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K B Weiss

Publications and source records attributed to K B Weiss.

66 records · Page 4Linked to original sources

The economic costs of asthma: a review and conceptual model.

There is a growing international concern about increasing asthma morbidity. While much is known about asthma morbidity, there are few available data on the economic burden of this condition, particularly in underdeveloped countries. In the absence of data on social costs, it is not possible to develop rational approaches to policies regarding resource allocation to reduce morbidity. The purpose of this article is to provide a review of the available literature on the social costs of illness for asthma. In light of this literature, we propose a conceptual model that links asthma morbidity to the social opportunity costs of the disease. We then delineate a framework, based on the proposed model, that can be used to conceptualise and evaluate the relative impact of alternative asthma intervention strategies. Based upon proposed analyses using this model, we believe that it would be possible to compare how various intervention strategies are likely to affect asthma costs and morbidity, thus providing a means for a more rational approach to healthcare policies regarding societal resource allocation for asthma.

Asthma↗

An economic evaluation of asthma in the United States.

BACKGROUND: Asthma is a common chronic illness. Recently, increases in morbidity and mortality due to this disease have been reported. We studied the distribution of health care resources used for asthma in order to lay the groundwork for further policy decisions aimed at reducing the economic burden of this disorder. METHODS: Estimates of direct medical expenditures and indirect costs (in 1985 dollars) were derived from data available from the National Center for Health Statistics. These cost estimates were projected to 1990 dollars. RESULTS: The cost of illness related to asthma in 1990 was estimated to be $6.2 billion. Inpatient hospital services represented the largest single direct medical expenditure for this chronic condition, approaching $1.6 billion. The value of reduced productivity due to loss of school days represented the largest single indirect cost, approaching $1 billion in 1990. Although asthma is often considered to be a mild chronic illness treatable with ambulatory care, we found that 43 percent of its economic impact was associated with emergency room use, hospitalization, and death. Nearly two thirds of the visits for ambulatory care were to physicians in three primary care specialties--pediatrics, family medicine or general practice, and internal medicine. CONCLUSIONS: Potential reductions in the costs related to asthma in the United States may be identified through a closer examination of the effectiveness of care associated with each category of cost. Future health policy efforts to improve the effectiveness of primary care interventions for asthma in the ambulatory setting may reduce the costs of this common illness.

Absenteeism↗

Changing patterns of asthma mortality. Identifying target populations at high risk.

Studies have suggested increases in hospitalization for asthma and in asthma mortality during the early 1980s. Using US Vital Records, we examined asthma mortality from 1968 through 1987 to describe the rates of change among children and young adults (aged 5 to 34 years) with time and in small geographic areas. During the 1970s, US asthma mortality declined by 7.8% per annum (+/- 1.0%), declining faster among women and nonwhites. During the 1980s, mortality increased by 6.2% per annum (+/- 1.2%), increasing faster among those aged 5 to 14 years than among those aged 15 to 34 years. Small-area geographic analysis revealed four areas with persistently high asthma mortality. Neither changes in International Classification of Diseases coding nor improved recognition of asthma, as demonstrated by trends in autopsy rates or rates of in-hospital deaths, seems to explain the increasing mortality of the 1980s.

Adolescent↗

Changing patterns of asthma hospitalization among children: 1979 to 1987.

The National Hospital Discharge Survey was used to evaluate the trends in asthma hospitalizations among children under International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): 1979 to 1987. During this period, asthma hospitalizations among children aged 0 to 17 years increased 4.5% per annum (95% confidence interval [Cl], 2% to 7.1%). The increase was largest among 0 to 4 year olds, 5.0% per annum (95% Cl, 3.4% to 6.7%), vs 2.9% per annum (95% Cl, -0.3% to 6.2%) observed among 5 to 17 year olds. Among children aged 0 to 4 years, blacks had approximately 1.8 times the increase of whites. During this time, total hospitalizations decreased -4.6% (95% Cl, -6.6% to -2.5%), while admissions for lower respiratory tract disease had a statistically insignificant decrease: -1.3%. Acute and chronic/unspecified bronchitis hospitalizations decreased -6.1% (95% Cl, -9.4% to -2.7%), but this decrease did not begin until 1983. Thus, a shift in coding from bronchitis to asthma does not seem to fully explain the increase.

Adolescent↗

Seasonal trends in US asthma hospitalizations and mortality.

Asthma morbidity is known to exhibit seasonal periodicity. Yet the relationship between trends in morbidity vs mortality is not known. This report describes and compares the seasonal variation in asthma hospitalizations and mortality in the US population. During 1982 through 1986, both mortality and hospitalizations demonstrated periodic seasonal trends that were age specific and did not differ by sex, race, or region. For persons aged 5 through 34 years, hospitalizations peaked in September through November, whereas mortality trends peaked in June through August. A disproportionate number of the summer deaths in this age group occurred out of the hospital. For individuals 65 years old or older, both asthma hospitalizations and mortality demonstrated increases during December through February. The results of this study demonstrate age-specific seasonal variations in the clinical expression of asthma. Perhaps the treatment and prevention of asthma hospitalizations and mortality might be improved through further understanding of these trends.

Adolescent↗

Geographic variations in US asthma mortality: small-area analyses of excess mortality, 1981-1985.

US asthma mortality rates have been increasing during the past 10 years. Little is known about the geographic variation of this infrequent health event. Using US vital records for the 1981-1985 period, small-area variation of excess asthma mortality of young adults was studied. Several geopolitical definitions were used to define populations. A total of 22 single counties, 12 metropolitan statistical areas, 11 health service areas, and 29 state economic areas were identified as having mortality significantly in excess of that expected, based on US race/sex-specific rates. Significant variation in asthma mortality was found at several levels of geopolitical classification of the data. Elevated areas included the central plains states and three large urban metropolitan areas--Chicago, Illinois, New York, New York, and Phoenix, Arizona--as well as a few mostly suburban populations. Areas with excess mortality may provide a useful population base for further epidemiologic investigation into the risk factors associated with the more frequent morbid events of this disease, such as emergency room and hospital utilization.

Adolescent↗

[Value of dietetics and general nutritional guidelines in the metaphylaxis of urinary calculi].

After a short historical survey the interest of our Socialist state in an optimum nutrition and nutritional education of the citizens is described. The importance of prophylaxis, therapy and metaphylaxis of urolithiasis is proved by the increasing morbidity rate of this disease (1-3%). Out of the series of vitamins above all the vitamin B6 is of importance in the oxalate lithiasis so that a diet rich in vitamin B6 is indicated. Of the quantity elements contained in nutrition calcium, phosphorus and magnesium are significant, wherefore the enteral supply of these elements is to be taken into consideration in the various kinds of urinary calculi. Furthermore, in carriers of calcium oxalate calculi nutrients rich in oxalic acid and in carriers of urinary calculi and in hyperuricaemia, respectively, nutrients rich in purine should be restricted. Adequate tables concerning the vitamin B6, Ca, P, Mg, oxalic acid and purine content of the nutrients are given. The increasing importance of the adiposity of carriers of uroliths is represented with the help of indices of our own urolith dispensary. Finally short references to diet for the 4 most important kinds of uroliths are proposed.

Diet↗