Publications by authors named "Paula W Yoon"

52 Publications

Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020.

MMWR Morb Mortal Wkly Rep 2020 Dec 11;69(49):1860-1867. Epub 2020 Dec 11.

CDC COVID-19 Emergency Response.

In the 10 months since the first confirmed case of coronavirus disease 2019 (COVID-19) was reported in the United States on January 20, 2020 (1), approximately 13.8 million cases and 272,525 deaths have been reported in the United States. On October 30, the number of new cases reported in the United States in a single day exceeded 100,000 for the first time, and by December 2 had reached a daily high of 196,227.* With colder weather, more time spent indoors, the ongoing U.S. holiday season, and silent spread of disease, with approximately 50% of transmission from asymptomatic persons (2), the United States has entered a phase of high-level transmission where a multipronged approach to implementing all evidence-based public health strategies at both the individual and community levels is essential. This summary guidance highlights critical evidence-based CDC recommendations and sustainable strategies to reduce COVID-19 transmission. These strategies include 1) universal face mask use, 2) maintaining physical distance from other persons and limiting in-person contacts, 3) avoiding nonessential indoor spaces and crowded outdoor spaces, 4) increasing testing to rapidly identify and isolate infected persons, 5) promptly identifying, quarantining, and testing close contacts of persons with known COVID-19, 6) safeguarding persons most at risk for severe illness or death from infection with SARS-CoV-2, the virus that causes COVID-19, 7) protecting essential workers with provision of adequate personal protective equipment and safe work practices, 8) postponing travel, 9) increasing room air ventilation and enhancing hand hygiene and environmental disinfection, and 10) achieving widespread availability and high community coverage with effective COVID-19 vaccines. In combination, these strategies can reduce SARS-CoV-2 transmission, long-term sequelae or disability, and death, and mitigate the pandemic's economic impact. Consistent implementation of these strategies improves health equity, preserves health care capacity, maintains the function of essential businesses, and supports the availability of in-person instruction for kindergarten through grade 12 schools and preschool. Individual persons, households, and communities should take these actions now to reduce SARS-CoV-2 transmission from its current high level. These actions will provide a bridge to a future with wide availability and high community coverage of effective vaccines, when safe return to more everyday activities in a range of settings will be possible.
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http://dx.doi.org/10.15585/mmwr.mm6949e2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737690PMC
December 2020

Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties - United States, 2010-2017.

MMWR Surveill Summ 2019 11 8;68(10):1-11. Epub 2019 Nov 8.

Problem/condition: A 2017 report quantified the higher percentage of potentially excess (or preventable) deaths in nonmetropolitan areas (often referred to as rural areas) compared with metropolitan areas. In that report, CDC compared national, regional, and state estimates of potentially excess deaths among the five leading causes of death in nonmetropolitan and metropolitan counties for 2010 and 2014. This report enhances the geographic detail by using the six levels of the 2013 National Center for Health Statistics (NCHS) urban-rural classification scheme for counties and extending estimates of potentially excess deaths by annual percent change (APC) and for additional years (2010-2017). Trends were tested both with linear and quadratic terms.

Period Covered: 2010-2017.

Description Of System: Mortality data for U.S. residents from the National Vital Statistics System were used to calculate potentially excess deaths from the five leading causes of death among persons aged <80 years. CDC's NCHS urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent's county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Potentially excess deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Potentially excess deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and District of Columbia.

Results: The number of potentially excess deaths among persons aged <80 years in the United States increased during 2010-2017 for unintentional injuries (APC: 11.2%), decreased for cancer (APC: -9.1%), and remained stable for heart disease (APC: 1.1%), chronic lower respiratory disease (CLRD) (APC: 1.7%), and stroke (APC: 0.3). Across the United States, percentages of potentially excess deaths from the five leading causes were higher in nonmetropolitan counties in all years during 2010-2017. When assessed by the six urban-rural county classifications, percentages of potentially excess deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan) for the study period. Potentially excess deaths from heart disease increased most in micropolitan counties (APC: 2.5%) and decreased most in large fringe metropolitan counties (APC: -1.1%). Potentially excess deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan (APC: -16.1%) and large fringe metropolitan (APC: -15.1%) counties. In all county categories, potentially excess deaths from the five leading causes increased, with the largest increases occurring in large central metropolitan (APC: 18.3%), large fringe metropolitan (APC: 17.1%), and medium metropolitan (APC: 11.1%) counties. Potentially excess deaths from CLRD decreased most in large central metropolitan counties (APC: -5.6%) and increased most in micropolitan (APC: 3.7%) and noncore (APC: 3.6%) counties. In all county categories, potentially excess deaths from stroke exhibited a quadratic trend (i.e., decreased then increased), except in micropolitan counties, where no change occurred. Percentages of potentially excess deaths also differed among and within public health regions and across states by urban-rural county classification during 2010-2017.

Interpretation: Nonmetropolitan counties had higher percentages of potentially excess deaths from the five leading causes than metropolitan counties during 2010-2017 nationwide, across public health regions, and in the majority of states. The gap between the most rural and most urban counties for potentially excess deaths increased during 2010-2017 for three causes of death (cancer, heart disease, and CLRD), decreased for unintentional injury, and remained relatively stable for stroke. Urban and suburban counties (large central metropolitan and large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in potentially excess deaths from unintentional injury during 2010-2017, leading to a narrower gap between the already high (approximately 55%) percentage of excess deaths in noncore and micropolitan counties.

Public Health Action: Routine tracking of potentially excess deaths by urban-rural county classification might help public health departments and decision-makers identify and monitor public health problems and focus interventions to reduce potentially excess deaths in these areas.
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http://dx.doi.org/10.15585/mmwr.ss6810a1DOI Listing
November 2019

Evaluation of Syndromic Surveillance Systems in 6 US State and Local Health Departments.

J Public Health Manag Pract 2018 May/Jun;24(3):235-240

Center for Surveillance, Epidemiology, and Laboratory Services (Captain Thomas and Dr Mac Kenzie) and Division of Health Informatics and Surveillance (Dr Yoon), Centers for Disease Control and Prevention, Atlanta, Georgia; Communicable Disease Division, Michigan Department of Community Health, Lansing, Michigan (Mr Collins); and Public Health Informatics, Epidemiology, and Preparedness, Denver Public Health, Denver, Colorado (Dr Davidson).

Objective: Evaluating public health surveillance systems is critical to ensuring that conditions of public health importance are appropriately monitored. Our objectives were to qualitatively evaluate 6 state and local health departments that were early adopters of syndromic surveillance in order to (1) understand the characteristics and current uses, (2) identify the most and least useful syndromes to monitor, (3) gauge the utility for early warning and outbreak detection, and (4) assess how syndromic surveillance impacted their daily decision making.

Design: We adapted evaluation guidelines from the Centers for Disease Control and Prevention and gathered input from the Centers for Disease Control and Prevention subject matter experts in public health surveillance to develop a questionnaire.

Participants: We interviewed staff members from a convenience sample of 6 local and state health departments with syndromic surveillance programs that had been in operation for more than 10 years.

Results: Three of the 6 interviewees provided an example of using syndromic surveillance to identify an outbreak (ie, cluster of foodborne illness in 1 jurisdiction) or detect a surge in cases for seasonal conditions (eg, influenza in 2 jurisdictions) prior to traditional, disease-specific systems. Although all interviewees noted that syndromic surveillance has not been routinely useful or efficient for early outbreak detection or case finding in their jurisdictions, all agreed that the information can be used to improve their understanding of dynamic disease control environments and conditions (eg, situational awareness) in their communities.

Conclusion: In the jurisdictions studied, syndromic surveillance may be useful for monitoring the spread and intensity of large outbreaks of disease, especially influenza; enhancing public health awareness of mass gatherings and natural disasters; and assessing new, otherwise unmonitored conditions when real-time alternatives are unavailable. Future studies should explore opportunities to strengthen syndromic surveillance by including broader access to and enhanced analysis of text-related data from electronic health records. Health departments may accelerate the development and use of syndromic surveillance systems, including the improvement of the predictive value and strengthening the early outbreak detection capability of these systems. These efforts support getting the right information to the right people at the right time, which is the overarching goal of CDC's Surveillance Strategy.
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http://dx.doi.org/10.1097/PHH.0000000000000679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198818PMC
November 2019

Using Syndromic Surveillance for All-Hazards Public Health Surveillance: Successes, Challenges, and the Future.

Public Health Rep 2017 Jul/Aug;132(1_suppl):3S-6S

3 Communicable Disease Control Division, Infectious Disease Bureau, Boston Public Health Commission, Boston, MA, USA.

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http://dx.doi.org/10.1177/0033354917708995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676514PMC
January 2018

The Evolution of BioSense: Lessons Learned and Future Directions.

Public Health Rep 2017 Jul/Aug;132(1_suppl):7S-11S

1 Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.

The BioSense program was launched in 2003 with the aim of establishing a nationwide integrated public health surveillance system for early detection and assessment of potential bioterrorism-related illness. The program has matured over the years from an initial Centers for Disease Control and Prevention-centric program to one focused on building syndromic surveillance capacity at the state and local level. The uses of syndromic surveillance have also evolved from an early focus on alerts for bioterrorism-related illness to situational awareness and response, to various hazardous events and disease outbreaks. Future development of BioSense (now the National Syndromic Surveillance Program) includes, in the short term, a focus on data quality with an emphasis on stability, consistency, and reliability and, in the long term, increased capacity and innovation, new data sources and system functionality, and exploration of emerging technologies and analytics.
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http://dx.doi.org/10.1177/0033354917706954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676506PMC
July 2017

Leading Causes of Death in Nonmetropolitan and Metropolitan Areas- United States, 1999-2014.

MMWR Surveill Summ 2017 Jan 13;66(1):1-8. Epub 2017 Jan 13.

Center for Surveillance, Epidemiology, and Laboratory Services, CDC.

Problem/condition: Higher rates of death in nonmetropolitan areas (often referred to as rural areas) compared with metropolitan areas have been described but not systematically assessed.

Period Covered: 1999-2014 DESCRIPTION OF SYSTEM: Mortality data for U.S. residents from the National Vital Statistics System were used to calculate age-adjusted death rates and potentially excess deaths for nonmetropolitan and metropolitan areas for the five leading causes of death. Age-adjusted death rates included all ages and were adjusted to the 2000 U.S. standard population by the direct method. Potentially excess deaths are defined as deaths among persons aged <80 years that exceed the numbers that would be expected if the death rates of states with the lowest rates (i.e., benchmark states) occurred across all states. (Benchmark states were the three states with the lowest rates for each cause during 2008-2010.) Potentially excess deaths were calculated separately for nonmetropolitan and metropolitan areas. Data are presented for the United States and the 10 U.S. Department of Health and Human Services public health regions.

Results: Across the United States, nonmetropolitan areas experienced higher age-adjusted death rates than metropolitan areas. The percentages of potentially excess deaths among persons aged <80 years from the five leading causes were higher in nonmetropolitan areas than in metropolitan areas. For example, approximately half of deaths from unintentional injury and chronic lower respiratory disease in nonmetropolitan areas were potentially excess deaths, compared with 39.2% and 30.9%, respectively, in metropolitan areas. Potentially excess deaths also differed among and within public health regions; within regions, nonmetropolitan areas tended to have higher percentages of potentially excess deaths than metropolitan areas.

Interpretation: Compared with metropolitan areas, nonmetropolitan areas have higher age-adjusted death rates and greater percentages of potentially excess deaths from the five leading causes of death, nationally and across public health regions.

Public Health Action: Routine tracking of potentially excess deaths in nonmetropolitan areas might help public health departments identify emerging health problems, monitor known problems, and focus interventions to reduce preventable deaths in these areas.
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http://dx.doi.org/10.15585/mmwr.ss6601a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829895PMC
January 2017

Potentially Preventable Deaths Among the Five Leading Causes of Death - United States, 2010 and 2014.

MMWR Morb Mortal Wkly Rep 2016 Nov 18;65(45):1245-1255. Epub 2016 Nov 18.

Death rates by specific causes vary across the 50 states and the District of Columbia.* Information on differences in rates for the leading causes of death among states might help state health officials determine prevention goals, priorities, and strategies. CDC analyzed National Vital Statistics System data to provide national and state-specific estimates of potentially preventable deaths among the five leading causes of death in 2014 and compared these estimates with estimates previously published for 2010. Compared with 2010, the estimated number of potentially preventable deaths changed (supplemental material at https://stacks.cdc.gov/view/cdc/42472); cancer deaths decreased 25% (from 84,443 to 63,209), stroke deaths decreased 11% (from 16,973 to 15,175), heart disease deaths decreased 4% (from 91,757 to 87,950), chronic lower respiratory disease (CLRD) (e.g., asthma, bronchitis, and emphysema) deaths increased 1% (from 28,831 to 29,232), and deaths from unintentional injuries increased 23% (from 36,836 to 45,331). A better understanding of progress made in reducing potentially preventable deaths in the United States might inform state and regional efforts targeting the prevention of premature deaths from the five leading causes in the United States.
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http://dx.doi.org/10.15585/mmwr.mm6545a1DOI Listing
November 2016

Editorial perspectives from the founding CDC leadership of the National Birth Defects Prevention study.

Birth Defects Res A Clin Mol Teratol 2015 Aug 10;103(8):649-51. Epub 2015 Jun 10.

Retired, Centers for Disease Control and Prevention, Atlanta, Georgia.

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http://dx.doi.org/10.1002/bdra.23393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513482PMC
August 2015

Differences in healthy life expectancy for the US population by sex, race/ethnicity and geographic region: 2008.

J Public Health (Oxf) 2015 Sep 30;37(3):470-9. Epub 2014 Aug 30.

Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Background: Healthy life expectancy (HLE) varies among demographic segments of the US population and by geography. To quantify that variation, we estimated the national and regional HLE for the US population by sex, race/ethnicity and geographic region in 2008.

Methods: National HLEs were calculated using the published 2008 life table and the self-reported health status data from the National Health Interview Survey (NHIS). Regional HLEs were calculated using the combined 2007-09 mortality, population and NHIS health status data.

Results: In 2008, HLE in the USA varied significantly by sex, race/ethnicity and geographical regions. At 25 years of age, HLE for females was 47.3 years and ∼2.9 years greater than that for males at 44.4 years. HLE for non-Hispanic white adults was 2.6 years greater than that for Hispanic adults and 7.8 years greater than that for non-Hispanic black adults. By region, the Northeast had the longest HLE and the South had the shortest.

Conclusions: The HLE estimates in this report can be used to monitor trends in the health of populations, compare estimates across populations and identify health inequalities that require attention.
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http://dx.doi.org/10.1093/pubmed/fdu059DOI Listing
September 2015

Potentially preventable deaths from the five leading causes of death--United States, 2008-2010.

MMWR Morb Mortal Wkly Rep 2014 May;63(17):369-74

In 2010, the top five causes of death in the United States were 1) diseases of the heart, 2) cancer, 3) chronic lower respiratory diseases, 4) cerebrovascular diseases (stroke), and 5) unintentional injuries. The rates of death from each cause vary greatly across the 50 states and the District of Columbia (2). An understanding of state differences in death rates for the leading causes might help state health officials establish disease prevention goals, priorities, and strategies. States with lower death rates can be used as benchmarks for setting achievable goals and calculating the number of deaths that might be prevented in states with higher rates. To determine the number of premature annual deaths for the five leading causes of death that potentially could be prevented ("potentially preventable deaths"), CDC analyzed National Vital Statistics System mortality data from 2008-2010. The number of annual potentially preventable deaths per state before age 80 years was determined by comparing the number of expected deaths (based on average death rates for the three states with the lowest rates for each cause) with the number of observed deaths. The results of this analysis indicate that, when considered separately, 91,757 deaths from diseases of the heart, 84,443 from cancer, 28,831 from chronic lower respiratory diseases, 16,973 from cerebrovascular diseases (stroke), and 36,836 from unintentional injuries potentially could be prevented each year. In addition, states in the Southeast had the highest number of potentially preventable deaths for each of the five leading causes. The findings provide disease-specific targets that states can use to measure their progress in preventing the leading causes of deaths in their populations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584887PMC
May 2014

Conclusion and future directions: CDC Health Disparities and Inequalities Report - United States, 2013.

MMWR Suppl 2013 Nov;62(3):184-6

The reports in this supplement document persistent disparities between some population groups in health outcomes, access to health care, adoption of health promoting behaviors, and exposure to health-promoting environments. Some improvements in overall rates and even reductions in some health disparities are noted; however, many gaps persist. These finding highlight the importance of monitoring health status, outcomes, behaviors, and exposures by population groups to assess trends and target interventions. In this report, disparities were found between race and ethnic groups across all of the health topics examined. Differences also were observed by other population characteristics. For example, persons with low socioeconomic status were more likely to be affected by diabetes, hypertension, and human immunodeficiency virus (HIV) infection and were less likely to be screened for colorectal cancer and vaccinated against influenza.
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November 2013

Introduction: CDC Health Disparities and Inequalities Report - United States, 2013.

MMWR Suppl 2013 Nov;62(3):3-5

This supplement is the second CDC Health Disparities and Inequalities Report (CHDIR). The 2011 CHDIR was the first CDC report to assess disparities across a wide range of diseases, behavioral risk factors, environmental exposures, social determinants, and health-care access (CDC. CDC Health Disparities and Inequalities Report-United States, 2011. MMWR 2011;60[Suppl; January 14, 2011]). The 2013 CHDIR provides new data for 19 of the topics published in 2011 and 10 new topics. When data were available and suitable analyses were possible for the topic area, disparities were examined for population characteristics that included race and ethnicity, sex, sexual orientation, age, disability, socioeconomic status, and geographic location. The purpose of this supplement is to raise awareness of differences among groups regarding selected health outcomes and health determinants and to prompt actions to reduce disparities. The findings in this supplement can be used by practitioners in public health, academia and clinical medicine; the media; the general public; policymakers; program managers; and researchers to address disparities and help all persons in the United States live longer, healthier, and more productive lives.
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November 2013

Preventable hospitalizations and emergency department visits for angina, United States, 1995-2010.

Prev Chronic Dis 2013 Jul 25;10:E126. Epub 2013 Jul 25.

Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

Introduction: Preventable hospitalizations for angina have been decreasing since the late 1980s - most likely because of changes in guidance, physician coding practices, and reimbursement. We asked whether this national decline has continued and whether preventable emergency department visits for angina show a similar decline.

Methods: We used National Hospital Discharge Survey data from 1995 through 2010 and National Hospital Ambulatory Medical Care Survey data from 1995 through 2009 to study preventable hospitalizations and emergency department visits, respectively. We calculated both crude and standardized rates for these visits according to technical specifications published by the Agency for Healthcare Research and Quality, which uses population estimates from the US Census Bureau as the denominator for the rates.

Results: Crude hospitalization rates for angina declined from 1995-1998 to 2007-2010 for men and women in all 3 age groups (18-44, 45-64, and ≥65) and age- and sex-standardized rates declined in a linear fashion (P = .02). Crude rates for preventable emergency department visits for angina declined for men and women aged 65 or older from 1995-1998 to 2007-2009. Age- and sex-standardized rates for these visits showed a linear decline (P = .05).

Conclusion: We extend previous research by showing that preventable hospitalization rates for angina have continued to decline beyond the time studied previously. We also show that emergency department visits for the same condition have also declined during the past 15 years. Although these declines are probably due to changes in diagnostic practices in the hospitals and emergency departments, more studies are needed to fully understand the reasons behind this phenomenon.
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http://dx.doi.org/10.5888/pcd10.120322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725848PMC
July 2013

Preventable hospitalizations for hypertension: establishing a baseline for monitoring racial differences in rates.

Prev Chronic Dis 2013 ;10:120165

Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Mailstop F-72, Atlanta, Georgia 30341, USA.

Introduction: Preventable hospitalization for hypertension is an ambulatory care-sensitive condition believed to indicate the failure of outpatient and public health systems to prevent and control hypertension. Blacks have higher rates of such hospitalizations than whites. The 2010 Patient Protection and Affordable Care Act (PPACA) seeks to implement higher quality health care, which may help close the racial gap in these rates. The objective of this study was to analyze pre-PPACA baseline rates of preventable hypertension hospitalizations in the United States and racial differences over time.

Methods: We used data from the 1995-2010 National Hospital Discharge Survey, a stratified, probability-designed survey representing approximately 1% of hospitalizations in the United States. Rates were calculated using specifications published by the Agency for Healthcare Research and Quality requiring census data as denominators for the rates. We combined at least 3 years of data to obtain more precise estimates and conducted a trend analysis by using rates calculated for each of the resulting 5 periods.

Results: For both sexes, all age groups, and each period, blacks had higher crude rates than whites. Age- and sex-standardized rates confirmed this finding (eg, 2007-2010: blacks, 334 per 100,000; whites, 97.4 per 100,000). Rates were generally flat over time; however, white women aged 65 or older showed increasing rates.

Conclusion: Using national data, we confirmed higher rates of preventable hypertension hospitalizations for blacks, showing little improvement in disparities over time. This pre-PPACA baseline for blacks and whites allows for ongoing monitoring of preventable hospitalizations for hypertension.
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http://dx.doi.org/10.5888/pcd10.120165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604803PMC
June 2013

Prevalence, management, and control of hypertension among US workers: does occupation matter?

J Occup Environ Med 2012 Sep;54(9):1150-6

Division of Public Health Systems and Workforce Development, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Objective: The role of occupation in the management of cardiovascular risk factors including hypertension is not well known.

Methods: We analyzed the 1999-2004 National Health and Nutrition Examination Survey data of 6928 workers aged 20 years or older from 40 occupational groups. Hypertension was defined as measured blood pressure of 140/90 mm Hg or greater or self-reported use of antihypertensive medication, treatment as use of antihypertensive medication, awareness as ever being told by a doctor about having hypertension, and control as having blood pressure of less than 140/90 mm Hg among treated participants.

Results: Protective service workers ranked among the lowest in awareness (50.6%), treatment (79.3%), and control (47.7%) and had lower odds of hypertension control and treatment compared with executive/administrative/managerial workers, adjusting for sociodemographic, body-weight, smoking, and alcohol.

Conclusions: Protective service workers may benefit the most from worksite hypertension management programs.
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http://dx.doi.org/10.1097/JOM.0b013e318256f675DOI Listing
September 2012

Lexicon, definitions, and conceptual framework for public health surveillance.

MMWR Suppl 2012 Jul;61(3):10-4

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia 30329-1902, USA.

Public health surveillance is essential to the practice of public health and to guide prevention and control activities and evaluate outcomes of such activities. With advances in information sciences and technology, changes in methodology, data availability and data synthesis, and expanded health information needs, the question arises whether redefining public health surveillance is needed for the 21st century. The current definition is "Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data, essential to the planning, implementation and evaluation of public health practice, closely integrated with the dissemination of these data to those who need to know and linked to prevention and control."
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July 2012

Conclusions and future directions for periodic reporting on the use of adult clinical preventive services of public health priority--United States.

MMWR Suppl 2012 Jun;61(2):73-8

Public Health Surveillance and Informatics Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, CDC, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.

The findings described in this supplement can help improve collaboration among public health and other stakeholders who influence population health, including employers, health plans, health professionals, and voluntary associations, to increase the use of a set of clinical preventive services that, with improved use, can substantially reduce morbidity and mortality in the U.S. adult population. This supplement highlighted that the use of the clinical preventive services in the U.S. adult population is not optimal and is quite variable, ranging from approximately 10% to 85%, depending on the particular service. Use was particularly low for tobacco cessation, aspirin use to reduce risk of cardiovascular disease, and influenza vaccination; however, ample opportunity exists to improve use of all of these services. Among the specific populations least likely to have used the recommended services, persons with no insurance, no usual source of care, or no recent use of the health-care system (if included in the analysis) were the groups least likely to have used the services. Use among the uninsured was generally 10 to 30 percentage points below the general population averages, suggesting that improvements in insurance coverage are likely to increase use of these clinical preventive services. A randomized, controlled trial of an expansion of Medicaid coverage by Oregon in 2008 supports this hypothesis by demonstrating improved use of clinical services with increased health insurance coverage. A recent survey among the uninsured found a low level of awareness of the provisions of the Patient Protection and Affordable Care Act of 2010 as amended by the Healthcare and Education Reconciliation Act of 2010 (referred to collectively as the Affordable Care Act [ACA]). Therefore, improving opportunities for coverage might be insufficient, and focused efforts by governmental health agencies and other stakeholders are likely to be needed to enroll uninsured persons in health plans. In addition, although use of the preventive services in insured populations was greater than among the uninsured, use among the insured was generally <75%, and often much less. Therefore, having health insurance coverage might not itself be sufficient to optimize use of clinical preventive services, and additional measures to improve use are likely to be necessary.
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June 2012

Control of hypertension among adults--National Health and Nutrition Examination Survey, United States, 2005-2008.

MMWR Suppl 2012 Jun;61(2):19-25

Epidemiology and Analysis Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, CDC, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.

Cardiovascular disease (CVD) is the leading cause of preventable death in the United States, and approximately 1 million heart attacks and 700,000 strokes occur annually. Hypertension is a major risk factor for cardiovascular disease and stroke; the unadjusted prevalence of hypertension among U.S. adults aged ≥18 years is approximately 31% (representing 68 million adults), and hypertension increases with age to approximately 70% among persons aged ≥65 years. Hypertension contributes to one out of every seven deaths in the United States, and approximately 70% of persons who have a first heart attack or stroke or who have heart failure have hypertension. In clinical trials, treatment of hypertension was associated with substantial reductions in stroke incidence (35%-40%), myocardial infarction (20%-25%), and heart failure (>50%). The estimated annual direct costs of hypertension are approximately $69.9 billion, and the estimated annual indirect costs are $23.6 billion.
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June 2012

Rationale for periodic reporting on the use of adult clinical preventive services of public health priority--United States.

MMWR Suppl 2012 Jun;61(2):3-10

Public Health Surveillance and Informatics Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, CDC, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.

This supplement introduces a CDC initiative to monitor and report periodically on the use of a set of selected clinical preventive services in the U.S. adult population in the context of recent national initiatives to improve access to and use of such services. Increasing the use of these services has the potential to lead to substantial reductions in the burden of illness, death, and disability and to lower treatment costs. The majority of clinical preventive services are provided by the health-care sector, and public health agencies play important roles in helping to support increases in the use of these services (e.g., by identifying and implementing policies that are effective in increasing use of the services and by collaborating with stakeholders to conduct programs to improve use). Recent health reform initiatives, including efforts to increase the accessibility and affordability of preventive services, fund community prevention programs, and improve the use of health information technologies, offer opportunities to enhance use of preventive services. This supplement provides baseline information on a set of selected clinical preventive services before implementation of these recent reforms and discusses opportunities to increase the use of such services. This information can help public health practitioners collaborate with other stakeholders that have key roles to play in improving public health (e.g., employers, health plans, health professionals, and voluntary associations), understand the potential benefits of the recommended services, address the problem of underuse, and identify opportunities to apply effective strategies to improve use and foster accountability among stakeholders.
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June 2012

Prevalence of cardiovascular disease risk factors among US adolescents, 1999-2008.

Pediatrics 2012 Jun 21;129(6):1035-41. Epub 2012 May 21.

Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Mailstop K-26, Atlanta, GA 30341, USA.

Objective: Overweight and obesity during adolescence are associated with an increased risk for cardiovascular disease (CVD) risk factors. The objective of this study was to examine the recent trends in the prevalence of selected biological CVD risk factors and the prevalence of these risk factors by overweight/obesity status among US adolescents.

Methods: The NHANES is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. The study sample included 3383 participants aged 12 to 19 years from the 1999 through 2008 NHANES.

Results: Among the US adolescents aged 12 to 19 years, the overall prevalence was 14% for prehypertension/hypertension, 22% for borderline-high/high low-density lipoprotein cholesterol, 6% for low high-density lipoprotein cholesterol (<35 mg/dL), and 15% for prediabetes/diabetes during the survey period from 1999 to 2008. No significant change in the prevalence of prehypertension/hypertension (17% and 13%) and borderline-high/high low-density lipoprotein cholesterol (23% and 19%) was observed from 1999-2000 to 2007-2008, but the prevalence of prediabetes/diabetes increased from 9% to 23%. A consistent dose-response increase in the prevalence of each of these CVD risk factors was observed by weight categories: the estimated 37%, 49%, and 61% of the overweight, obese, and normal-weight adolescents, respectively, had at least 1 of these CVD risk factors during the 1999 through 2008 study period.

Conclusions: The results of this national study indicate that US adolescents carry a substantial burden of CVD risk factors, especially those youth who are overweight or obese.
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http://dx.doi.org/10.1542/peds.2011-1082DOI Listing
June 2012

Preventable hospitalizations for congestive heart failure: establishing a baseline to monitor trends and disparities.

Prev Chronic Dis 2012 12;9:E85. Epub 2012 Apr 12.

Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, 4770 Buford Hwy NE, Mailstop F-72, Atlanta, GA 30341, USA.

Introduction: Preventable hospitalization for congestive heart failure (CHF) is believed to capture the failure of the outpatient health care system to properly manage and treat CHF. In anticipation of changes in the national health care system, we report baseline rates of these hospitalizations and describe trends by race over 15 years.

Methods: We used National Hospital Discharge Survey data from 1995 through 2009, which represent approximately 1% of hospitalizations in the United States each year. We calculated age-, sex-, and race-stratified rates and age- and sex-standardized rates for preventable CHF hospitalizations on the basis of the Agency for Healthcare Research and Quality's specifications, which use civilian population estimates from the US Census Bureau as the denominator for rates.

Results: Approximately three-fourths of the hospitalizations occurred among people aged 65 years or older. In each subgroup and period, rates were significantly higher (P < .05) for blacks than whites. Only black men aged 18 to 44 showed a linear increase (P = .004) in crude rates across time. Subpopulations aged 65 or older, except black men, showed a linear decrease (P < .05) in crude rates over time. Age- and sex-standardized rates showed a significant linear decrease in rates for whites (P = .01) and a borderline decrease for blacks (P = .06)

Conclusion: Before implementation of the Patient Protection and Affordable Care Act, we found that blacks were disproportionately affected by preventable CHF hospitalizations compared with whites. Our results confirm recent findings that preventable CHF hospitalization rates are declining in whites more than blacks. Alarmingly, rates for younger black men are on the rise.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396552PMC
August 2012

Age-specific gender differences in in-hospital mortality by type of acute myocardial infarction.

Am J Cardiol 2012 Apr 14;109(8):1097-103. Epub 2012 Jan 14.

Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Younger women hospitalized with an acute myocardial infarction (MI) have a poorer prognosis than men. Whether this is true for patients with acute ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) is not extensively studied. Using the MarketScan 2004 to 2007 Commercial and Medicare supplemental admission databases, we assessed gender differences in in-hospital mortality according to age in 91,088 patients (35,899 with STEMI, 55,189 with NSTEMI) who were 18 to 89 years old and had acute MI as their primary diagnosis. Patients with STEMI had significantly higher in-hospital mortality than those with NSTEMI (4.35% vs 3.53%, p <0.0001). Compared to men women were older, had higher co-morbidity scores, and were less likely to undergo revascularization during hospitalization in the STEMI and NSTEMI populations. In patients with STEMI the unadjusted women-to-men odds ratio for in-hospital mortality was 2.29 (95% confidence interval 1.48 to 3.55) for the 18- to 49-year age group, 1.68 (1.28 to 2.21) for 50 to 59, 1.48 (1.17 to 1.88) for 60 to 69, 1.28 (1.06 to 1.57) for 70 to 79, and 1.01 (0.83 to 1.23) for 80 to 89. Corresponding unadjusted odds ratios were 1.51 (0.87 to 2.61), 1.46 (1.11 to 1.92), 1.29 (1.04 to 1.61), 0.83 (0.70 to 0.99) and 0.82 (0.70 to 0.94) for patients with NSTEMI. After adjustment for potential confounding factors, excess risk for in-hospital mortality in younger women versus their men counterparts (<60 years old) persisted in STEMI. In patients with NSTEMI the difference between younger women and younger men was not statistically significant; however, older women (≥70 years old) had better survival than men. In conclusion, higher risk of in-hospital mortality in younger women compared to younger men is more evident in patients with STEMI.
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http://dx.doi.org/10.1016/j.amjcard.2011.12.001DOI Listing
April 2012

Associations between sleep disorders, sleep duration, quality of sleep, and hypertension: results from the National Health and Nutrition Examination Survey, 2005 to 2008.

J Clin Hypertens (Greenwich) 2011 Oct 14;13(10):739-43. Epub 2011 Jul 14.

Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

Sleep is a contributing factor to optimal health and vitality. However, to date, no national study has evaluated the simultaneous relationship between sleep disorders, quality, and duration with hypertension. Using data from National Health and Nutrition Examination Survey (NHANES) (2005 to 2008), hypertension was defined by current use of antihypertensive medication or systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Self-reported sleep disorders and duration were categorized from a single household interview question, and sleep quality was determined from several questions on sleeping habits. The prevalence of hypertension was 30.2% and 7.5%, and 33.0% and 52.1% reported having sleep disorders, short sleep, and poor sleep, respectively. After adjustment for demographic characteristics and comorbidities, having sleep disorders only was not significantly associated with hypertension (odds ratio [OR], 1.65; 95% confidence interval [CI], 0.73-3.77). However, this association was modified by sleep duration: significant associations were observed among adults with concurrent sleep disorders and short sleep (OR, 2.30; 95% CI, 1.49-3.56) and with sleep disorders, short sleep, and poor sleep (OR, 1.84; 95% CI, 1.13-2.98). These findings indicate an association between a combination of sleep problems and hypertension, but prospective studies are needed to understand the complex interplay between them.
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http://dx.doi.org/10.1111/j.1751-7176.2011.00500.xDOI Listing
October 2011

Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010.

MMWR Surveill Summ 2011 Jul;60(8):1-19

Emory University, Atlanta, Georgia, USA.

Problem/condition: Each year, approximately 300,000 persons in the United States experience an out-of-hospital cardiac arrest (OHCA); approximately 92% of persons who experience an OHCA event die. An OHCA is defined as cessation of cardiac mechanical activity that occurs outside of the hospital setting and is confirmed by the absence of signs of circulation. Whereas an OHCA can occur from noncardiac causes (i.e., trauma, drowning, overdose, asphyxia, electrocution, primary respiratory arrests, and other noncardiac etiologies), the majority (70%--85%) of such events have a cardiac cause. The majority of persons who experience an OHCA event, irrespective of etiology, do not receive bystander-assisted cardiopulmonary resuscitation (CPR) or other timely interventions that are known to improve the likelihood of survival to hospital discharge (e.g., defibrillation). Because nearly half of cardiac arrest events are witnessed, efforts to increase survival rates should focus on timely and effective delivery of interventions by bystanders and emergency medical services (EMS) personnel. This is the first report to provide summary data from an OHCA surveillance registry in the United States.

Reporting Period: This report summarizes surveillance data collected during October 1, 2005-- December 31, 2010.

Description Of The System: In 2004, CDC established the Cardiac Arrest Registry to Enhance Survival (CARES) in collaboration with the Department of Emergency Medicine at the Emory University School of Medicine. This registry evaluates only OHCA events of presumed cardiac etiology that involve persons who received resuscitative efforts, including CPR or defibrillation. Participating sites collect data from three sources that define the continuum of emergency cardiac care: 911 dispatch centers, EMS providers, and receiving hospitals. OHCA is defined in CARES as a cardiac arrest that occurred in the prehospital setting, had a presumed cardiac etiology, and involved a person who received resuscitative efforts, including CPR or defibrillation.

Results: During October 1, 2005--December 31, 2010, a total of 40,274 OHCA records were submitted to the CARES registry. After noncardiac etiology arrests and missing hospital outcomes were excluded from the analysis (n = 8,585), 31,689 OHCA events of presumed cardiac etiology (e.g., myocardial infarction or arrhythmia) that received resuscitation efforts in the prehospital setting were analyzed. The mean age at cardiac arrest was 64.0 years (standard deviation [SD]: 18.2); 61.1% of persons who experienced OHCA were male (n = 19,360). According to local EMS agency protocols, 21.6% of patients were pronounced dead after resuscitation efforts were terminated in the prehospital setting. The survival rate to hospital admission was 26.3%, and the overall survival rate to hospital discharge was 9.6%. Approximately 36.7% of OHCA events were witnessed by a bystander. Only 33.3% of all patients received bystander CPR, and only 3.7% were treated by bystanders with an automated external defibrillator (AED) before the arrival of EMS providers. The group most likely to survive an OHCA are persons who are witnessed to collapse by a bystander and found in a shockable rhythm (e.g., ventricular fibrillation or pulseless ventricular tachycardia). Among this group, survival to discharge was 30.1%. A subgroup analysis was performed among persons who experienced OHCA events that were not witnessed by EMS personnel to evaluate rates of bystander CPR for these persons. After exclusion of 3,400 OHCA events that occurred after the arrival of EMS providers, bystander CPR information was analyzed for 28,289 events. In this group, whites were significantly more likely to receive CPR than blacks, Hispanics, or members of other racial/ethnic populations (p<0.001). Overall survival to hospital discharge of patients whose events were not witnessed by EMS personnel was 8.5%. Of these, patients who received bystander CPR had a significantly higher rate of overall survival (11.2%) than those who did not (7.0%) (p<0.001).

Interpretation: CARES data have helped identify opportunities for improvement in OHCA care. The registry is being used continually to monitor prehospital performance and selected aspects of hospital care to improve quality of care and increase rates of survival following OHCA. CARES data confirm that patients who receive CPR from bystanders have a greater chance of surviving OHCA than those who do not.

Public Health Actions: Medical directors and public health professionals in participating communities use CARES data to measure and improve the quality of prehospital care for persons experiencing OHCA. Tracking performance longitudinally allows communities to better understand which elements of their care are working well and which elements need improvement. Education of public officials and community members about the importance of increasing rates of bystander CPR and promoting the use of early defibrillation by lay and professional rescuers is critical to increasing survival rates. Reporting at the state and local levels can enable state and local public health and EMS agencies to coordinate their efforts to target improving emergency response for OHCA events, regardless of etiology, which can lead to improvement in OHCA survival rates.
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July 2011

Clinical preventive services for patients at risk for cardiovascular disease, National Ambulatory Medical Care Survey, 2005-2006.

Prev Chronic Dis 2011 Mar 15;8(2):A43. Epub 2011 Feb 15.

Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

Introduction: Clinical preventive services can detect diseases early, when they are most treatable, but these services may not be provided as recommended. Assessing the provision of services to patients at risk for cardiovascular disease (CVD) could help identify disparities and areas for improvement.

Methods: We used data on patient visits (n = 21,261) from the National Ambulatory Medical Care Survey, 2005-2006, and classified patients with hypertension, hyperlipidemia, obesity, or diabetes as being at risk for CVD. We assessed differences in the provision of preventive services offered to patients who were and who were not at risk for CVD. Further, for those at risk, we compared the demographic characteristics of those who had and who had not been offered services.

Results: Patients at risk for CVD received significantly more preventive services compared with those not at risk. For patients at risk for CVD, aspirin therapy was more likely to be recommended to those aged 65 years or older than those aged 45 to 64 years and to men than women. Cholesterol screening was more likely for men and was less likely for patients with Medicare/Medicaid or no insurance than for patients who were insured. Rates of counseling for diet and nutrition, weight reduction, and exercise were low overall, but younger patients received these services more than older patients did.

Conclusion: Patients at risk for CVD are not all receiving the same level of preventive care, suggesting the need to clarify clinical practice guidelines and provide clinicians with education and support for more effective lifestyle counseling.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073436PMC
March 2011

Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999-2006.

Ann Fam Med 2010 Jul-Aug;8(4):327-33

Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.

Purpose: Previous studies have reported low rates of screening for high cholesterol levels among young adults in the United States. Although recommendations for screening young adults without risk factors for coronary heart disease (CHD) differ, all guidelines recommend screening adults with CHD, CHD equivalents, or 1 or more CHD risk factors. This study examined national prevalence of CHD risk factors and compliance with the cholesterol screening guidelines among young adults.

Methods: National estimates were obtained using results for 2,587 young adults (men aged 20 to 35 years; women aged 20 to 45 years) from the 1999-2006 National Health and Nutrition Examination Surveys. We defined high low-density lipoprotein cholesterol (LDL-C) as levels higher than the goal specific for each CHD risk category outlined in the National Cholesterol Education Program Adult Treatment Panel III guidelines.

Results: About 59% of young adults had CHD or CHD equivalents, or 1 or more of the following CHD risk factors: family history of early CHD, smoking, hypertension, or obesity. In our study, the overall screening rate in this population was less than 50%. Moreover, no significant difference in screening rates between young adults with no risk factors and their counterparts with 1 or more risk factors was found even after adjustment for sociodemographic and health care factors. Approximately 65% of young adults with CHD or CHD equivalents, 26% of young adults with 2 or more risk factors, 12% of young adults with 1 risk factor, and 7% with no risk factor had a high level of LDL-C.

Conclusions: CHD risk factors are common in young adults but do not appear to alter screening rates. Improvement of risk assessment and management for cardiovascular disease among young adults is warranted.
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http://dx.doi.org/10.1370/afm.1137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906527PMC
January 2011

Using family history information to promote healthy lifestyles and prevent diseases; a discussion of the evidence.

BMC Public Health 2010 May 13;10:248. Epub 2010 May 13.

Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.

Background: A family history, reflecting genetic susceptibility as well as shared environmental and behavioral factors, is an important risk factor for common chronic multifactorial diseases such as cardiovascular diseases, type 2 diabetes and many cancers.

Discussion: The purpose of the present paper is to discuss the evidence for the use of family history as a tool for primary prevention of common chronic diseases, in particular for tailored interventions aimed at promoting healthy lifestyles. The following questions are addressed: (1) What is the value of family history information as a determinant of personal disease risk?; (2)How can family history information be used to motivate at-risk individuals to adopt and maintain healthy lifestyles in order to prevent disease?; and (3) What additional studies are needed to assess the potential value of family history information as a tool to promote a healthy lifestyle?

Summary: In addition to risk assessment, family history information can be used to personalize health messages, which are potentially more effective in promoting healthy lifestyles than standardized health messages. More research is needed on the evidence for the effectiveness of such a tool.
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http://dx.doi.org/10.1186/1471-2458-10-248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875210PMC
May 2010

Is there an association between quality of in-hospital cardiac care and proportion of low-income patients?

Med Care 2010 Mar;48(3):273-8

Department of Health Policy and Management Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.

Background: Process measures have been developed and implemented to evaluate the quality of care patients receive in the hospital. This study examines whether there is an association between the quality of in-hospital cardiac care and a hospital's proportion of low-income patients.

Methods And Results: A retrospective analysis of 1979 hospitals submitting information on 12 quality of care (QoC) process measures for acute myocardial infarction (AMI) and congestive heart failure (CHF) patients to the Hospital Quality Alliance during 2005 and 2006 and meeting all study inclusion criteria. Mean hospital performance ranged from 84.2% (ACE inhibitor for left ventricular systolic dysfunction) to 95.9% (aspirin on arrival) for AMI QoC process measures and from 64.4% (discharge instructions) to 92.4% (left ventricular function assessment) for CHF QoC process measures. Regression analyses indicated a statistically significant negative association between the proportion of low-income patients and hospital performance for 10 of the 12 cardiac QoC process measures, after controlling for selected hospital characteristics.

Conclusions: Hospital adherence to QoC process measures for AMI and CHF patients declined as the proportion of low-income patients increased. Future research is needed to examine the role of community characteristics and market forces on the ability of hospitals with a disproportionate share of low-income patients to maintain the staffing, equipment, and policies necessary to provide the recommended standards of care for AMI and CHF patients.
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http://dx.doi.org/10.1097/MLR.0b013e3181c161baDOI Listing
March 2010

Family history in public health practice: a genomic tool for disease prevention and health promotion.

Annu Rev Public Health 2010 ;31:69-87 1 p following 87

Office of Public Health Genomics, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

Family history is a risk factor for many chronic diseases, including cancer, cardiovascular disease, and diabetes. Professional guidelines usually include family history to assess health risk, initiate interventions, and motivate behavioral changes. The advantages of family history over other genomic tools include a lower cost, greater acceptability, and a reflection of shared genetic and environmental factors. However, the utility of family history in public health has been poorly explored. To establish family history as a public health tool, it needs to be evaluated within the ACCE framework (analytical validity; clinical validity; clinical utility; and ethical, legal, and social issues). Currently, private and public organizations are developing tools to collect standardized family histories of many diseases. Their goal is to create family history tools that have decision support capabilities and are compatible with electronic health records. These advances will help realize the potential of family history as a public health tool.
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http://dx.doi.org/10.1146/annurev.publhealth.012809.103621DOI Listing
June 2010

Trends in high levels of low-density lipoprotein cholesterol in the United States, 1999-2006.

JAMA 2009 Nov;302(19):2104-10

Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop K-37, Atlanta, GA 30341-3724, USA.

Context: Studies show that a large proportion of adults with high levels of low-density lipoprotein cholesterol (LDL-C) remain untreated or undertreated despite growing use of lipid-lowering medications.

Objective: To investigate trends in screening prevalence, use of cholesterol-lowering medications, and LDL-C levels across 4 study cycles (1999-2000, 2001-2002, 2003-2004, and 2005-2006).

Design, Setting, And Participants: The National Health and Nutrition Examination Survey (NHANES) is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. After we restricted the study sample to fasting participants aged 20 years or older (n = 8018) and excluded pregnant women (n = 464) and participants with missing data (n = 510), our study sample consisted of 7044 participants.

Main Outcome Measure: High LDL-C levels, defined as levels above the specific goal for each risk category outlined in guidelines from the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). All presented results are weighted and age-standardized to 2000 standard population estimates.

Results: Prevalence of high LDL-C levels among persons aged 20 years or older decreased from 31.5% in 1999-2000 to 21.2% in 2005-2006 (P < .001 for linear trend) but varied by risk category. By the 2005-2006 study cycle, prevalence of high LDL-C was 58.9%, 30.2%, and 11.0% for high-, intermediate-, and low-risk categories, respectively. Self-reported use of lipid-lowering medications increased from 8.0% to 13.4% (P < .001 for linear trend), but screening rates did not change significantly, remaining less than 70% (P = .16 for linear trend) during the study periods.

Conclusions: Among the NHANES population aged 20 years or older, the prevalence of high LDL-C levels decreased from 1999-2000 to 2005-2006. In the most recent period, the prevalence was 21.2%.
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http://dx.doi.org/10.1001/jama.2009.1672DOI Listing
November 2009