outcome (odds ratio 3.5; 95% CI 1.8-6.8) after adjustment for pneumonia severity and baseline comorbidity. We concluded that discharging an unstable patient hospitalized with pneumonia is associated with elevated risk of death or readmission within 60 d. Pneumonia guidelines should include objective criteria for judging patients' stability and promptness for discharge.
Collapse
Affiliation(s)
- Elad Dagan
- Soroka University Medical Centre, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | | | | |
Collapse
|
41
|
Gross R, Tabenkin H, Porath A, Heymann A, Porter B. Working together? Int J Health Care Qual Assur 2009; 22:353-65. [DOI: 10.1108/09526860910964825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis article aims to analyze existing and preferred labor divisions between physicians and nurses treating patients with hypertension and diabetes in managed care organizations.Design/methodology/approachA mail survey was conducted in 2002/2003 among a representative sample of 743 physicians employed by Israel's largest managed care health plans (78 percent response rate). A telephone survey among a representative sample of 1,369 hypertensive or diabetic patients (77 percent response rate) was also used.FindingsFindings reveal a conspicuous gap between actual labor division and what physicians perceive to be ideal. Possible reasons for this gap are discussed and strategies for facilitating collaboration, which would improve service quality as well as work life quality for both physicians and nurses.Originality/valueThis study provides empirical data on the extent of nurse involvement in managed care organization chronic patient care, as well as comparing them to physicians' preferences regarding nurse involvement.
Collapse
|
42
|
Dreiher J, Ginsberg G, Rabinowitz G, Raskin-Segal A, Weitzman R, Porath A. Estimation of mortality savings due to a national program for diabetes care. Eur J Intern Med 2009; 20:307-12. [PMID: 19393499 DOI: 10.1016/j.ejim.2008.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 08/28/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diabetes-related complications can be reduced by better control of glycemia, lipid abnormalities and blood pressure. In recent years, efforts at improving diabetes care in Israel have been made. This study aims to estimate mortality savings related to a national program for diabetes care in Israel. METHODS Total population data for Israel was projected to 2020. Current diabetes prevalence and disease management data were obtained from a national program of diabetes care. Projections of the program's effect were based on two models: improvement in glycemic control, reflected in Hb A1c levels, and improvement in overall diabetes care, reflected in the percentage with LDL<100 mg/dl, a proxy for multi-factorial control. Potential years of life lost (PYLL) and quality-adjusted life years (QALYs) saved were calculated. RESULTS A drop in average Hb A1c values from 8.13% at baseline to 7.36% in 2020 is expected, and as a result 4216 deaths from diabetes will be prevented over the period 2001-2020, saving around 47,773 life years or 34,342 QALYs. Overall diabetes care, reflected in improving the control rate of LDL levels to <100 mg/dl from 36% in 2000 to 58% in 2020, is estimated to prevent around 4803 deaths from diabetes over the period 2001-2020., so the program will save around 47,127 PYLL or 32,862 QALYs. CONCLUSIONS A nationwide program of diabetes care is estimated to result in significant reductions of overall, as well as CHD-related, mortality.
Collapse
Affiliation(s)
- Jacob Dreiher
- Clalit Health Services, Israel; Division of Health in the Community, Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | | | | | | | | |
Collapse
|
43
|
Gilutz H, Novack L, Shvartzman P, Zelingher J, Bonneh DY, Henkin Y, Maislos M, Peleg R, Liss Z, Rabinowitz G, Vardy D, Zahger D, Ilia R, Leibermann N, Porath A. Computerized community cholesterol control (4C): meeting the challenge of secondary prevention. Isr Med Assoc J 2009; 11:23-29. [PMID: 19344008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Dyslipidemia remains underdiagnosed and undertreated in patients with coronary artery disease. The Computer-based Clinical Decision Support System provides an opportunity t close these gaps. OBJECTIVES To study the impact of computerized intervention on secondary prevention of CAD. METHODS The CDSS was programmed to automatically detect patients with CAD and to evaluate the availability of an updated lipoprotein profile and treatment with lipid-lowering drugs. The program produced automatic computer-generated monitoring and treatment recommendations. Adjusted primary clinics were randomly assigned to intervention (n=56) or standard care arms (n=56). Reminders were mailed to the primary medical teams in the intervention arm every 4 months updating them with current lipid levels and recommendations for further treatment. Compliance and lipid levels were monitored. The study group comprised all patients with CAD who were alive at least 3 months after hospitalization. RESULTS Follow-up was available for 7448 patients (median 19.8 months, range 6-36 months). Overall, 51.7% of patients were adequately screened, and 55.7% of patients were compliant with treatment to lower lipid level. In patients with initial low density lipoprotein >120 mg/dl, a significant decrease in LDL levels was observed in both arms, but was more pronounced in the intervention arm: 121.9 +/- 34.2 vs. 124.3 +/- 34.6 mg/dl (P < 0.02). A significantly lower rate of cardiac rehospitalizations was documented in patients who were adequately treated with lipid-lowering drugs, 37% vs. 40.9% (P < 0.001). CONCLUSIONS This initial assessment of our data represent a real-world snapshot where physicians and CAD patients often do not adhere to clinical guidelines, presenting a major obstacle to implementing effective secondary prevention. Our automatic computerized reminders system substantially facilitates adherence to guidelines and supports wide-range implementation.
Collapse
Affiliation(s)
- Harel Gilutz
- Department of Cardiology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Barski L, Horowitz S, Rabaev E, Sidi A, Porath A, Jotkowitz AB. Mycoplasmal myopericarditis in an elderly woman. Isr Med Assoc J 2008; 10:660-661. [PMID: 18847177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Leonid Barski
- Department of Medicine F, Soroka University Medical Center, Beer Sheva, Israel.
| | | | | | | | | | | |
Collapse
|
45
|
Ayalon L, Gross R, Tabenkin H, Porath A, Heymann A, Porter B. Determinants of quality of life in primary care patients with diabetes: implications for social workers. Health Soc Work 2008; 33:229-236. [PMID: 18773798 DOI: 10.1093/hsw/33.3.229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Using a cross-sectional design of 400 primary care patients with diabetes, the authors evaluated demographics, health status, subjective health and mental health, health behaviors, health beliefs, knowledge of diabetes treatment, satisfaction with medical care, and quality of medical care as potential predictors of QoL and QoL in the hypothetical absence of diabetes. Those who reported difficulties meeting basic needs, diabetes-related complications, worse subjective health, and dissatisfaction with medical care were more likely to report worse QoL. Those who reported difficulties meeting basic needs, higher cholesterol level, and worse subjective health also were more likely to report better QoL in the hypothetical absence of diabetes. In addition, diabetes management played a major role in one's QoL in the hypothetical absence of diabetes: Engaging in stricter diabetes self-care and taking pharmaceutical treatment for managing diabetes were associated with better QoL in the hypothetical absence of diabetes. Providing psychosocial support geared toward diabetes self-management may improve patients' QoL. When doing so, social workers need to be aware of the potential trade-off between following medical recommendations that advocate for a strict lifestyle and patients' QoL.
Collapse
Affiliation(s)
- Liat Ayalon
- School of Social Work, Bar Ilan University, Israel.
| | | | | | | | | | | |
Collapse
|
46
|
Barski L, Rabaev E, Sztarkier I, Delgado J, Porath A, Jotkowitz AB. Autoimmune hepatitis and hypergammaglobulinemic purpura associated with herbal medicine use. Isr Med Assoc J 2008; 10:390-1. [PMID: 18605369 DOI: pmid/18605369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Leonid Barski
- Department of Medicine F, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | | | | | | | | | | |
Collapse
|
47
|
Jotkowitz AB, Novack V, Rabinowitz G, Segal AR, Weitzman R, Porath A. A national study on lipid management. Eur J Intern Med 2008; 19:356-61. [PMID: 18549939 DOI: 10.1016/j.ejim.2007.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 09/09/2007] [Accepted: 10/08/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hyperlipidemia remains a major cause of morbidity in Western countries. The objective of this study was to document the percentage of adults who underwent periodical LDL measurement, and the percentage of patients with diabetes and post-angioplasty who were treated to goal. METHODS Using a national database, data were obtained on the percentage of adults who had an LDL performed and the percentage of adults with an LDL at pre-specified levels. We also assessed the attainment of target LDL levels in diabetic and post-angioplasty patients. Data were also collected from patients with an acute coronary syndrome (ACS) admitted to seven hospitals within a 5 year period (2000-2004). RESULTS Primary prevention: In 2005, 64.6% of the total population of 754,910 aged 35-44 had at least one record of LDL cholesterol measurement documented. This figure was 79.6% in the 717,617 adults aged 45-54. Secondary prevention: Of 253,233 diabetics in 2005, 220,023 (86.9%) have undergone at least one annual LDL measurement. The percentage of patients on statin therapy 3 and 12 months after an ACS admission increased significantly during the years 2000-2004 and reached 87%. Of the 42,292 patients who underwent PTCA during 2005, 34,346 (81.2%) have purchased at least 3 prescriptions of statins during 2005, 35,261 (83.4%) have performed at least one LDL measurement and 57.8% attained an LDL level of <100 mg/dl. CONCLUSIONS We have shown an improvement in primary and secondary preventions of CV disease as documented by LDL measured and attainment of treatment goals, but further efforts are needed.
Collapse
Affiliation(s)
- Alan B Jotkowitz
- Department of Internal Medicine F, Soroka University Medical Center, Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | | | | | | | | |
Collapse
|
48
|
Novack V, Cutlip DE, Jotkowitz A, Lieberman N, Porath A. Reduction in sex-based mortality difference with implementation of new cardiology guidelines. Am J Med 2008; 121:597-603.e1. [PMID: 18538296 DOI: 10.1016/j.amjmed.2008.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 01/15/2008] [Accepted: 01/23/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mortality from acute coronary syndrome has historically been higher in women as compared with men. We hypothesized that adoption of a more sensitive definition for the diagnosis of acute myocardial infarction and managing patients according to the 2000 European Society of Cardiology and American College of Cardiology guidelines would reduce this difference. METHODS A retrospective cohort study was conducted of all acute coronary syndrome admissions to 7 regional tertiary hospitals in Israel during 1999-2004. The primary end point was all-cause 1-year mortality. Differences in risk between men and women were assessed using Cox proportional hazards regression. RESULTS The number of patients admitted with acute coronary syndrome was 20,206 and 15,583 before and after adoption of the guidelines, respectively. An invasive strategy during the index hospitalization was more frequent in men in both the pre- (47.6% vs 33.6, P <.001) and post- (55.7% vs 40.9%, P <.001) transition periods. Secondary prevention was intensified in the post-transition period in both sexes. Multivariate analysis adjusting for differences in baseline clinical characteristics between men and women and invasive strategy demonstrated that female sex was associated with increased 1-year mortality during the pretransition period (hazard ratio 1.34, 95% confidence interval, 1.24-1.45), but was not a significant factor in the post-transition period (hazard ratio 1.04, 95% confidence interval, 0.94-1.14). CONCLUSIONS The transition to the 2000 European Society of Cardiology and American College of Cardiology guidelines was associated with a reduction in the sex-based mortality difference in patients with acute coronary syndrome despite the fact that an early invasive strategy and secondary prevention continued to be underutilized in female patients in both periods.
Collapse
Affiliation(s)
- Victor Novack
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | | | | | | | | |
Collapse
|
49
|
Elbaz G, Etzion O, Delgado J, Porath A, Talmor D, Novack V. Hypothermia in a desert climate: severity score and mortality prediction. Am J Emerg Med 2008; 26:683-8. [PMID: 18606321 DOI: 10.1016/j.ajem.2007.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 10/12/2007] [Accepted: 10/14/2007] [Indexed: 02/05/2023] Open
Affiliation(s)
- Gabby Elbaz
- Department of Internal Medicine, Asaf-Harofeh, Rechovot, 20300 Beer-Sheva, Israel
| | | | | | | | | | | |
Collapse
|
50
|
Gross R, Ashkenazi Y, Tabenkin H, Porath A, Aviram A. Implementing QA programs in managed care health plans: factors contributing to success. Int J Health Care Qual Assur 2008; 21:308-24. [PMID: 18578215 DOI: 10.1108/09526860810868247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to identify the factors that contribute to the success or failure of quality assurance programs implemented by Israeli managed care health plans. DESIGN/METHODOLOGY/APPROACH An in-depth study of seven quality assurance programs was conducted, comparing successful with unsuccessful ones using the comparative "case study" method. Employing a semi-structured questionnaire, 42 program directors and professionals in the field were interviewed. FINDINGS A number of factors associated with the programs' success emerged. Those external to the program included: ongoing management support, resource allocation, information system support and perceived financial benefit for the organization. Internal factors included: leadership, perceived problem's importance, laying the groundwork in the field, involving field staff in planning and implementation and staff motivation. ORIGINALITY/VALUE The study provides insights into ways to encourage the implementation of successful quality assurance programs in the special organizational context of managed care health plans. As the implementation relies heavily on data, one important precondition is the development of computerized information systems to facilitate ongoing data collection. It is also necessary from the planning stage to take into account organizational factors that affect success.
Collapse
|