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Racial differences in outcomes of veterans undergoing percutaneous coronary interventions

AMERICAN HEART JOURNAL 2001年第2期142卷 309-313页

作者： Maynard, C Wright, SM Every, NR Ritchie, JL Dept Vet Affairs Dept Med & Hlth Serv Res & Dev Seattle WA 98108 USA Univ Washington Dept Hlth Serv Dept Med Seattle WA 98195 USA Boston Hlth Care Syst Dept Vet Affairs Massachusetts Vet Epidemiol Res Informat Ctr W Roxbury MA USA

Background In the era of stenting relatively little is known about racial differences in the outcomes of percutaneous interventions (PCI). The purpose of this study was to determine whether there were racial differences with respect to short- and long-term outcomes in veterans undergoing PCI. Methods We used the national Department of Veterans Affairs (VA) patient treatment file to identify 24,625 African American and white veterans who had PCI in VA medical centers between October 1, 1994, and September 30, 1999. Baseline demographic characteristics were obtained, as was a measure of comorbidity. Short-term outcomes included hospital mortality and same-admission coronary artery bypass surgery, and long-term outcomes were vital status and rehospitalization. Multivariate statistical methods were used to adjust for patient differences when comparing both short- and long-term outcomes for African American and white veterans. Results African Americans were 11% of veterans, and in comparison with their white counterparts had more hypertension, diabetes, and acute myocardial infarction. African Americans less often underwent stenting (44% vs 49%), although hospital mortality (2.0% vs 1.9%) and same-admission bypass surgery (1.9% vs 2.2%) rates were similar, Two-year survival was 89% in African Americans and 91% in white veterans (P=.0014), and after adjustment for covariates African Americans had slightly higher mortality rates (hazard ratio 1.11, 95% confidence interval 1.05-1.17). At 2 years almost 61% of both African American and white veterans were rehospitalized for any reason. Conclusion Short- and long-term outcomes for African American and white veterans undergoing PCI in VA medical centers were similar, although African Americans underwent stenting less often.

关键词：非洲裔美国人/统计学和数值数据血管成形术经腔经皮冠状动脉/利用欧洲大陆世系人群/统计学和数值数据医院死亡率医院退伍军人/统计学和数值数据医院退伍军人/利用心肌梗死/人种学心肌梗死/死亡率心肌梗死/治疗结果评价(卫生保健) 支架/利用存活率分析美国/流行病学退伍军人/统计学和数值数据女(雌)性人类男(雄)性中年人

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Severity of coronary artery disease in black and white male veterans and likelihood of revascularization

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AMERICAN HEART JOURNAL 2000年第5期139卷 840-847页

作者： Peniston, RL Lu, DY Papademetriou, V Fletcher, RD Dept Vet Adm Med Ctr Div Cardiothorac Surg Washington DC USA Dept Vet Adm Med Ctr Div Cardiol Washington DC USA Howard Univ Coll Med Washington DC USA Georgetown Univ Sch Med Washington DC USA George Washington Univ Sch Med & Hlth Sci Washington DC 20052 USA

Background Many reports in the literature have found the use of invasive cardiac procedures in black patients to be less common than in white patients. These reports tend to have small numbers of black patients compared with white patients or rely on the information contained in claims or administrative data. Methods and Results Cardiac catheterization reports were reviewed in a Veterans Administration hospital that serves a large number of black patients. After review of the medical histories and hemodynamic and angiographic findings in 726 black and 734 white male veterans, data were collected to determine recommended and actual therapy. Death was assessed after a 4- to 10-year follow-vp period. White patients were more likely to have significant coronary artery lesions than black patients. Multivariate analysis showed that the likelihood of patients actually having percutaneous transluminal coronary angioplasty or coronary artery bypass surgery did not differ by ethnicity when controlling for disease extent or severity. Coronary artery bypass surgery was associated with decreased mortality rates for both black and white patients. Although short-term death in blacks was not different from whites, blacks had an increased long-term risk for death. Conclusions After coronary angiography, black veterans and white veterans appear to undergo revascularization procedures related to the severity of disease. The decreased long-term life expectancy of black men as compared with whites is not necessarily explained by the presence of or treatment for coronary artery disease in this population.

关键词：非洲大陆世系人群冠心病/人种学冠心病/死亡率冠心病/治疗文化交叉比较欧洲大陆世系人群随访研究卫生服务易得程度/统计学和数值数据心肌血管重建术/统计学和数值数据回顾性研究危险因素存活率分析退伍军人/统计学和数值数据老年人人类男(雄)性中年人

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Is there a Persian Gulf War syndrome? Evidence from a large population-based survey of veterans and nondeployed controls

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AMERICAN JOURNAL OF MEDICINE 2000年第9期108卷 695-704页

作者： Doebbeling, BN Clarke, WR Watson, D Torner, JC Woolson, RF Voelker, MD Barrett, DH Schwartz, DA Univ Iowa Coll Med Dept Internal Med Iowa City IA 52242 USA Iowa City Vet Affairs Med Ctr Iowa City IA USA Iowa City Vet Affairs Med Ctr Iowa City IA USA Univ Iowa Coll Publ Hlth Dept Biostat Iowa City IA USA Univ Iowa Dept Psychol Iowa City IA 52242 USA Ctr Dis Control & Prevent Div Environm Hazards & Hlth Effects Natl Ctr Environm Hlth Atlanta GA USA Univ Iowa Coll Publ Hlth Dept Environm & Occupat Hlth Iowa City IA USA

PURPOSE: Concerns have been raised about whether veterans of the Gulf War have a medical illness of uncertain etiology. We surveyed veterans to look for evidence of an illness that was unique to those deployed to the Persian Gulf and was not seen in comparable military controls. SUBJECTS AND METHODS: A population-based sample of veterans (n = 1,896 from 889 units) deployed to the Persian Gulf and other Gulf War-era controls (n = 1799 from 893 units) who did not serve in the Gulf were surveyed in 1995-1996. Seventy-six percent of eligible subjects, including 91% of located subjects, answered questions about commonly reported and potentially important symptoms. We used factor analysis, a statistical technique that can identify patterns of related responses, on a random subset of the deployed veterans to identify latent patterns of symptoms. The results from this derivation sample were compared with those obtained from a separate validation sample of deployed veterans, as well as the nondeployed controls, to determine whether the results were replicable and unique. RESULTS: One half (50%) of the deployed veterans and 14% of the nondeployed controls reported health problems that they attributed to military service during 1990-1991. Compared with the nondeployed controls, the deployed veterans had significantly greater prevalences of 123 of 137 (90%) symptoms;none was significantly lower. Factor analysis identified three replicable symptom factors (or patterns) in the deployed veterans (convergent correlations greater than or equal to 0.85). However, these patterns were also highly replicable in the nondeployed controls (convergent correlations of 0.95 to 0.98). The three factors also accounted for similar proportions of the common variance among the deployed veterans (35%) and nondeployed controls (30%). CONCLUSIONS: The increased prevalence of nearly every symptom assessed from all bodily organ systems among the Gulf War veterans is difficult to explain pathophysiologi

关键词：病例对照研究因素分析统计学健康状况中东军事人员/统计学和数值数据波斯湾综合征人群监测患病率可重复性结果美国/流行病学退伍军人/统计学和数值数据战争成年人女(雌)性人类男(雄)性

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Epidemiology of hepatitis C virus infection in American Veterans

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第3期95卷 740-747页

作者： Cheung, RC VA Palo Alto Hlth Care Syst Div Gastroenterol Palo Alto CA 94304 USA Stanford Univ Sch Med Stanford CA 94305 USA

OBJECTIVE: This study reports the findings of hepatitis C virus (HCV) infection in a large Department of Veterans Affairs Health Care System in suburban Northern California. METHODS: All veterans who had anti-HCV (EIA II) tested during a 6-yr period (7/92 to 6/98) were included in this study. To estimate the seroprevalence of anti-HCV among our population, 126 consecutive bloodborne pathogen exposure accidents were studied. RESULTS: Of 8558 veterans tested for anti-HCV (EIA II), 2985 (35%) veterans were positive with a mean age of 48.4 yr (range, 28-89 yr). Sixty percent were between the age of 41 and 50 yr. Risk factors for HCV infection identified in 409 consecutive veterans were intravenous drug abuse (81%), unknown (11%), blood transfusion (3%), sexual/ household contact (2%), transfusion and intravenous drug use (2%), and tattoo (1%). Of 215 consecutive anti-HCV-positive veterans whose sera were tested by polymerase chain reaction, 96% were viremic. The most common HCV genotypes were 1a (50.5%), 1b (22.8%), 3a (12.1%), 2b (9.7%), 2a (1.9%), undetermined (1.9%), and mixed infection (1%). Veterans infected with genotype Ib were significantly alder. Among 126 consecutive bloodborne pathogen exposure accidents, hepatitis C serology was available for 72 index veterans involved in the accidents and 18% were positive. CONCLUSIONS: We found the epidemiology of hepatitis C infection was different in the veteran population when compared to other published data on nonveterans. Hepatitis C infection was much more common among veteran, within a very narrow age distribution and intravenous drug use was the major risk factor. (Am J Gastroenterol 2000;95: 740-747. (C) 2000 by Am. Cell. of Gastroenterology).

关键词：血传病原体横断面研究基因型肝炎病毒属/遗传学肝炎丙型/传播肝炎丙型慢性/流行病学肝炎丙型慢性/病毒学发病率危险因素美国/流行病学退伍军人/统计学和数值数据病毒血症/流行病学病毒血症/病毒学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Hepatitis c in African Americans: Summary of a workshop

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GASTROENTEROLOGY 2000年第5期119卷 1385-+页

作者： Howell, C Jeffers, L Hoofnagle, JH Univ Maryland Sch Med Div Gastroenterol & Hepatol Baltimore MD 21201 USA Univ Miami Sch Med Ctr Liver Dis Miami FL USA Vet Adm Med Ctr Miami FL 33125 USA NIDDKD Div Digest Dis & Nutr NIH Bethesda MD 20892 USA

GASTROENTEROLOGY 2000;119:1385-1396

关键词：非洲裔美国人/统计学和数值数据抗病毒药/治疗应用癌肝细胞/流行病学癌肝细胞/病毒学丙型肝炎慢性/流行病学丙型肝炎慢性/病因学丙型肝炎慢性/病理生理学丙型肝炎慢性/治疗发病率干扰素类/治疗应用肝肿瘤/流行病学肝肿瘤/病毒学肝移植患病率利巴韦林/治疗应用物质滥用静脉内/并发症美国退伍军人/统计学和数值数据人类

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Doing battle with HCV

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第3期95卷 582-583页

作者： Fimmel, CJ St Louis VA Med Ctr St Louis MO 63125 USA

Hepatitis C virus (HCV) infection has emerged as a major health care problem in the US veteran population. The growing awareness of its importance is reflected in the recent mandate by the Department of Veterans Affairs to perform HCV testing on all veterans at risk for the disease (1) and to manage patients according to the Center for Disease Control and Prevention guidelines (2). Interferon/ribavirin combination therapy is available to VA patients, and Congress has earmarked $230 million for HCV diagnosis and treatment for the year 2000 VA budget. Gastroenterologists practicing in the VA system have noticed a drastic increase in HCV-related morbidity over the past years. However, the full impact of the disease is unknown. This is due to the lack of epidemiological data that would allow one to estimate the number of affected patients and to calculate the HCV-related expenditures. The study by Ramsey Cheung in this issue of the American Journal of Gastroenterology (3) provides a first systematic and detailed report on HCV antibody seroprevalence, risk factors, genotypes, and age distribution of infected patients. The data were obtained in a retrospective analysis of the Palo Alto VA Healthcare system. Over a period of 6 yr, (1992-1998), approximately one-fifth of the approximately 40,000 veterans living in this predominantly suburban area were tested for HCV antibodies by a second generation ELISA assay. The test was positive in 2985 subjects, corresponding to a point prevalence of 35%. The overwhelming majority of these patients were found to be viremic, as confirmed by PCR analysis. As pointed out by the authors, the high rate of seropositivity is likely to be affected by selection and referral bias, as patients were tested based on the presence of HCV risk factors or abnormal liver tests. To obtain a more representative seroprevalence rate, the author measured HCV antibodies in 126 consecutive patients involved in blood-borne exposure accidents and obtained a pre

关键词：抗病毒药/经济学抗病毒药/治疗应用横断面研究药费支出药物疗法联合肝炎丙型慢性/药物疗法肝炎丙型慢性/经济学肝炎丙型慢性/流行病学干扰素类/经济学干扰素类/治疗应用利巴韦林/经济学利巴韦林/治疗应用美国退伍军人/统计学和数值数据人类

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Birth defects prevalence among infants of Persian Gulf War veterans born in Hawaii, 1989-1993

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TERATOLOGY 2000年第4期62卷 195-204页

作者： Araneta, MRG Destiche, DA Schlangen, KM Merz, RD Forrester, MB Gray, GC USN Hlth Res Ctr DoD Ctr Deployment Hlth Res San Diego CA 92186 USA Hawaii Birth Defects Program Honolulu HI 96817 USA Texas Birth Defects Monitoring Div Austin TX 78756 USA

Background: Gulf War veterans (GWVs) have expressed concern about possible teratogenic exposures. However, epidemiologic studies on birth defects prevalence among their progeny have been limited to military hospitals, anomalies diagnosed among newborns, or self-reported data. To measure the prevalence of selected birth defects among infants of GWVs and nondeployed veterans (NDVs) in Hawaii, using birth defects surveillance records. Methods: Personal identifiers of 684,645 GWVs and 1,587,102 NDVs and their families were matched against birth certificate records of 99,545 live births reported to the State of Hawaii Department of Health between 1989 and 1993 to identify births to military personnel. These births were matched with records from the Hawaii Birth Defects Program. Results: A total of 17,182 military infants (3,717 GWV infants and 13,465 NDV infants) were identified. Of these, 367 infants (2.14/100 live births) were identified with one or more of 48 major birth defects diagnoses. The prevalence of the 48 birth defects were similar for GWV and NDV infants during the prewar and postwar periods, and among GWV infants who were conceived before and after the Gulf war. Conclusions: The results must be interpreted with caution because of the small number of affected infants in each birth defects category. This study demonstrated the feasibility of measuring birth defects prevalence among military infants through multiple data linkage. Further, it included live births to parents who had separated from the military, births in civilian hospitals, and birth defects diagnosed through the first year of life. Published 2000 Wiley-Liss, ***

关键词：畸形/流行病学病例对照研究夏威夷/流行病学中东军事人员/统计学和数值数据人群监测妊娠结局患病率退伍军人/统计学和数值数据战争成年人女(雌)性人类婴儿新生男(雄)性妊娠

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The risk of subsequent fractures in community-dwelling men and male veterans with hip fracture

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AMERICAN JOURNAL OF MEDICINE 2000年第4期109卷 324-326页

作者： Colón-Emeric, CS Sloane, R Hawkes, WG Magaziner, J Zimmerman, SI Pieper, CF Lyles, KW Vet Affairs Med Ctr CRECC 182 Durham NC 27706 USA Duke Univ Med Ctr Ctr Study Aging Durham NC USA Univ Maryland Sch Med Dept Epidemiol & Prevent Med Baltimore MD 21201 USA Univ N Carolina Cecil G Sheps Ctr Hlth Serv Res Chapel Hill NC USA Duke Univ Dept Community & Family Hlth Div Biometry Durham NC USA

More than one-third of the 300,000 hip fractures that occur each year among the elderly in the United States occur in men, with a rate in white men of approximately 19 per 1,000 person-years (1). The 1-year mortality after hip fracture is up to 33%, and there are also substantial economic, functional, and psychological burdens (2–9). However, little is known about the risk of subsequent fractures in these men. We hypothesized that men with hip fractures would have a significantly greater rate of subsequent skeletal fractures than men of the same age without hip fracture.

关键词：意外跌倒/统计学和数值数据年龄分布队列研究共病现象置信区间骨折/流行病学髋骨折/流行病学发病率北卡罗来纳/流行病学概率比例危险度模型复发危险因素存活率退伍军人/统计学和数值数据老年人老年人 80以上人类男(雄)性

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JOURNAL OF GERIATRIC PSYCHIATRY AND NEUROLOGY 2000年第1期13卷 33-37页

作者： Edgell, RC Kunik, ME Molinari, VA Hale, D Orengo, CA Vet Affairs Med Ctr Dept Psychiat Houston TX 77030 USA Baylor Coll Med Dept Psychiat & Behav Sci Houston TX 77030 USA Vet Affairs Med Ctr Mental Illness Res Educ & Clin Ctr 16 Vet Integrated Serv Network Houston TX 77030 USA Univ Houston Dept Psychol Houston TX USA

The authors determined the prevalence and demographic features of drug use disorders in a database of 565 veteran geropsychiatric inpatients. Twenty-four patients (4%) were diagnosed with nonalcoholic substance use disorders, including 18 (3%) with prescription drug use disorders and 6 (1%) with illegal drug use disorders. The patients diagnosed with prescription drug use disorders were predominantly Caucasian, whereas those diagnosed with illegal substance use disorders were predominantly African American. No other significant demographic differences were noted. Nonalcohol substance use disorders represent an unappreciated problem in psychiatrically hospitalized older adults, with illegal substance use disorders making up a larger than expected proportion of this group.

关键词：酒精中毒/诊断酒精中毒/流行病学酒精中毒/心理学阿尔茨海默病/诊断阿尔茨海默病/流行病学阿尔茨海默病/心理学共病现象横断面研究精神治疗药物江湖药物质相关性障碍/诊断物质相关性障碍/流行病学物质相关性障碍/心理学退伍军人/心理学退伍军人/统计学和数值数据成年人老年人老年人 80以上人类男(雄)性中年人

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Percutaneous cholecystostomy for acute cholecystitis in veteran patients

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AMERICAN JOURNAL OF SURGERY 2000年第3期180卷 198-202页

作者： Chang, L Moonka, R Stelzner, M Univ Washington Dept Surg VAPSHCS Surg Serv 112 Seattle WA 98108 USA

BACKGROUND: Surgical cholecystostomy has been shown to carry a significantly higher mortality rate at Veterans Administration (VA) hospitals than at non-federal hospitals in the past. METHODS: A retrospective outcomes study was undertaken at a large VA medical center with a policy favoring radiologic over surgical cholecystostomy over the past 9 years. Records of 24 consecutive patients with acute cholecystitis were reviewed to evaluate the effectiveness of the procedure. RESULTS: Cholecystostomy was performed radiologically in 22 patients and surgically in 2 patients. Most (78%) of patients improved within 48 hours. The periprocedural mortality was 25%. The majority of these patients died from unrelated illnesses. Four patients developed complications, none of which required operative intervention. CONCLUSIONS: Comorbidities are the most important mortality factor for cholecystostomies in VA patients. Radiologic tube placement is effective and uncomplicated in most cases. Am J Surg. 2000;180:198-202. (C) 2000 by Excerpta Medica, Inc.

关键词：急性病胆囊炎/死亡率胆囊炎/外科学胆囊造口术/方法胆囊造口术/统计学和数值数据病案回顾性研究支架存活率分析治疗结果退伍军人/统计学和数值数据华盛顿/流行病学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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