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Mauk KC, Torrone EA, Flagg EW. Can Diagnostic Codes in Health Care Claims Data Identify Confirmed Chlamydial and Gonococcal Infections? A Retrospective Cohort Study, 2003 to 2017. Sex Transm Dis 2021; 48:S26-S31. [PMID: 33967233 PMCID: PMC8284366 DOI: 10.1097/olq.0000000000001454] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Because most sources of administrative claims data do not contain laboratory result data, researchers rely on diagnosis codes to identify cases of disease. The validity of using diagnosis codes to identify chlamydial and gonococcal infections in administrative claims data remains largely uninvestigated. METHODS We conducted a retrospective cohort analysis using OptumLabs Data Warehouse, which includes deidentified medical (inpatient and outpatient) claims and laboratory test results. Among males and females aged 15 to 39 years during the period 2003-2017, we identified chlamydia and gonorrhea test results and corresponding diagnosis codes. Using test results as the criterion standard, we calculated the sensitivity and specificity of chlamydia and gonorrhea diagnosis codes to identify laboratory-confirmed infections. RESULTS We identified 9.7 million chlamydia and gonorrhea test results among 3.1 million enrollees. Of the 176,241 positive chlamydia test results, only 11,515 had a corresponding diagnosis code, for a sensitivity of 6.5 (95% confidence interval [CI], 6.4-6.7) and a specificity of 99.5 (95% CI, 99.5-99.5). Corresponding diagnosis codes were identified for 8056 of the 31,766 positive gonorrhea test results, for a sensitivity of 25.4 (95% CI, 24.9-25.8) and a specificity of 99.7 (95% CI, 99.7-99.7). CONCLUSIONS Our findings indicate that using only International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification diagnosis codes to identify chlamydial and gonococcal infections substantially underestimates the burden of these diseases and inaccurately classifies laboratory-confirmed infections.
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Affiliation(s)
- Kerry C. Mauk
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- OptumLabs Visiting Fellow, Eden Prairie, MN
| | - Elizabeth A. Torrone
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elaine W. Flagg
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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2
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Willis SJ, Elder H, Cocoros N, Young J, Marcus JL, Eberhardt K, Callahan M, Herrick B, Weiss M, Hafer E, Erani D, Josephson M, Llata E, Flagg EW, Hsu KK, Klompas M. More Screening or More Disease? Gonorrhea Testing and Positivity Patterns Among Men in 3 Large Clinical Practices in Massachusetts, 2010-2017. Clin Infect Dis 2021; 71:e399-e405. [PMID: 31967644 DOI: 10.1093/cid/ciaa066] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/18/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Gonorrhea diagnosis rates in the United States increased by 75% during 2009-2017, predominantly in men. It is unclear whether the increase among men is being driven by more screening, an increase in the prevalence of disease, or both. We sought to evaluate changes in gonorrhea testing patterns and positivity among men in Massachusetts. METHODS The analysis included men (aged ≥15 years) who received care during 2010-2017 in 3 clinical practice groups. We calculated annual percentages of men with ≥1 gonorrhea test and men with ≥1 positive result, among men tested. Log-binomial regression models were used to examine trends in these outcomes. We adjusted for clinical and demographic characteristics that may influence the predilection to test and probability of gonorrhea disease. RESULTS On average, 306 348 men had clinical encounters each year. There was a significant increase in men with ≥1 gonorrhea test from 2010 (3.1%) to 2017 (6.4%; adjusted annual risk ratio, 1.12; 95% confidence interval, 1.12-1.13). There was a significant, albeit lesser, increase in the percentage of tested men with ≥1 positive result (1.0% in 2010 to 1.5% in 2017; adjusted annual risk ratio, 1.07; 95% confidence interval, 1.04-1.09). CONCLUSIONS We estimated significant increases in the annual percentages of men with ≥1 gonorrhea test and men with ≥1 positive gonorrhea test result between 2010 and 2017. These results suggest that observed increases in gonorrhea rates could be explained by both increases in screening and the prevalence of gonorrhea.
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Affiliation(s)
- Sarah J Willis
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.,Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | - Heather Elder
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | - Noelle Cocoros
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jessica Young
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | | | | | - Brian Herrick
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Michelle Weiss
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Ellen Hafer
- Massachusetts League of Community Health Centers, Boston, Massachusetts, USA
| | - Diana Erani
- Massachusetts League of Community Health Centers, Boston, Massachusetts, USA
| | - Mark Josephson
- Massachusetts League of Community Health Centers, Boston, Massachusetts, USA
| | - Eloisa Llata
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elaine W Flagg
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine K Hsu
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Abstract
BACKGROUND Although there are more recent estimate of genital herpes prevalence, incidence estimates in the United States (US) have not been updated since 2008. METHODS We estimated genital herpes prevalence and incidence for 2018 among adults aged 18 to 49 years. We estimated prevalence using 2015-2018 National Health and Nutrition Examination Survey herpes simplex virus type 2 (HSV-2) seroprevalence data among the noninstitutionalized civilian population and extrapolated this prevalence to the full US population using 2018 American Community Survey data. We estimated incidence using 2011 to 2018 National Health and Nutrition Examination Survey HSV-2 data as inputs to a simple mathematical model. We used Monte Carlo simulation to generate 10,000 input parameter sets for age and sex subpopulations and summarized our estimates by their median; uncertainty intervals for these estimates are characterized by their first (Q1) and third (Q3) quartiles. We conducted sensitivity analyses investigating the impact of HSV type 1 (HSV-1) infection on estimates of genital herpes burden. RESULTS In 2018, there were an estimated 18.6 (Q1 = 18.1, Q3 = 19.0) million prevalent and 572,000 (Q1 = 479,000, Q3 = 673,000) incident genital herpes infections among 18- to 49-year-olds. Women accounted for two thirds of prevalent infections with an estimated 12.1 (Q1 = 11.9, Q3 = 12.5) million infections. Incidence was highest among 18- to 24-year-olds with an estimated 242,000 (Q1 = 210,000, Q3 = 274,000) infections. Sensitivity analyses indicated that HSV-1 could be responsible for millions more prevalent genital herpes infections, and tens of thousands of additional incident genital herpes infections, depending on the percentage of HSV-1 infections that are genital. DISCUSSION Genital herpes is a common sexually transmitted disease in the United States. Future research to understand the burden of genital infections attributable to HSV-1 would refine estimates of genital herpes burden.
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Affiliation(s)
- Ian H Spicknall
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Lewis FMT, Spicknall IH, Flagg EW, Papp JR, Kreisel KM. Incidence and Prevalence of Trichomonas vaginalis Infection Among Persons Aged 15 to 59 Years: United States, 2018. Sex Transm Dis 2021; 48:232-237. [PMID: 33492095 PMCID: PMC10240849 DOI: 10.1097/olq.0000000000001383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trichomonas vaginalis (TV) is a sexually transmitted parasite associated with multiple adverse outcomes in women. Estimating TV incidence is challenging because of its largely asymptomatic presentation. METHODS Per-capita prevalence was estimated using the National Health and Nutrition Examination Survey, 2013 to 2018. Incidence was estimated using ordinary differential equations assuming static incidence at steady state and fit using Bayesian techniques. Model inputs included estimates of proportion of asymptomatic cases, natural clearance, and time to symptomatic treatment seeking. Posterior distributions were drawn, and uncertainty was reported, from 25th (Q1) to 75th (Q3) percentiles. Aggregated measures were estimated by combining component distributions. RESULTS Among 15- to 59-year-olds in 2018, the number of prevalent TV infections was 2.6 (Q1, 2.4; Q3, 2.7) million overall, 470,000 (Q1, 414,000; Q3, 530,000) among men, and 2.1 (Q1, 2.0; Q3, 2.2) million among women; the numbers of incident infections were 6.9 (Q1, 6.2; Q3, 7.6) million, 3.3 (Q1, 2.8; Q3, 3.8) million, and 3.5 (Q1, 3.1; Q3, 4.0) million among all persons, men, and women, respectively. Persons aged 15 to 24 years comprised 15.6% and 16.3% of all prevalent and incident infections, respectively; prevalence and incidence in both sexes increased with age. Incidences in both sexes were highly dependent on estimates of natural clearance, which were based on few data. CONCLUSIONS Prevalence and incidence of TV are substantial in the United States, particularly among those 25 years or older. Although estimated prevalence is higher in women, estimated incidence is similar in men and women. Data on key parameters of TV infection are limited; future research should focus on clarifying the natural history of TV.
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Affiliation(s)
| | - Ian H Spicknall
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elaine W Flagg
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - John R Papp
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kristen M Kreisel
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Elder HR, Gruber S, Willis SJ, Cocoros N, Callahan M, Flagg EW, Klompas M, Hsu KK. Can Machine Learning Help Identify Patients at Risk for Recurrent Sexually Transmitted Infections? Sex Transm Dis 2021; 48:56-62. [PMID: 32810028 PMCID: PMC10949112 DOI: 10.1097/olq.0000000000001264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A substantial fraction of sexually transmitted infections (STIs) occur in patients who have previously been treated for an STI. We assessed whether routine electronic health record (EHR) data can predict which patients presenting with an incident STI are at greatest risk for additional STIs in the next 1 to 2 years. METHODS We used structured EHR data on patients 15 years or older who acquired an incident STI diagnosis in 2008 to 2015 in eastern Massachusetts. We applied machine learning algorithms to model risk of acquiring ≥1 or ≥2 additional STIs diagnoses within 365 or 730 days after the initial diagnosis using more than 180 different EHR variables. We performed sensitivity analysis incorporating state health department surveillance data to assess whether improving the accuracy of identifying STI cases improved algorithm performance. RESULTS We identified 8723 incident episodes of laboratory-confirmed gonorrhea, chlamydia, or syphilis. Bayesian Additive Regression Trees, the best-performing algorithm of any single method, had a cross-validated area under the receiver operating curve of 0.75. Receiver operating curves for this algorithm showed a poor balance between sensitivity and positive predictive value (PPV). A predictive probability threshold with a sensitivity of 91.5% had a corresponding PPV of 3.9%. A higher threshold with a PPV of 29.5% had a sensitivity of 11.7%. Attempting to improve the classification of patients with and without repeat STIs diagnoses by incorporating health department surveillance data had minimal impact on cross-validated area under the receiver operating curve. CONCLUSIONS Machine algorithms using structured EHR data did not differentiate well between patients with and without repeat STIs diagnosis. Alternative strategies, able to account for sociobehavioral characteristics, could be explored.
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Affiliation(s)
- Heather R. Elder
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston
| | | | - Sarah J. Willis
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | - Noelle Cocoros
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | | | - Elaine W. Flagg
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
- Department of Medicine, Brigham and Women’s Hospital
| | - Katherine K. Hsu
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston
- Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, MA
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Mann LM, Llata E, Flagg EW, Hong J, Asbel L, Carlos-Henderson J, Kerani RP, Kohn R, Pathela P, Schumacher C, Torrone EA. Trends in the Prevalence of Anogenital Warts Among Patients at Sexually Transmitted Disease Clinics-Sexually Transmitted Disease Surveillance Network, United States, 2010-2016. J Infect Dis 2020; 219:1389-1397. [PMID: 30500908 DOI: 10.1093/infdis/jiy684] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/27/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Approximately 90% of genital warts are caused by human papillomavirus (HPV) types 6 and 11. In the United States, HPV vaccination has been recommended for girls and women aged ≤26 years, and since 2011, for boys and men aged ≤21 years and for gay, bisexual, and other men who have sex with men (MSM) aged ≤26 years. METHODS Data were obtained from 27 clinics participating in the STD Surveillance Network. Trends in the annual prevalence of anogenital warts (AGW) from 2010-2016 were described by sex and by the sex of sex partners. RESULTS During 2010-2016, significant declines in the prevalence of AGW were observed in women aged <40 years, men who have sex with women only (MSW) aged <40 years, and MSM of all age categories. An inflection in trend in 2012 was noted for MSW aged 20-24 or 25-29 years and for MSM aged 20-24 years. CONCLUSIONS The observed declines in the prevalence of AGW suggest that HPV morbidity is declining among populations attending STD clinics, including MSW, MSM, and women. Declines in younger age groups are consistent with what would be expected following the implementation of HPV vaccination. However, declines were also observed in older age groups and are not likely to be the result of vaccination.
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Affiliation(s)
- Laura M Mann
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Eloisa Llata
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elaine W Flagg
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jaeyoung Hong
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lenore Asbel
- City of Philadelphia Department of Public Health, Pennsylvania
| | | | | | - Robert Kohn
- San Francisco Department of Public Health, California
| | - Preeti Pathela
- New York City Department of Health and Mental Hygiene, New York
| | | | - Elizabeth A Torrone
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
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Dee EC, Hsu KK, Kruskal BA, Menchaca JT, Zambarano B, Cocoros N, Herrick B, Weiss MDP, Hafer E, Erani D, Josephson M, Young J, Torrone EA, Flagg EW, Klompas M. Temporal Patterns in Chlamydia Repeat Testing in Massachusetts. Am J Prev Med 2019; 56:458-463. [PMID: 30777163 PMCID: PMC6931253 DOI: 10.1016/j.amepre.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 06/05/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION National guidelines recommend test-of-cure for pregnant women and test-of-reinfection for all patients with chlamydia infections in order to interrupt transmission and prevent adverse sequelae for patients, partners, and newborns. Little is known about retesting and positivity rates, and whether they are changing over time, particularly in private sector practices. METHODS Electronic health record data on patients with chlamydia tests were extracted from three independent clinical practice groups serving ≅20% of the Massachusetts population. Records were extracted using the Electronic medical record Support for Public Health platform (esphealth.org). These data were analyzed for temporal trends in annual repeat testing rates by using generalized estimating equations after index positive chlamydia tests between 2010 and 2015 and for differences in intervals to first repeat tests among pregnant females, non-pregnant females, and males. Data extraction and analysis were performed during calendar years 2017 and 2018. RESULTS An index positive C. trachomatis result was identified for 972 pregnant female cases, 10,309 non-pregnant female cases, and 4,973 male cases. Test-of-cure 3-5 weeks after an index positive test occurred in 37% of pregnant females. Test-of-reinfection 8-16 weeks after an index positive test occurred in 39% of pregnant females, 18% of non-pregnant females, and 9% of males. There were no significant increases in test-of-cure or test-of-reinfection rates from 2010 to 2015. Among cases with repeat tests, 16% of pregnant females, 15% of non-pregnant females, and 16% of males had positive results. CONCLUSIONS Chlamydia test-of-cure and test-of-reinfection rates are low, with no evidence of improvement over time. There are substantial opportunities to improve adherence to chlamydia repeat testing recommendations.
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Affiliation(s)
- Elizabeth C Dee
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Katherine K Hsu
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - John T Menchaca
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Noelle Cocoros
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | | | - Ellen Hafer
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Diana Erani
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Mark Josephson
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Jessica Young
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Elizabeth A Torrone
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elaine W Flagg
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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Watson M, Benard V, Flagg EW. Assessment of trends in cervical cancer screening rates using healthcare claims data: United States, 2003-2014. Prev Med Rep 2018; 9:124-130. [PMID: 29527465 PMCID: PMC5840841 DOI: 10.1016/j.pmedr.2018.01.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 08/11/2017] [Revised: 12/27/2017] [Accepted: 01/20/2018] [Indexed: 01/18/2023] Open
Abstract
Improved understanding of the natural history of cervical cancer has led to changes in screening recommendations, including the addition of the human papillomavirus (HPV) testing as an option in routine screening. Most studies of screening trends have used national self-reported survey data. To better understand recent trends in cervical cancer screening, including cytology (Papanicolaou, or Pap, tests) and human papillomavirus co-tests (HPV + Pap test), we used healthcare claims data to examine screening practices and trends. We analyzed screening among commercially-insured females ages 18-65 during 2005-2014 who were continuously enrolled during three or more contiguous calendar years, to identify those who received cervical cancer screening with a Pap test or co-test. We examined screening prevalence by age group and year. During the latter years of our study period, screening prevalence (regardless of screening method) declined significantly for women in all age groups examined. Despite declines in overall screening, the prevalence of co-testing increased in all age groups except those aged 18-20. In 2014, women aged 30-39 had the highest overall screening uptake (77.5%) and the highest use of co-testing (44.4%); this group also had the lowest overall declines in screening over the time period (-4.5%). These screening measures from healthcare claims were lower than self-reported screening from national surveys of the general population. More research to explore the reasons for these differences is needed to ensure that women are receiving appropriate screening, and to better understand why screening prevalence is declining among this population of commercially insured women.
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Affiliation(s)
- Meg Watson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Vicki Benard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elaine W. Flagg
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R. Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015-2016. NCHS Data Brief 2018:1-8. [PMID: 29442994] [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: 06/08/2023]
Abstract
Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are common, lifelong infections, which often have no symptoms (1). People with symptoms may have painful blisters or sores at the site of infection (2,3). The viruses are transmitted through contact with an infected person’s lesion, mucosal surface, or genital or oral secretions. This report provides recent national estimates of HSV-1 and HSV-2 antibody prevalence from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) among persons aged 14–49 by age, sex, and race and Hispanic origin, and examines trends in prevalence by race and Hispanic origin from 1999–2000 to 2015–2016.
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10
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Kreisel K, Flagg EW, Torrone E. Trends in pelvic inflammatory disease emergency department visits, United States, 2006-2013. Am J Obstet Gynecol 2018; 218:117.e1-117.e10. [PMID: 29045851 DOI: 10.1016/j.ajog.2017.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/25/2017] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pelvic inflammatory disease is a female genital tract disorder with severe reproductive sequelae. Because of the difficulties in diagnosing pelvic inflammatory disease, it is not a reportable condition in many states. Females seeking care in emergency departments are a sentinel population for pelvic inflammatory disease surveillance. OBJECTIVE The objective of the study was to determine trends in diagnoses of acute pelvic inflammatory disease in a nationally representative sample of emergency departments. STUDY DESIGN All emergency department visits among females aged 15-44 years with an International Classification of Diseases, ninth revision, Clinical Modification diagnosis code indicating pelvic inflammatory disease during 2006-2013 were assessed from the HealthCare Utilization Project Nationwide Emergency Department Sample. Total and annual percentage changes in the proportion of pelvic inflammatory disease emergency department visits were estimated using trend analyses. RESULTS While the number of emergency department visits among females aged 15-44 years during 2006-2013 increased (6.5 million to 7.4 million), the percentage of visits due to pelvic inflammatory disease decreased from 0.57% in 2006 to 0.41% in 2013 (total percentage change, -28.4%; annual percent change, -4.3%; 95% confidence interval, -5.7% to -2.9%). The largest decreases were among those aged 15-19 years (total percent change, -40.6%; annual percentage change, -6.6%; 95% confidence interval, -8.6% to -4.4%) and living in the South (total percentage change, -38.0%; annual percentage change, -6.2%; 95% confidence interval, -7.8% to -4.6%). Females aged 15-19 years who lived in the South had a 47.9% decrease in visits due to pelvic inflammatory disease (annual percentage change, -8.4%, 95% confidence interval, -10.4 to -6.5). Patients living in ZIP codes with the lowest median income (<$38,000) had the highest percent of visits with a pelvic inflammatory disease diagnosis; the smallest declines over time were in patients living in ZIP codes with the highest median income (i.e., >$64,000, total percent change, -24.4%; annual percent change, -3.8%; 95% confidence interval, -5.2% to -2.4%). The percentage of emergency department visits due to pelvic inflammatory disease was highest among patients not charged for their visit, self-paying, or those covered by Medicaid, with total percentage changes in these 3 groups of -27.8%, -30.7%, and -35.1%, respectively. Patients with Medicaid coverage had the largest decrease in visits with a diagnosis of pelvic inflammatory disease (total percent change, -35.1%; annual percent change, -5.8%; 95% confidence interval, -7.2% to -4.3%). CONCLUSION Nationally representative data indicate the percentage of emergency department visits with a pelvic inflammatory disease diagnosis decreased during 2006-2013 among females aged 15-44 years, primarily driven by decreased diagnoses of pelvic inflammatory disease among females aged 15-19 years and among women living in the southern United States. Despite declines, a large number of females of reproductive age are receiving care for pelvic inflammatory disease in emergency departments. Patients with lower median income and no or public health insurance status, which may decrease access to and use of health care services, consistently had the highest percentage of emergency department visits due to pelvic inflammatory disease. Future research should focus on obtaining a better understanding of factors influencing trends in pelvic inflammatory disease diagnoses and ways to address the challenges surrounding surveillance for this condition.
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Affiliation(s)
- Kristen Kreisel
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA.
| | - Elaine W Flagg
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA
| | - Elizabeth Torrone
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA
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Flagg EW, Torrone EA. Declines in Anogenital Warts Among Age Groups Most Likely to Be Impacted by Human Papillomavirus Vaccination, United States, 2006-2014. Am J Public Health 2017; 108:112-119. [PMID: 29161070 DOI: 10.2105/ajph.2017.304119] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To detect decreases in anogenital warts (AGW) among sex and age groups likely to be affected by human papillomavirus vaccination. METHODS We estimated annual AGW prevalence during 2006 to 2014 using health care claims among US private health insurance enrollees aged 15 to 39 years. We derived AGW diagnoses using 1 of the following: (1) condylomata acuminata diagnosis, (2) viral wart diagnosis combined with a benign anogenital neoplasm diagnosis or destruction or excision of an anogenital lesion, or (3) AGW medication combined with a benign anogenital neoplasm diagnosis or destruction or excision of an anogenital lesion. RESULTS Prevalence decreased during 2008 to 2014 among females aged 15 to 19 years (annual percentage change [APC] = -14.1%; P < .001) and during 2009 to 2014 among women aged 20 to 24 years (APC = -12.9%; P < .001) and among women aged 25 to 29 years (APC = -6.0%; P = .001). We observed significant declines among men aged 20 to 24 years (APC = -6.5%; P = .005). Prevalence increased or was stable in all other sex and age groups. CONCLUSIONS We observed AGW decreases among females in the age groups most likely to be affected by human papillomavirus vaccination and decreases in men aged 20 to 24 years. Decreased prevalence in young men is likely attributable to herd protection from vaccination among females.
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Affiliation(s)
- Elaine W Flagg
- Both authors are with the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth A Torrone
- Both authors are with the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Watson M, Soman A, Flagg EW, Unger E, Deapen D, Chen VW, Peres LC, Copeland G, Tucker TC, Garnett E, Saraiya M. Surveillance of high-grade cervical cancer precursors (CIN III/AIS) in four population-based cancer registries, United States, 2009-2012. Prev Med 2017; 103:60-65. [PMID: 28765084 PMCID: PMC5591775 DOI: 10.1016/j.ypmed.2017.07.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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] [Received: 03/27/2017] [Revised: 06/27/2017] [Accepted: 07/24/2017] [Indexed: 01/09/2023]
Abstract
Surveillance of cervical intraepithelial neoplasia grade III (CIN III) and adenocarcinoma in situ (AIS) is important for determining the burden of a preventable disease, identifying effects of vaccination on future diagnoses, and developing targeted programs. We analyzed population-based rates of high-grade cervical cancer precursor lesions using data from four central cancer registries (diagnosis years 2009-2012 from Louisiana, Kentucky, Michigan, and diagnosis years 2011-2012 from Los Angeles) by age, race, and histology. We also compared rates of precursors to invasive cancers. With 4 complete years of data from Michigan, we were able to conduct a trend analysis for that state. Data analysis was conducted in Atlanta during 2016. Kentucky reported the highest rate of CIN III/AIS (69.8), followed by Michigan (55.4), Louisiana (42.3), and Los Angeles (19.2). CIN III/AIS rates declined among women in Michigan by 37% each year for women aged 15-19, 14% for those aged 20-24, and 7% for those aged 25-29. Rates of CIN III/AIS vary by registry, and were higher than invasive cancer. In Michigan, declines in CIN III/AIS among women aged 15-29 are likely related in part to updated screening recommendations, and to the impact of human papillomavirus vaccination.
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Affiliation(s)
- Meg Watson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | | | - Elaine W Flagg
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elizabeth Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dennis Deapen
- Los Angeles County Cancer Surveillance Program, Los Angeles, CA, United States
| | - Vivien W Chen
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Lauren C Peres
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Glenn Copeland
- Michigan Cancer Surveillance Program, Lansing, MI, United States
| | | | - Erin Garnett
- Advanced Technical Logistics, Inc., Newnan, GA, United States
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Flagg EW, Torrone EA, Weinstock H. Ecological Association of Human Papillomavirus Vaccination with Cervical Dysplasia Prevalence in the United States, 2007-2014. Am J Public Health 2016; 106:2211-2218. [PMID: 27736208 DOI: 10.2105/ajph.2016.303472] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine prevalence of low- and high-grade cervical lesions over time in a large cohort of US female adolescents and women. METHODS We used health care claims data from 9 million privately insured female patients aged 15 to 39 years to estimate annual prevalence of cytologically detected cervical low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and high-grade histologically detected cervical intraepithelial neoplasia grades 2 and 3 (CIN2+) during 2007 through 2014. We restricted analyses to those who received cervical cancer screening in a given calendar year. RESULTS Prevalence of HSIL and CIN2+ decreased significantly for those aged 15 to 19 years. Average annual percent change in prevalence in this group during 2007 through 2014 for HSIL and CIN2+ was -8.3% and -14.4%, respectively (P < .001 for both estimates). Prevalence of HSIL and CIN2+ also decreased significantly for women aged 20 to 24 years. No decreases were seen in women aged 25 to 39 years. CONCLUSIONS Decreases in high-grade lesions reflected their greater association with human papillomavirus types 16 and 18, compared with low-grade lesions, providing ecological evidence of population effectiveness of human papillomavirus vaccination among young, privately insured women.
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Affiliation(s)
- Elaine W Flagg
- At the time of the study, all of the authors were with the Division of STD Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention; Atlanta, GA
| | - Elizabeth A Torrone
- At the time of the study, all of the authors were with the Division of STD Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention; Atlanta, GA
| | - Hillard Weinstock
- At the time of the study, all of the authors were with the Division of STD Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention; Atlanta, GA
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Flagg EW, Torrone E, Weinstock H. P10.08 Prevalence of low- and high-grade cervical intraepithelial lesions among female participants in private health plans in the united states, 2007–2013: ecologic evidence of population effectiveness of human papillomavirus vaccination. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.436] [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: 11/04/2022]
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Potter RC, Flagg EW, Datta SD, Saraiya M, Copeland G. Monitoring the impact of human papillomavirus vaccines on high-grade pre-invasive cervical lesions: designing a framework of linked immunization information system and cancer registry data in Michigan. Vaccine 2015; 33:1400-5. [PMID: 25573038 PMCID: PMC6921485 DOI: 10.1016/j.vaccine.2014.12.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 11/30/2022]
Abstract
State immunization and cancer registries contain data that, if linked, could be used to monitor the impact of human papillomavirus (HPV) vaccine on cervical cancer and precancer. Michigan is uniquely positioned to examine these outcomes using two population-based resources: the state-wide cancer registry and immunization information system (IIS). We assessed the feasibility of identifying females in the IIS who had continuous Michigan residence and linking them to the cancer registry. We considered continuous residence necessary for future studies of vaccine impact to avoid misclassifying those who may have been immunized while residing out-of-state and whose immunization therefore may not have been reported in Michigan. We identified females with 1976-1996 birthdates in the IIS and used probabilistic linkage software to match them with Michigan birth records. A stratified random sample of IIS-birth matches was provided to a commercial locator service to identify females with continuous Michigan residence. Cervical carcinoma in situ cases diagnosed in 2006 among females aged 10 through 30 years were also matched with the birth records; cancer registry-birth matches were merged with the IIS-birth matches using the birth record identifier. Overall, 68% of the 1274,282 IIS and 61% of the 1358 cancer registry records could be matched with birth records. Among the sample of IIS-birth matches, most (86%) were continuous residents. Seventy percent or more of cancer registry-birth matches merged with IIS-birth matches for cases born after 1984. This is the first effort in the U.S. to show that linking records across IIS and cancer registries is practical and reasonably efficient. The increasing proportion of matches between the registries and live birth file with birth year, and the use of population-based data, strengthen the utility of this approach. Future steps include use of this method to examine incidence of cervical cancer precursors in HPV immunization-eligible females.
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Affiliation(s)
- Rachel C Potter
- Michigan Department of Community Health, Division of Immunization, 201 Townsend, PO Box 30195, Lansing, MI 48909, United States.
| | - Elaine W Flagg
- Surveillance and Data Management Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE MS E-02, Atlanta, GA 30333, United States.
| | - S Deblina Datta
- Surveillance and Data Management Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE MS E-02, Atlanta, GA 30333, United States.
| | - Mona Saraiya
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE MS K-40, Atlanta, GA 30341, United States.
| | - Glenn Copeland
- Michigan Department of Community Health, Division for Vital Records and Health Statistics, 201 Townsend, PO Box 30195, Lansing, MI 48909, United States.
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Drolet M, Bénard É, Boily MC, Ali H, Baandrup L, Bauer H, Beddows S, Brisson J, Brotherton JML, Cummings T, Donovan B, Fairley CK, Flagg EW, Johnson AM, Kahn JA, Kavanagh K, Kjaer SK, Kliewer EV, Lemieux-Mellouki P, Markowitz L, Mboup A, Mesher D, Niccolai L, Oliphant J, Pollock KG, Soldan K, Sonnenberg P, Tabrizi SN, Tanton C, Brisson M. Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis 2015; 15:565-80. [PMID: 25744474 DOI: 10.1016/s1473-3099(14)71073-4] [Citation(s) in RCA: 457] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination programmes were first implemented in several countries worldwide in 2007. We did a systematic review and meta-analysis to assess the population-level consequences and herd effects after female HPV vaccination programmes, to verify whether or not the high efficacy reported in randomised controlled clinical trials are materialising in real-world situations. METHODS We searched the Medline and Embase databases (between Jan 1, 2007 and Feb 28, 2014) and conference abstracts for time-trend studies that analysed changes, between the pre-vaccination and post-vaccination periods, in the incidence or prevalence of at least one HPV-related endpoint: HPV infection, anogenital warts, and high-grade cervical lesions. We used random-effects models to derive pooled relative risk (RR) estimates. We stratified all analyses by age and sex. We did subgroup analyses by comparing studies according to vaccine type, vaccination coverage, and years since implementation of the vaccination programme. We assessed heterogeneity across studies using I(2) and χ(2) statistics and we did trends analysis to examine the dose-response association between HPV vaccination coverage and each study effect measure. FINDINGS We identified 20 eligible studies, which were all undertaken in nine high-income countries and represent more than 140 million person-years of follow-up. In countries with female vaccination coverage of at least 50%, HPV type 16 and 18 infections decreased significantly between the pre-vaccination and post-vaccination periods by 68% (RR 0·32, 95% CI 0·19-0·52) and anogenital warts decreased significantly by 61% (0·39, 0·22-0·71) in girls 13-19 years of age. Significant reductions were also recorded in HPV types 31, 33, and 45 in this age group of girls (RR 0·72, 95% CI 0·54-0·96), which suggests cross-protection. Additionally, significant reductions in anogenital warts were also reported in boys younger than 20 years of age (0·66 [95% CI 0·47-0·91]) and in women 20-39 years of age (0·68 [95% CI 0·51-0·89]), which suggests herd effects. In countries with female vaccination coverage lower than 50%, significant reductions in HPV types 16 and 18 infection (RR 0·50, 95% CI 0·34-0·74]) and in anogenital warts (0·86 [95% CI 0·79-0·94]) occurred in girls younger than 20 years of age, with no indication of cross-protection or herd effects. INTERPRETATION Our results are promising for the long-term population-level effects of HPV vaccination programmes. However, continued monitoring is essential to identify any signals of potential waning efficacy or type-replacement. FUNDING The Canadian Institutes of Health Research.
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Affiliation(s)
- Mélanie Drolet
- Centre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | - Élodie Bénard
- Centre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | - Marie-Claude Boily
- Centre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Hammad Ali
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Louise Baandrup
- Unit of Virus, Lifestyle and Genes, The Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Heidi Bauer
- STD Control Branch of the California Department of Public Health, Richmond, CA, USA
| | - Simon Beddows
- Virus Reference Department, Public Health England, London, UK
| | - Jacques Brisson
- Centre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | - Julia M L Brotherton
- National HPV Vaccination Program Register, Victorian Cytology Service, East Melbourne, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Teresa Cummings
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia; Central Clinical School, Monash University, Alfred Hospital, Melbourne, VIC, Australia
| | - Elaine W Flagg
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jessica A Kahn
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, The Danish Cancer Society Research Centre, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Erich V Kliewer
- Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada; Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Philippe Lemieux-Mellouki
- Centre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | - Lauri Markowitz
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aminata Mboup
- Centre de Recherche du CHU de Québec, Québec, QC, Canada
| | - David Mesher
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Linda Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, CT, USA
| | | | | | - Kate Soldan
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, UK
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Regional WHO HPV Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Clare Tanton
- Research Department of Infection and Population Health, University College London, London, UK
| | - Marc Brisson
- Centre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
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Owusu-Edusei K, Flagg EW, Gift TL. Hospitalization cost per case of neonatal herpes simplex virus infection from claims data. J Pediatr Nurs 2015; 30:346-52. [PMID: 25193688 DOI: 10.1016/j.pedn.2014.08.004] [Citation(s) in RCA: 11] [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] [Received: 04/17/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to estimate the average excess inpatient cost of neonatal herpes simplex virus (NHSV) infection from 2005 to 2009 insurance claims data. The estimated adjusted average excess inpatient cost for neonate admissions with HSV diagnosis and >7 days of hospitalization was $40,044 [95% confidence interval (CI), $33,529-$47,775]. When disaggregated by the days of admission, cost estimates were: 8-13 days, $23,918 [CI, $19,490-$29,282]; 14-21 days, $44,358 [CI, $34,654-$56,673]; >21 days, $68,916 [CI, $49,905-$94,967]). Although these estimates are not representative of the entire US, they can inform future economic evaluation studies on NHSV interventions.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Elaine W Flagg
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Thomas L Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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18
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Flagg EW, Schwartz R, Weinstock H. Prevalence of anogenital warts among participants in private health plans in the United States, 2003-2010: potential impact of human papillomavirus vaccination. Am J Public Health 2013; 103:1428-35. [PMID: 23763409 DOI: 10.2105/ajph.2012.301182] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We estimated anogenital wart prevalence from 2003 to 2010 by gender and age group in a large US cohort with private insurance to detect potential decreases among people most likely to be affected by human papillomavirus (HPV) vaccination. METHODS We restricted health care claims to those from individuals aged 10 to 39 years with continuous insurance within a given year. We derived anogenital wart diagnoses from a diagnosis of condyloma acuminata, or either a less specific viral wart diagnosis or genital wart medication combined with either a benign anogenital neoplasm or destruction or excision of a noncervical anogenital lesion. RESULTS Prevalence increased slightly in 2003 to 2006, then significantly declined in 2007 to 2010 among girls aged 15 to 19 years; increased in 2003 to 2007, remained level through 2009, and declined in 2010 among women aged 20 to 24 years; and increased through 2009 but not in 2010 for women aged 25 to 39 years. For males aged 15 to 39 years, prevalence for each 5-year age group increased in 2003 to 2009, but no increases were observed for 2010. CONCLUSIONS These data indicate reductions in anogenital warts among US females aged 15 to 24 years, the age group most likely to be affected by introduction of the HPV vaccine.
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Affiliation(s)
- Elaine W Flagg
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E., MS E-02, Atlanta, GA 30333, USA.
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19
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Chesson HW, Flagg EW, Koutsky L, Hsu K, Unger ER, Shlay JC, Kerndt P, Ghanem KG, Zenilman JM, Hagensee M, Weinstock H, Datta SD. Modeling the impact of quadrivalent HPV vaccination on the incidence of Pap test abnormalities in the United States. Vaccine 2013; 31:3019-24. [PMID: 23664991 DOI: 10.1016/j.vaccine.2013.04.051] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 03/28/2013] [Accepted: 04/24/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND We present data on Pap test results and HPV prevalence from the HPV Sentinel Surveillance project, a multiyear surveillance project enrolling women from a diverse set of 26 clinics throughout the US from 2003 to 2005. We use mathematical modeling to illustrate the potential timing and magnitude of decreases in Pap test abnormalities in sexually transmitted disease (STD), family planning, and primary care clinics in the US as a result of HPV vaccination. METHODS The probability of an abnormal Pap result was based on three factors: (1) infection with HPV 16/18, or both; (2) infection with high-risk HPV types other than HPV 16/18; and (3) infection with HPV 6/11, or both. We estimated the relative reduction in the probability of an abnormal Pap result over the first 25 years of a female-only, quadrivalent HPV vaccination program, compared to a scenario of no HPV vaccination in which the probability of abnormal Pap results was assumed constant. RESULTS The probability of an abnormal Pap result ranged from 7.0% for the lowest risk group (those without any high-risk HPV types and without HPV 6/11) to 45.2% for the highest risk group (those with HPV 16/18 and at least one other high-risk HPV type). Estimated reductions in abnormal Pap results among women in the 21- to 29-year age group were 0.8%, 10.2%, and 11.3% in years 5, 15, and 25 of the vaccine program respectively, in the lower vaccine coverage scenario, and 7.4%, 21.4%, and 22.2%, respectively, in the higher coverage scenario. CONCLUSIONS Our results suggest that HPV vaccination will have a discernable impact on the probability of Pap abnormalities, but the timing and magnitude of the reduction will depend substantially on vaccine coverage and the degree of cross-protection against high risk HPV types other than HPV 16/18.
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20
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Frankel MR, McNaghten A, Shapiro MF, Sullivan PS, Berry SH, Johnson CH, Flagg EW, Morton S, Bozzette SA. A probability sample for monitoring the HIV-infected population in care in the U.S. and in selected states. Open AIDS J 2012; 6:67-76. [PMID: 23049655 PMCID: PMC3462615 DOI: 10.2174/1874613601206010067] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 08/22/2011] [Accepted: 09/14/2011] [Indexed: 11/22/2022] Open
Abstract
Epidemiologic and clinical changes in the HIV epidemic over time have presented a challenge to public health surveillance to monitor behavioral and clinical factors that affect disease progression and HIV transmission. The Medical Monitoring Project (MMP) is a supplemental surveillance project designed to provide representative, population-based data on clinical status, care, outcomes, and behaviors of HIV-infected persons receiving care at the national level. We describe a three-stage probability sampling method that provides both nationally and state-level representative estimates.In stage-I, 20 states, which included 6 separately funded cities/counties, were selected using probability proportional to size (PPS) sampling. PPS sampling was also used in stage-II to select facilities for participation in each of the 26 funded areas. In stage-III, patients were randomly selected from sampled facilities in a manner that maximized the possibility of having overall equal selection probabilities for every patient in the state or city/county. The sampling methods for MMP could be adapted to other research projects at national or sub-national levels to monitor populations of interest or evaluate outcomes and care for a range of specific diseases or conditions.
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Affiliation(s)
- Martin R Frankel
- Baruch College, The City University of New York, New York City, New York, USA
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21
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Gaffga NH, Flagg EW, Weinstock HS, Shlay JC, Ghanem KG, Koutsky LA, Kerndt PR, Hsu KK, Unger ER, Datta SD. Monitoring HPV type-specific prevalence over time through clinic-based surveillance: a perspective on vaccine effectiveness. Vaccine 2012; 30:1959-64. [PMID: 22265859 DOI: 10.1016/j.vaccine.2012.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 01/06/2012] [Accepted: 01/07/2012] [Indexed: 10/14/2022]
Abstract
We investigated the feasibility of monitoring trends in prevalence of vaccine-preventable human papillomavirus (HPV) types in different clinic populations. We collected cervical specimens from women presenting to family planning, primary care, and sexually transmitted disease (STD) clinics for routine pap smears in five US cities during 2003-2005. We performed HPV genotyping and calculated annual type-specific prevalences; pre-vaccine era prevalence was highest for HPV 16 (6.0; 95% confidence interval [CI] 5.5-6.6%) and annual prevalences for vaccine-preventable types were stable, with few exceptions, after controlling for clinic type, age group, and city. With sufficient sample size and stable population characteristics, clinic-based surveillance systems can contribute to monitoring HPV vaccine impact in the cervical screening population.
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Affiliation(s)
- N H Gaffga
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Epidemiology and Surveillance Branch, Atlanta, GA 30333, United States
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Abstract
OBJECTIVES Neonatal herpes simplex virus (nHSV) infections, although relatively rare, cause significant morbidity and mortality. Estimates of nHSV incidence across the United States vary widely and have been derived by using a variety of methods. We estimated the incidence of nHSV infections for the United States during 2006, as well as demographic-specific rates, by using nationally and regionally weighted estimates from a population-based sample of inpatient data. METHODS We examined inpatient records of infants aged 60 days or younger at admission using the Healthcare Cost and Utilization Project Kids' Inpatient Database. Patients with a length of stay that exceeded 7 days (or deceased during hospitalization) were identified at discharge from the International Classification of Diseases, Ninth Revision, Clinical Modification codes for herpes simplex (054.0-054.9). Cases for which patients had been transferred from another hospital or readmitted were excluded from case counts. RESULTS We found an overall US incidence of 9.6 per 100 000 births in 2006. Rates per 100 000 births among US regions were 8.2 in the Northeast, 12.9 in the Midwest, 8.9 in the South, and 8.8 in the West. Rates of 13.8, 9.9, and 7.5 were observed for black, white, and Hispanic newborns, respectively; these differences were not statistically significant. Rates were significantly higher among cases for which the expected primary payer was Medicaid (15.1) compared with private insurance or managed health care (5.4). Median age at admission was 10 days; 25% of admissions were on the day of birth. CONCLUSIONS This description of regional and demographic-specific nHSV incidence rates for the United States provides important new information on the extent of this potentially devastating disease.
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Affiliation(s)
- Elaine W Flagg
- US Centers for Disease Control and Prevention, 1600 Clifton Rd, Mail Stop E02, Atlanta, GA 30333, USA.
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Shah JJ, Maloney SA, Cetron MS, Wilkins PP, Maguire JH, Causer L, Sharp DJ, Merritt S, Weston R, Young SA, Flagg EW, Calderon J, Johnston SP, Liu Y, Keane V. Evaluation of the Impact of Overseas Pre-departure Treatment for Infection with Intestinal Parasites among Montagnard Refugees Migrating from Cambodia to North Carolina. Am J Trop Med Hyg 2008. [DOI: 10.4269/ajtmh.2008.78.754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shah JJ, Maloney SA, Liu Y, Flagg EW, Johnston SP, Young SA, Weston R, Merritt S, Wilkins PP, Keane V, Calderon J, Sharp DJ, Causer L, Maguire JH, Cetron MS. Evaluation of the impact of overseas pre-departure treatment for infection with intestinal parasites among Montagnard refugees migrating from Cambodia to North Carolina. Am J Trop Med Hyg 2008; 78:754-759. [PMID: 18458310] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We evaluated the effectiveness of an overseas pre-departure regimen of five days of albendazole for presumptive treatment of intestinal parasites by examining stool specimens in treated and untreated Montagnard refugees after arrival in the United States. Among 815 refugees evaluated, fully treated refugees had a significantly lower prevalence of helminths (11 [1.4%] of 777), specifically hookworm and Ascaris lumbricoides, than untreated pregnant women (3 [20%] of 15) (P < 0.001). Multivariate analysis showed that treatment was associated with significantly lower rates of infection with helminths but not protozoa. Post-arrival gastrointestinal symptoms were not associated with findings on stool examination. Our evaluation suggests that although additional studies are needed to determine optimal treatment regimens for intestinal parasites, especially among young children and pregnant women, a five-day course of pre-departure albendazole was effective in reducing helminthic infection in treated refugees.
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Affiliation(s)
- J Jina Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia 30329-4018, USA.
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25
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Lund MJ, Trivers KF, Porter PL, Coates RJ, Leyland-Jones B, Brawley OW, Flagg EW, O'Regan RM, Gabram SGA, Eley JW. Race and triple negative threats to breast cancer survival: a population-based study in Atlanta, GA. Breast Cancer Res Treat 2008; 113:357-70. [PMID: 18324472 DOI: 10.1007/s10549-008-9926-3] [Citation(s) in RCA: 293] [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] [Received: 01/24/2008] [Accepted: 01/28/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breast cancers with a triple negative tumor (TNT) subtype (as defined by lacking protein expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)) preclude the use of available targeted therapies and may contribute to poor outcome and to the historically poorest survival observed among African-American (AA) women. This study examines association of the ER/PR/HER2 subtypes with race and breast cancer survival. METHODS Breast tumors from a population-based cohort of 116 AA and 360 white Atlanta women aged 20-54, diagnosed from 1990 to 1992 were centrally reviewed and tested by immunohistochemistry. Multivariate survival analyses within subtypes (TNT, ER-PR-HER2+, ER+/PR+HER2+, ER+/PR+HER2-) were conducted using weighted Cox regression and included socio-demographic, prognostic, and treatment factors. RESULTS TNTs were more prevalent among young women and particularly among AA women (Odds Ratio [OR] = 1.9, 95% Confidence Interval [CI] 1.2-2.9), adjusting for age, stage, grade, and poverty index. Overall mortality was higher for AA women (Hazard Ratio [HR] = 1.9, 95% CI, 1.5-2.5) and differed by subtypes (P < 0.001). Within the TNT subtype, racial differences in survival persisted, after additional adjustment for treatment and comorbidities (HR = 2.0, 95% CI 1.0-3.7). TNTs were uniquely associated with high expression of p16, p53, and Cyclin E; and low Bcl-2 and Cyclin D1 expression. CONCLUSIONS The high prevalence of TNTs among younger women and particularly younger AA women, along with unique protein expression patterns and poorer survival, suggests varying gene-environment etiologies with respect to age and race/ethnicity and a need for effective therapies.
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Affiliation(s)
- Mary Jo Lund
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
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Hahn KME, Bondy ML, Selvan M, Lund MJ, Liff JM, Flagg EW, Brinton LA, Porter P, Eley JW, Coates RJ. Factors associated with advanced disease stage at diagnosis in a population-based study of patients with newly diagnosed breast cancer. Am J Epidemiol 2007; 166:1035-44. [PMID: 17690220 DOI: 10.1093/aje/kwm177] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Breast cancer is diagnosed at a younger age and a more advanced stage in African-American women than in White women. The authors investigated the effects of several factors, including race, on stage of breast cancer in women aged 20-54 years living in Atlanta, Georgia, and diagnosed between 1990 and 1992. A total of 251 African-American and 580 White women were interviewed and their medical records reviewed. By use of polytomous logistic regression, factors possibly influencing stage and racial differences in stage were studied. In African-American women, the odds of stage III/IV breast cancer at diagnosis were almost four times the odds in White women (odds ratio = 3.79, 95% confidence interval: 2.45, 5.89) and approximately two and one-half times for stage IIA or stage IIB disease (odds ratio = 2.57, 95% confidence interval: 1.66, 3.99; odds ratio = 1.94, 95% confidence interval: 1.31, 2.86, respectively). These racial differences appeared to be largely explained by insurance status, poverty, history of mammography, method of tumor detection, and obesity. Interventions targeting these factors could potentially lower the stage at diagnosis for African-American breast cancer patients and, in doing so, improve their survival and other outcomes.
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Affiliation(s)
- Karin M E Hahn
- Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77230, USA.
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Posey DL, Blackburn BG, Weinberg M, Flagg EW, Ortega L, Wilson M, Secor WE, Sanders-Lewis K, Won K, Maguire JH. High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis 2007; 45:1310-5. [PMID: 17968826 DOI: 10.1086/522529] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 07/02/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Schistosomiasis and strongyloidiasis cause substantial morbidity and mortality among hundreds of millions of infected persons worldwide. In the United States, these infections are most commonly found among international travelers, immigrants, and refugees from areas of endemicity. Refugees resettled to the United States since 2000 include >3800 "Lost Boys and Girls" of Sudan and 8000 Somali Bantu. Many Lost Boys and Girls of Sudan reported chronic abdominal pain only since arrival, and some received diagnoses of schistosomiasis or strongyloidiasis. We assessed seroprevalence of these infections among these refugees and hypothesized an association between infection and abdominal pain. METHODS We offered a survey assessing chronic abdominal pain and serologic testing for schistosomiasis and strongyloidiasis to all 800 attendees of a Lost Boys and Girls of Sudan reunion in the United States. Serologic testing was performed on preimmigration specimens obtained from 100 United States-bound Somali Bantu refugees. RESULTS Of the 462 Sudanese refugees (58%) tested, 44% and 46% were seropositive for schistosomiasis (primarily due to Schistosoma mansoni) and strongyloidiasis, respectively; 24% of those who tested positive for schistosomiasis had S. mansoni antigenemia. Forty-six percent reported chronic abdominal pain, which was not associated with either infection. Among 100 Somali Bantu, 73% and 23% tested seropositive for schistosomiasis (primarily due to Schistosoma haematobium) and strongyloidiasis, respectively. CONCLUSIONS The high seroprevalence of schistosomiasis and strongyloidiasis among Sudanese Lost Boys and Girls and Somali Bantu refugees supports presumptive treatment for these refugees. Current refugee resettlement policies inadequately address these diseases; our data support consideration of predeparture presumptive therapy for all refugees from areas of endemicity.
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Affiliation(s)
- Drew L Posey
- Division of Global Migration and Quarantine, National Center for Preparedness, Detection, and Control of Infectious Diseases, Atlanta, GA 30333, USA.
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Trivers KF, Gammon MD, Abrahamson PE, Lund MJ, Flagg EW, Moorman PG, Kaufman JS, Cai J, Porter PL, Brinton LA, Eley JW, Coates RJ. Oral Contraceptives and Survival in Breast Cancer Patients Aged 20 to 54 Years. Cancer Epidemiol Biomarkers Prev 2007; 16:1822-7. [PMID: 17855700 DOI: 10.1158/1055-9965.epi-07-0053] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Recent oral contraceptive (OC) use is associated with modestly higher breast cancer incidence among younger women, but its impact on survival is unclear. This study examined the relationship between OC use before breast cancer diagnosis and survival. A population-based sample of 1,264 women aged 20 to 54 years with a first primary invasive breast cancer during 1990 to 1992 were followed up for 8 to 10 years. OC and covariate data were obtained by interviews conducted shortly after diagnosis and from medial records. All-cause mortality was ascertained through the National Death Index (n = 292 deaths). Age- and income-adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated by Cox regression methods. All-cause mortality was not associated with ever use of OCs or duration of use. Compared with nonusers, mortality estimates were elevated among women who were using OCs at diagnosis or stopped use in the previous year (HR, 1.57; 95% CI, 0.95-2.61). The HR for use of high-dose estrogen pills within 5 years before diagnosis was double that of nonusers (HR, 2.39; 95% CI, 1.29-4.41) or, if the most recent pill included the progestin levonorgestrel, compared with nonusers (HR, 2.01; 95% CI, 1.03-3.91). Because subgroup estimates were based on small numbers of OC users, these results should be cautiously interpreted. Overall, most aspects of OC use did not seem to influence survival, although there is limited evidence that OC use just before diagnosis, particularly use of some pill types, may negatively impact survival in breast cancer patients aged 20 to 54 years.
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Affiliation(s)
- Katrina F Trivers
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-52, Atlanta, GA 30341, USA.
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Abrahamson PE, Gammon MD, Lund MJ, Flagg EW, Porter PL, Stevens J, Swanson CA, Brinton LA, Eley JW, Coates RJ. General and abdominal obesity and survival among young women with breast cancer. Cancer Epidemiol Biomarkers Prev 2006; 15:1871-7. [PMID: 17035393 DOI: 10.1158/1055-9965.epi-06-0356] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Among postmenopausal women, obesity is linked to increased risk of breast cancer and poorer subsequent survival. For premenopausal women, obesity may reduce incidence, but less is known about its effect on prognosis, particularly for abdominal obesity. This study investigated whether general or abdominal obesity at diagnosis influenced survival in a cohort of young women with breast cancer. A population-based follow-up study was conducted among 1,254 women ages 20 to 54 who were diagnosed with invasive breast cancer between 1990 and 1992 in Atlanta or New Jersey. Women were interviewed within several months of diagnosis and asked about their weight and height at age 20 and in the year before diagnosis. Study personnel did anthropometric measures at the interview. With 8 to 10 years of follow-up, all-cause mortality status was determined using the National Death Index (n = 290 deaths). Increased mortality was observed for women who were obese [body mass index (BMI), > or =30] at the time of interview compared with women of ideal weight [BMI, 18.5-24.9; stage- and income-adjusted hazard ratio (HR), 1.48; 95% confidence interval (95% CI), 1.09-2.01]. A similar result was seen for the highest versus lowest quartile of waist-to-hip ratio (HR, 1.52; 95% CI, 1.05-2.19). Strong associations with mortality were found for women who were obese at age 20 (HR, 2.49; 95% CI, 1.15-5.37) or who were overweight/obese (BMI, > or =25) at both age 20 and the time of interview (HR, 2.22; 95% CI, 1.45-3.40). This study provides evidence that breast cancer survival is reduced among younger women with general or abdominal obesity.
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Affiliation(s)
- Page E Abrahamson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Trivers KF, Gammon MD, Abrahamson PE, Lund MJ, Flagg EW, Kaufman JS, Moorman PG, Cai J, Olshan AF, Porter PL, Brinton LA, Eley JW, Coates RJ. Association between reproductive factors and breast cancer survival in younger women. Breast Cancer Res Treat 2006; 103:93-102. [PMID: 17004111 DOI: 10.1007/s10549-006-9346-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 07/17/2006] [Indexed: 10/24/2022]
Abstract
This analysis investigated whether reproductive factors such as age at menarche, parity, and timing and outcomes of pregnancies were associated with survival among women with breast cancer younger than 55 years. Female residents of Atlanta, Georgia, and central New Jersey who were diagnosed with a primary, incident invasive breast cancer between 1990 and 1992 and enrolled in a population-based study (n = 1,264) were followed for 8-10 years. Detailed exposure and covariate information was collected via in-person interviews administered shortly after diagnosis. Vital status as of January 1, 2000 was ascertained through the National Death Index via the state cancer registries (n = 292 deaths). Cox regression methods were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for confounders. Parity of 4 or more births, as compared with nulliparity, was positively associated with all-cause mortality, [HR (95% CI) = 1.71 (1.09-2.67)]. Increased mortality was associated with having given birth within 5 years prior to diagnosis (<or=5 vs. >5 years) [1.78 (1.28-2.47)], and was more pronounced among women with a pre-diagnostic body mass index of <25 kg/m2 [2.54 (1.61-4.00)]. Early age at menarche and early age at first birth also modestly increased mortality; history of miscarriage, induced abortion, and ever breastfeeding were not related to survival. These results may help elucidate breast cancer progression mechanisms and enable a better understanding of how reproductive characteristics influence breast cancer survival.
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Affiliation(s)
- Katrina F Trivers
- Department of Epidemiology, University of North Carolina at Chapel Hill, CB #7435, Chapel Hill, NC 27599-7435, USA.
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Abstract
BACKGROUND Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) was introduced to the United States through air travel. Although the risk of SARS-CoV transmission within aircraft cabins has been addressed by several studies, the magnitude of the risk remains unclear. METHODS We attempted to contact all persons with working US telephone numbers aboard seven US-bound flights carrying SARS patients. Consenting participants responded to a questionnaire, and a serum sample was collected at least 38 days after the flight and tested for SARS-CoV-associated antibodies. Participants reporting an illness compatible with SARS, with onset during the 2- to 10-day incubation period, were considered suspect cases; positive serology was required for confirmed cases. RESULTS Among 1,766 passengers and crew, 339 (19%) persons were contacted. Of these, 312 (92%) completed questionnaires, and blood was collected from 127 (37%). Serology was negative for all 127 participants, including three of four who met the clinical case criteria for SARS, and the fourth had a mild illness that lasted only 5 days. CONCLUSIONS Transmission of SARS-associated CoV was not observed, suggesting that the risk of transmission is not amplified aboard aircraft.
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Affiliation(s)
- Tara M Vogt
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MD G-37, Atlanta, GA 30333, USA.
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Rossing MA, Tang MTC, Flagg EW, Weiss LK, Wicklund KG, Weiss NS. Body Size and Risk of Epithelial Ovarian Cancer (United States). Cancer Causes Control 2006; 17:713-20. [PMID: 16633919 DOI: 10.1007/s10552-006-0010-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 01/12/2006] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We conducted a population-based case-control study of epithelial ovarian cancer in relation to measures of body size and adult weight change. In particular, we sought to characterize the independent relation of body weight at particular ages with risk. METHODS In-person interviews were sought with 35-54 year-old female residents of metropolitan Atlanta, Seattle or Detroit diagnosed with ovarian cancer during 1994-1998, and with controls sampled from these populations. Information provided by 355 cases and 1,637 controls was analyzed using unconditional logistic regression. RESULTS The risk among women in the top tenth, relative to women in the lowest fourth, of the distribution of body weight at age 18 years was 1.5 (95% confidence interval, 1.0-2.2); at age 30, 1.9 (1.2-2.9); and 5 years before the reference date, it was 2.1 (1.4-3.3). While our results did not substantiate risk elevations reported in previous studies among subsets of women (e.g., with particular histologic tumor subtypes or according to past oral contraceptive use), we noted a particularly increased risk among women who reported 10 or more pounds gained during their first year of oral contraceptive use. CONCLUSIONS Our findings suggest that risk of epithelial ovarian cancer may be most closely linked with body weight in the relatively recent past (but before the time in which the disease may manifest as weight loss) among women who develop this disease during the years before or shortly after menopause.
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Affiliation(s)
- Mary Anne Rossing
- Program in Epidemiology, Fred Hutchinson Cancer Research Center, P.O. Box 19024, Seattle, WA 98109-1024, USA.
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Abrahamson PE, Gammon MD, Lund MJ, Britton JA, Marshall SW, Flagg EW, Porter PL, Brinton LA, Eley JW, Coates RJ. Recreational physical activity and survival among young women with breast cancer. Cancer 2006; 107:1777-85. [PMID: 16967443 DOI: 10.1002/cncr.22201] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most epidemiologic studies report a reduced risk of developing breast cancer associated with higher levels of recreational physical activity, but little is known regarding its effect on prognosis. METHODS In this study, the authors investigated whether activity undertaken prior to diagnosis influenced breast cancer survival in a population-based cohort. A follow-up study was conducted among 1264 women ages 20 to 54 years who were diagnosed with invasive breast cancer between 1990 and 1992. Women in the study were interviewed within several months of diagnosis and were asked about their average frequency of moderate and vigorous activity at age 13 years, age 20 years, and during the year before diagnosis. With 8 to 10 years of follow-up, all-cause mortality status was determined by using the National Death Index (n = 290 deaths). RESULTS A modest reduction in the hazards ratio (HR) was observed for the highest quartile of activity in the year before diagnosis compared with the lowest quartile (stage-adjusted and income-adjusted HR, 0.78; 95% confidence interval [95% CI], 0.56-1.08). High activity was associated with a reduced HR among women who were overweight or obese at the time of diagnosis (HR, 0.70; 95% CI, 0.49-0.99) but not among ideal weight or underweight women (HR, 1.08; 95% CI, 0.77-1.52). A reduced HR was not evident for activity at age 13 years or 20 years or for average activity across the 3 periods studied. CONCLUSIONS The results of this study provided some suggestive evidence for a beneficial effect on survival of recreational physical activity undertaken in the year before diagnosis, particularly among women who are overweight or obese near the time of diagnosis.
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Affiliation(s)
- Page E Abrahamson
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
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Causer LM, Bishop HS, Sharp DJ, Flagg EW, Calderon JF, Keane V, Shah JJ, Macarthur JR, Maloney SA, Cetron MS, Bloland PB. Rapid malaria screening and targeted treatment of United States-bound Montagnard refugees from Cambodia in 2002. Am J Trop Med Hyg 2005; 72:688-93. [PMID: 15964951] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
In 2002, a group of Montagnard refugees living in Cambodia was accepted for resettlement in the United States. Pre-departure malaria screening and targeted treatment was conducted to prevent morbidity, and minimize the potential for local malaria transmission post-arrival. We screened 902 of 906 refugees using rapid diagnostic tests (RDTs), microscopy, and polymerase chain reaction (PCR) analysis. Twelve (1.3%) RDT results were positive and 28 (3.1%) were indeterminate. Microscopy confirmed Plasmodium species in two of the positive RDT and one of the indeterminate results. Among a random 10% sample of negative RDT results (n = 86), none were positive by microscopy. The PCR confirmed the two microscopically (and RDT) positive specimens. The PCR result was negative for all other specimens tested. Eighteen (2.0%) refugees were treated with antimalarials. The RDTs were useful in this setting, facilitating timely, sensitive diagnosis and targeted treatment. Evaluations to determine the most appropriate interventions in other refugee settings should include cost-effectiveness analyses of alternative strategies.
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Affiliation(s)
- Louise M Causer
- Division of Parasitic Diseases and Division of Global Migration and Quarantine, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Rossing MA, Tang MTC, Flagg EW, Weiss LK, Wicklund KG. A case-control study of ovarian cancer in relation to infertility and the use of ovulation-inducing drugs. Am J Epidemiol 2004; 160:1070-8. [PMID: 15561986 DOI: 10.1093/aje/kwh315] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [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: 01/17/2023] Open
Abstract
The authors conducted a population-based, case-control study among women aged 35-54 years to assess the influence of infertility and use of ovulation-inducing drugs on ovarian cancer risk. The study was conducted from 1994 to 1998 in three regions (metropolitan Atlanta, Georgia, Detroit, Michigan, and Seattle, Washington) and included 378 cases and 1,637 controls. Data were obtained through in-person interviews, and analysis was conducted using unconditional logistic regression. Among parous women, the authors observed no association of cancer risk with a history of infertility, medical evaluation for infertility, specific types of infertility, or use of ovulation-inducing drugs. Among nulliparous women, risk was increased among women with a history of infertility (odds ratio = 1.6, 95% confidence interval: 1.0, 2.6), particularly when infertility first became manifest relatively late in reproductive life (for first infertility at > or =30 years of age: odds ratio = 2.2, 95% confidence interval: 1.1, 4.5); risk was not associated with medical evaluation for infertility, specific types of infertility, or use of ovulation-inducing drugs. Findings were similar when borderline and invasive epithelial tumors were considered separately. While the results of this study support the hypothesis that a subset of nulliparous women who experience infertility may be at increased risk of ovarian cancer, the reasons for this increase in risk remain unclear.
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Affiliation(s)
- Mary Anne Rossing
- Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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Gwyn K, Bondy ML, Cohen DS, Lund MJ, Liff JM, Flagg EW, Brinton LA, Eley JW, Coates RJ. Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma. Cancer 2004; 100:1595-604. [PMID: 15073845 DOI: 10.1002/cncr.20169] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Few studies have addressed the issue of whether delays in the interval between medical consultation and the diagnosis and treatment of breast carcinoma are greater for African American women than for white women. The authors examined differences with respect to these delays and analyzed the factors that may have contributed to such differences among women ages 20-54 years who had invasive breast carcinoma diagnosed between 1990 and 1992 and who lived in Atlanta, Georgia. METHODS A total of 251 African American women and 580 white women were interviewed and had their medical records reviewed. The authors estimated racial differences in delay times and used polytomous logistic regression to determine the contributions of various factors (socioeconomic and other) to these differences. RESULTS Although most women in both groups were treated within 3 months of initial consultation, 22.4% of African American women and 14.3% of white women had clinical delays of > 3 months. Compared with white women, African American women were more likely to experience delays in diagnosis and treatment. Access to care (as represented by method of detection and insurance status) and poverty index partially accounted for these differences in delay time; however, racial differences in terms of delayed treatment and diagnosis remained even after adjustment for contributing factors. CONCLUSIONS The findings of the current study suggest that among women ages 20-54 years who have breast carcinoma, potentially clinically significant differences in terms of delayed diagnosis and treatment exist between African American women and white women. Improvements in access to care and in socioeconomic circumstances may address these differences to some degree, but additional research is needed to identify other contributing factors.
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Affiliation(s)
- Karin Gwyn
- Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Porter PL, Lund MJ, Lin MG, Yuan X, Liff JM, Flagg EW, Coates RJ, Eley JW. Racial differences in the expression of cell cycle-regulatory proteins in breast carcinoma. Cancer 2004; 100:2533-42. [PMID: 15197793 DOI: 10.1002/cncr.20279] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND African-American (AA) women are more likely to be diagnosed with an advanced stage of breast carcinoma than are white women. After adjustment for disease stage, many studies indicate that tumors in AA women are more likely than tumors in white women are to exhibit a high level of cell proliferation and features of poor prognosis. The purpose of the current study was to compare tumor characteristics and cell cycle alterations in AA women and white women that might affect the aggressiveness of breast carcinoma. METHODS The study included 124 AA and 397 white women, ages 20-54 years. These women were enrolled in a case-control study in Atlanta, Georgia, between 1990 and 1992. Breast tumor specimens obtained from these women were centrally reviewed for histologic characteristics and evaluated for expression of estrogen and progesterone receptors (ER/PR), c-ErbB-2, Ki-67, p53, cyclin E, cyclin D1, p27, p16, pRb, and p21 by immunohistochemistry. Logistic regression models were used to assess the age- and stage-adjusted associations of various tumor characteristics with race. RESULTS The odds of a breast carcinoma diagnosis at a younger age and at a later stage were higher for AA women than for white women. After adjustment for disease stage and age at diagnosis, AA women also were found to have increased odds of having a higher-grade tumor, a higher mitotic index, marked tumor necrosis, ductal histology, loss of ER and PR, overexpression of cyclin E, p16, and p53 and low expression of cyclin D1 at diagnosis. CONCLUSIONS The observed differences between tumor specimens obtained from AA women and tumor specimens obtained from white women, independent of stage and age at diagnosis, indicated that race may be a determinant, or a surrogate for other determinants, of aggressive breast carcinoma and specific cell cycle defects.
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Affiliation(s)
- Peggy L Porter
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
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Norman SA, Localio AR, Zhou L, Bernstein L, Coates RJ, Flagg EW, Marchbanks PA, Malone KE, Weiss LK, Lee NC, Nadel MR. Validation of self-reported screening mammography histories among women with and without breast cancer. Am J Epidemiol 2003; 158:264-71. [PMID: 12882949 DOI: 10.1093/aje/kwg136] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
As part of a case-control study of the efficacy of screening mammography, the authors validated the mammography histories of 2,495 women aged 40-64 years with incident breast cancer diagnosed in 1994-1998 and a 25% random sample of 615 controls never diagnosed with breast cancer, all reporting a mammogram in the past 5 years. Subjects from five metropolitan areas of the United States were cross-classified by facility records ("gold standard") and self-report according to history of a recent screening mammogram (within 1 year or within 2 years). Sensitivity and specificity of self-reported screening at 1 year were 0.93 and 0.82, respectively, for cases and 0.92 and 0.80 for controls. At 2 years, sensitivity and specificity were 0.97 and 0.78 for both cases and controls. Confidence intervals for the differences in sensitivity and specificity were narrow and included zero. Scant evidence was found of telescoping (recollection of events as more recent than actual). Findings suggest that, in an interview-based case-control study of the efficacy of screening mammography, 1) estimated true prevalences of recent screening mammography adjusted for sensitivity and specificity will be slightly lower than self-reported prevalences, and 2) differential misclassification of exposure status is slight. Therefore, odds ratios will likely be biased toward the null, underestimating screening efficacy.
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Affiliation(s)
- Sandra A Norman
- Center for Clinical Epidemiology and Biostatistics and Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia 19104-6021, USA.
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Seymour JD, Calle EE, Flagg EW, Coates RJ, Ford ES, Thun MJ. Diet Quality Index as a predictor of short-term mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort. Am J Epidemiol 2003; 157:980-8. [PMID: 12777361 DOI: 10.1093/aje/kwg077] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [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: 11/14/2022] Open
Abstract
The Diet Quality Index (DQI) was developed to measure overall dietary patterns and to predict chronic disease risk. This study examined associations between DQI and short-term all-cause, all-circulatory-disease, and all-cancer mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort, a cohort of US adults aged 50-79 years enrolled in a prospective study. After 4 years of follow-up (1992-1996), there were 869 deaths among 63,109 women and 1,736 deaths among 52,724 men. All study participants reported being disease free at baseline in 1992-1993. In age-adjusted Cox models, a higher DQI, which was indicative of a poorer quality diet, was positively related to all-cause and all-circulatory-disease mortality rates in both women and men and to cancer mortality in men only. However, in fully adjusted Cox models, only circulatory disease mortality was clearly positively related to DQI and only in women (medium-low-quality diet vs. highest-quality diet: rate ratio = 1.86, 95% confidence interval: 1.19, 2.89). Although trend tests indicated significant positive relations between DQI and all-cause mortality, effects were small (rate ratios </= 1.31), and confidence intervals were wide, generally including 1.0. DQI was unrelated to cancer mortality. As currently constructed, the DQI may have limited ability to predict mortality.
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Affiliation(s)
- Jennifer D Seymour
- Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA, USA.
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Abstract
OBJECTIVE We examined the relation between race/ethnicity and receipt of preventive services and the effect of having a usual source of care (USOC) on receipt of preventive services in different racial and ethnic groups. DESIGN/PARTICIPANTS We analyzed data from adults, aged 18 to 64 years in the Household Component of the 1996 Medical Expenditure Panel Survey, a nationally representative survey of health care use for the United States. MEASUREMENTS The proportion of adults who received age-appropriate preventive services. RESULTS Compared to white respondents, Hispanics were less likely to receive breast exams and blood pressure and cholesterol screening than were white respondents, and blacks were more likely to report receiving a Pap smear. Despite being less likely to report having a USOC, black and Hispanic women were as likely or more likely to report receiving breast and cervical cancer screening, after controlling for having a USOC and other factors. Hispanics reported receiving blood pressure screening less often, and blacks reported receiving more cholesterol screening. For each race/ethnicity group, having a USOC was associated with receiving preventive services. However, controlling for USOC and other confounders attenuated, but did not eliminate, differences by race/ethnicity. CONCLUSION The differences by race in receipt of preventive services suggest the need for different starting points for devising strategies to address racial differences in disease outcomes. While having a USOC will be important in narrowing the differences by race in receipt of preventive services, attending to other factors that contribute to disparities in health will also be essential.
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Affiliation(s)
- Giselle Corbie-Smith
- Departments of Social Medicine and Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7240, USA.
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Abstract
Agricultural exposures differ across the United States by region, calendar time period, and agricultural practice, but most of the published literature focuses on white men in the Midwest. A pilot study was conducted to explore the breadth and diversity of farming practices over time among African-American farmers in Georgia whose exposures may differ in important ways. Using a comprehensive life events calendar questionnaire, 17 male African-American farmers aged 36 to 86 yr residing in southeastern Georgia were interviewed regarding their agricultural history in July 1997. Most men (15/17) reported working on multiple farms in their lifetime; 3 men worked on 5 different farms during their lifetime. These farmers reported using more chemicals during their lifetime than farmers in the Midwest. Used motor oil was the most frequently reported insecticide applied to animals; this apparently common practice has not been described in the literature and should be better understood since its use may result in dermal exposure to polyaromatic hydrocarbons. Better characterization of regionally specific farming history and individual farming practices will facilitate studies of the health effects of farming.
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Affiliation(s)
- J A Hoppin
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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Coates RJ, Uhler RJ, Brogan DJ, Gammon MD, Malone KE, Swanson CA, Flagg EW, Brinton LA. Patterns and predictors of the breast cancer detection methods in women under 45 years of age (United States). Cancer Causes Control 2001; 12:431-42. [PMID: 11545458 DOI: 10.1023/a:1011218005063] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Few studies have examined methods by which breast cancers are detected, and only one study has been published on predictors of those methods. This study examined patterns and predictors of breast cancer detection methods during 1990-1992 among women age 20-44. METHODS In-person interview and medical record data were obtained during a population-based case-control study of 1619 women newly diagnosed with breast cancer in three areas of the United States (US). RESULTS Seventy-one percent of the cancers were identified by self-detection, 9% by routine clinical breast exam (CBE), and 20% by routine mammography. Cancers detected by mammography and CBE, but not those detected by breast self-exam, were much more likely to be early-stage. Detection by mammography increased with age, and a history of mammography use was associated with detection by mammography or CBE. Several commonly studied predictors of screening utilization in the US population were associated with CBE detection, but were less clearly related to or unrelated to mammography detection. CONCLUSION Findings suggest that, during the 1990s in the US, most breast cancers among women under age 45, including those age 40-44, were self-detected. Few factors other than age and prior screening are verified predictors of method of breast cancer detection.
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Affiliation(s)
- R J Coates
- Division of Cancer Prevention and Control, CDC, Atlanta, GA 30341-3717, USA.
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Brogan DJ, Denniston MM, Liff JM, Flagg EW, Coates RJ, Brinton LA. Comparison of telephone sampling and area sampling: response rates and within-household coverage. Am J Epidemiol 2001; 153:1119-27. [PMID: 11390332 DOI: 10.1093/aje/153.11.1119] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Random digit dialing is used frequently in epidemiologic case-control studies to select population-based controls, even when both cases and controls are interviewed face-to-face. However, concerns persist about the potential biases of random digit dialing, particularly given its generally lower response rates. In an Atlanta, Georgia, case-control study of breast cancer among women aged 20-54 years, all of whom were interviewed face-to-face, two statistically independent control groups were compared: those obtained through random digit dialing (n = 652) and those obtained through area probability sampling (n = 640). The household screening rate was significantly higher for the area sample, by 5.5%. Interview response rates were comparable. The telephone sample estimated a significantly larger percentage (by approximately 7%) of households to have no age-eligible women. Both control groups, appropriately weighted, had characteristics similar to US Census demographic characteristics for Atlanta women, except that respondents in both control groups were more educated and more likely to be married. The authors conclude that households contacted through random digit dialing are somewhat less likely to participate in the household screening process, and if they are cooperative, some households may not disclose that age-eligible women reside therein. Investigators need to develop improved methods for screening and enumerating household members in random digit dialing surveys that target a specific subpopulation, such as women.
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Affiliation(s)
- D J Brogan
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Flagg EW, Coates RJ, Calle EE, Potischman N, Thun MJ. Validation of the American Cancer Society Cancer Prevention Study II Nutrition Survey Cohort Food Frequency Questionnaire. Epidemiology 2000; 11:462-8. [PMID: 10874556 DOI: 10.1097/00001648-200007000-00017] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.8] [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: 11/26/2022]
Abstract
We assessed the validity and reproducibility of a self-administered 68-item food frequency questionnaire completed in 1992-1993 by approximately 185,000 adults. Four hundred forty-one participants completed four 24-hour dietary recall interviews over a 1-year period and a repeat administration of the food frequency questionnaire. For 20 nutrients and 10 food groups, measured nutrient intakes, but not food group intakes, were consistently lower by food frequency questionnaire than by recall. Energy-adjusted, attenuation-corrected Pearson validity correlations ranged from 0.12 to 0.80, with a median of 0.58. Reproducibility measures were generally high, with a median of 0.69. The food frequency questionnaire performed similarly to food frequency questionnaires used in other cohort studies, indicating similar ability to examine diet-disease relations.
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Affiliation(s)
- E W Flagg
- School of Medicine, Emory University, Atlanta, GA 30322, USA
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Hoppin JA, Flagg EW, Eley WJ, Tolbert PE. The validity of self-reported prostrate cancer screening history. Prev Med 2000; 30:78-9. [PMID: 10642463 DOI: 10.1006/pmed.1999.0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
BACKGROUND Precise and valid exposure assessment is generally the primary challenge in retrospective occupational epidemiology studies, particularly when the only available method for exposure characterization is a personal interview. Agricultural workers may represent a particular challenge; for example, whereas many farmers have worked from childhood at the same location, raising the same crops and animals, they may have used different equipment, chemicals, and protective gear over time. One method to assist in recall is the "life events calendar," a cognitive tool based on the subject's own life history to help anchor occupational activities in time. METHODS Unstructured interviews of farmers, focus groups, and pilot interviews among rural men, primarily African-Americans, were conducted to create a questionnaire for obtaining farm history information within the context of personal life events. RESULTS Farmers used both personal events and national events (as well as events relating directly to farming) to recall their activities. These subjects had extensive history of farming (10-75 years) and chemical use (median lifetime chemicals = 13). CONCLUSION The life events calendar provided a useful tool to facilitate the recall of a lifetime of agricultural activity. Life events calendars are useful additions to the tools available for retrospective occupational exposure assessment.
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Affiliation(s)
- J A Hoppin
- Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Samiec PS, Drews-Botsch C, Flagg EW, Kurtz JC, Sternberg P, Reed RL, Jones DP. Glutathione in human plasma: decline in association with aging, age-related macular degeneration, and diabetes. Free Radic Biol Med 1998; 24:699-704. [PMID: 9586798 DOI: 10.1016/s0891-5849(97)00286-4] [Citation(s) in RCA: 341] [Impact Index Per Article: 13.1] [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] [Indexed: 02/07/2023]
Abstract
Blood samples were analyzed for GSH and GSH redox state in 40 age-related macular degeneration (ARMD) patients (> 60 y), 33 non-ARMD diabetic patients (> 60 years), 27 similarly aged non-ARMD and nondiabetic individuals (> 60 years), and 19 younger individuals (< 60 years) without ARMD or diabetes. Results showed a significantly lower plasma GSH in older individuals (ARMD, diabetes, and controls) than in younger individuals (p < .01). Total GSH (GSHt) obtained following treatment with dithiothreitol was significantly lower only in diabetic cases (p < .05) but also approached significance for ARMD cases (p = .089). Estimation of redox potential indicated that the plasma GSH pool is considerably more oxidized in all of the older groups. Analyses of whole blood GSH showed that GSH was significantly lower in diabetic cases compared to the other groups, but did not reveal any difference associated with age or ARMD. In contrast, GSSG in whole blood was significantly higher in the older groups compared to the younger controls. The results suggest that in studies of age-related pathologies, oxidation of GSH may be a more important parameter than a decline in pool size, while in specific pathologies such as diabetes, both oxidation and a decline in pool size may be important.
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Affiliation(s)
- P S Samiec
- Department of Biochemistry, School of Medicine, Emory University, Atlanta, GA 30322, USA
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Abstract
OBJECTIVE To investigate whether body mass index (BMI) is related to energy intake during pregnancy, and whether BMI, energy intake and other factors are related to net weight gain. DESIGN Longitudinal, duration of pregnancy. SUBJECTS 156 healthy pregnant women residing in Quedlinburg county, Germany. METHODS Weighed 7 d food records and standardized anthropometric measures in the first, second and third trimester. The analysis of variance (ANOVA) statistical technique was used to analyze differences in energy intake, net weight gain and birthweight across BMI groups, and the Cochran-Mantel Haenszel test was used to analyze food group intake by BMI group. RESULTS Women at the highest level of BMI were significantly less often in the high energy intake category than women at the medium or low level of BMI (15% vs 36% and 48%). Net weight gain during pregnancy was independently influenced by BMI status and energy intake. Women at the highest level of BMI gained significantly less weight (4.2 kg) from first to third trimester than women at the medium or low levels of BMI (weight gains of 6.2 kg and 5.9 kg, respectively). Women with a low daily energy intake gained 4.6 kg during pregnancy, while women with medium and high energy intakes gained 6.0 kg and 6.1 kg, respectively. Examination of net weight gain simultaneously across BMI and parity groups revealed a much lower net weight gain among multigravid women at the highest BMI level (3.3 kg). Primigravid high BMI women, in contrast, gained 6.9 kg, whereas multigravid and primigravid women at medium and low BMI levels gained average of 4.8 kg and 6.5 kg, respectively. The mean birth weight in the three BMI groups did not differ and was not influenced by age, marital status, education, parity or smoking. CONCLUSION Because other studies have shown that weight gain during pregnancy increases the risk of subsequent overweight, multigravid high BMI women may prevent an increased weight retention after pregnancy due to lower weight gain in the current gestation. A lower caloric diet may help to accomplish a lower weight gain during pregnancy in overweight women without increased risk of low birth weight infants. These findings indicate further investigation of the associations between BMI, parity and caloric intake during pregnancy are needed to increase understanding of factors affecting subsequent weight gain.
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Affiliation(s)
- M M Bergmann
- German Institute of Human Nutrition, Unit Medical Epidemiology, Potsdam-Rehbrücke, Germany
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Lahey BB, Flagg EW, Bird HR, Schwab-Stone ME, Canino G, Dulcan MK, Leaf PJ, Davies M, Brogan D, Bourdon K, Horwitz SM, Rubio-Stipec M, Freeman DH, Lichtman JH, Shaffer D, Goodman SH, Narrow WE, Weissman MM, Kandel DB, Jensen PS, Richters JE, Regier DA. The NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study: background and methodology. J Am Acad Child Adolesc Psychiatry 1996; 35:855-64. [PMID: 8768345 DOI: 10.1097/00004583-199607000-00011] [Citation(s) in RCA: 162] [Impact Index Per Article: 5.8] [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] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A collaborative study was conducted to develop methods for surveys of mental disorder and service utilization in unscreened population-based samples of children and adolescents. METHOD Probability household samples of youths 9 through 17 years of age were selected at four sites and interviews were conducted with a total of 1,285 pairs of youths and their adult caretakers in their homes. Lay interviewers administered a computer-assisted version of the NIMH Diagnostic Interview Schedule for Children Version 2.3 and structured interviews to assess demographic variables, functional impairment, risk factors, service utilization, and barriers to service utilization. RESULTS More than 7,500 households were enumerated at four sites, with enumeration response rates above 99%. Across sites, 84% of eligible youth-caretaker pairs were interviewed for about 2 hours each. Ninety-five percent of both youths and caretakers found the interview to be acceptable enough to recommend to a friend. CONCLUSIONS These findings indicate that large-scale epidemiological surveys of mental disorders and mental health service use involving lengthy interviews in the homes of unscreened population-based samples of youths and their adult caretakers are acceptable to the community and can achieve good response rates. The other reports in this Special Section address the reliability and validity of the various survey instruments and other key findings.
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Affiliation(s)
- B B Lahey
- Department of Psychiatry, University of Chicago, IL 60637, USA.
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Abstract
To assess whether antioxidants may reduce the risk of cancer, we reviewed the epidemiologic literature from 1985 through 1993. We assessed the separate relationships of three antioxidants (carotenoids, vitamin C, and vitamin E) with six sites of cancer (lung, upper aerodigestive tract, uterine cervix, colon, breast, prostate). This review was limited to dietary intake or serum nutrient studies that met a predefined set of methodologic standards. We judged the evidence in support of causal relationships based upon consistency of results across studies, strength of association, and evidence of a dose-response relationship. The data concerning carotenoids and lung cancer risk were most consistent (protection found in 4 of 8 diet studies and 5 of 6 serum studies), with strong associations that tended to follow a dose-response pattern. For lung cancer, there was weaker evidence of protection from vitamin C (2 of 6 diet studies) and vitamin E (3 of 4 serum studies). For upper aerodigestive tract cancers (oral cavity, pharynx, or larynx), there was evidence of a protective effect of carotenoids (3 of 4 diet studies) and vitamin C (4 of 5 diet studies). For cancer of the uterine cervix, we found suggestive evidence of protection from vitamin C (4 of 5 diet studies) and perhaps carotenoids (2 of 5 diet studies). For cancers of the colon, breast, and prostate, the current data do not support a protective effect of antioxidants. More definite conclusions about the benefits of antioxidants in cancer prevention will be derived from on-going intervention trials.
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Affiliation(s)
- E W Flagg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA
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