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Peter Richardson

Publications and source records attributed to Peter Richardson.

At least 19 recordsLinked to original sources
PubMed2006

The use of screening colonoscopy for patients cared for by the Department of Veterans Affairs.

BACKGROUND: Medicare data indicate an increase in colorectal cancer (CRC) screening using colonoscopy and a decline in fecal occult blood testing, flexible sigmoidoscopy, and double-contrast barium enema. Because of differences in the delivery of health care, this trend in use of colonoscopy in fee-for-service settings might not be paralleled in the Department of Veterans Affairs (VA). METHODS: National inpatient and outpatient VA databases were searched for codes indicative of colonoscopy, flexible sigmoidoscopy, fecal occult blood testing, and double-contrast barium enema during fiscal years 1998 to 2003 among VA users aged 49 to 75 years. RESULTS: The frequency of tests for CRC screening increased from 432,778 in 1998 to 1,179,764 in 2003. Of those who were screened, only the proportion of subjects screened with fecal occult blood testing increased from 81.7% to 90.4%, while screening colonoscopy declined from 5.7% to 4.7%; flexible sigmoidoscopy declined from 8.3% to 3.6%; and double-contrast barium enema declined from 4.1% to 1.3%. The total use of screening colonoscopy procedures increased from 24,955 in 1998 to 55,199 in 2003, but the proportion of colonoscopy procedures performed for CRC screening purposes increased only slightly from 34.3% to 38.4%. In regression models adjusting for age, race, and sex, there was no consistent secular trend in the likelihood of undergoing screening colonoscopy for patients cared for in the VA health care system. CONCLUSIONS: Colorectal cancer screening has dramatically increased in the VA, but unlike in other practice settings, fecal occult blood testing is the dominant mode of screening. Although screening colonoscopy more than doubled in frequency, it constitutes a small proportion of the total CRC screening procedures used in the VA health care setting.

Aged↗
PubMed2006

The prevalence of suspected Barrett's esophagus in children and adolescents: a multicenter endoscopic study.

BACKGROUND: The prevalence of Barrett's esophagus (BE) in young individuals is unclear. OBJECTIVE: To estimate the prevalence of suspected BE in children and adolescent patients undergoing endoscopy. DESIGN: A retrospective cross-sectional study. SETTING: Prospectively collected data in the Pediatric Clinical Outcomes Research Initiative (PEDS-CORI). PATIENTS: We identified patients younger than 20 years of age with suspected BE in the PEDS-CORI between 1999 and 2002; the corresponding histopathologic records were examined. MAIN OUTCOME MEASUREMENTS: We analyzed the distribution of demographic and endoscopic risk factors for BE between cases and non-cases with and without suspected BE in bivariate and multivariable analyses. RESULTS: We identified a total of 6731 patients who underwent upper endoscopy in 12 pediatric facilities. Only 17 patients had suspected BE (prevalence, 2.5 per 1000). Intestinal metaplasia was reported in only 9 of these patients (53%). Patients with suspected BE were older than patients without BE (median 14.7 vs 10.1 years; P = .011). Hiatus hernia was more commonly recorded in patients with suspected BE (11.8% vs 2.2%; P = .008). In a logistic regression model, both older age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02-1.35) and hiatus hernia (OR 4.62, 95% CI 1.03-20.66) were independently associated with suspected BE. CONCLUSIONS: Endoscopically suspected BE is rare (<0.25%) in children and adolescents. Older age and the presence of hiatus hernia are possible risk factors for BE in this group. LIMITATIONS: Lack of standardization for identifying and recording endoscopic landmarks.

Adolescent↗
PubMed2006

Detection of cardiac cycle from intracoronary ultrasound.

In this paper, we describe a method automatically to determine the phase of a cardiac cycle for each video frame of an intravascular ultrasound (IVUS) video recorded in vivo. We first review the principle of IVUS video and demonstrate the general applicability of our method. We show that the pulsating heart leads to phasic changes in image content of an IVUS video. With an image processing method, we can reverse this process and reliably extract the heart-beat phase directly from IVUS video. With the phase information, we demonstrate that we can build 3-D (3D) time-variant shapes and measure lumen volume changes within a cardiac cycle. We may also measure the changes of IVUS imaging probe off-center vector within a cardiac cycle, which serves as an indicator of vessel center-line curvature. The cardiac cycle extraction algorithm requires one scan of the IVUS video frames and takes O(n) time to complete, n being the total number of the video frames. The advantage of this method is that it requires no user interaction and no hardware set-up and can be applied to coronary scans of live beating hearts. The extracted heart-beat rate, compared with clinical recordings, has less than 1% error.

Animals↗
PubMed2006

Anthropometric correlates of intragastric pressure.

OBJECTIVE: Obesity may increase intra-abdominal pressure on the stomach leading to an increase in intragastric pressure, which in turn induces lower esophageal sphincter relaxation, with subsequent reflux. However, the association between anthropometric measures of total body as well as abdominal obesity and intragastric pressure has not been examined. MATERIAL AND METHODS: This prospective cross-sectional study included consecutive patients undergoing manometry at an open access Reflux Center. Standardized measurements of body-weight, height, and waist and hip circumference were prospectively obtained. To assess the intragastric pressure, the perfusion port levels of the catheter were verified to be at the same vertical height (0 mmHg) inside the patient as they were outside the patient during calibration. Correlation between gastric pressure and anthropometric measures was calculated and adjusted for demographic features and presenting symptoms. RESULTS: A total of 322 patients (67% women) with a mean age of 52.5 years were enrolled. The mean values for weight, height, and body mass index (BMI) were 77.2 kg, 168 cm, and 27.5 kg/m2, respectively (range 16.0-52.0, median 27.0). The mean intragastric pressure was 2.9 cm H2O (SD: 1.7). There was a weak, positive correlation between gastric pressure and both BMI (r=0.11, p=0.05) and waist circumference (r=0.11, p=0.06). The associations between gastric pressure and both BMI and waist circumference were relatively unaffected by adjusting for several variables including age, indications for manometry, race, and gender in a multivariable linear regression model. For each unit increase in BMI, there was approximately a 10% increase in intragastric pressure. CONCLUSIONS: In this study of consecutive patients with wide-ranging BMI values, there was a weak, positive correlation between intragastric pressure and both BMI and waist circumference. This indicates that obesity operates to increase the risk of gastroesophageal reflux disease (GERD) at least partly by increasing intragastric pressure.

Body Fat Distribution↗
PubMed2006

Adapting the Rx-Risk-V for mortality prediction in outpatient populations.

OBJECTIVES: We sought to operationalize, test, and validate an outpatient pharmacy-based case-mix adjuster. METHODS: Outpatients from the Department of Veterans Affairs (VA) prescribed a nonsteroidal anti-inflammatory drug (NSAID) or cyclooxygenase-2 selective drug during 2002 were identified. We updated and extended the Rx-Risk-V by adding 26 additional disease categories and mapping them to VA drug-class codes; derived empirical weights for each from a logistic model of 1-year mortality; adjusted for age, race and sex; and scored the weights into 1 measure of comorbidity. We compared the weighted score to the Deyo diagnosis-based comorbidity index and validated it in a national cohort of 260,321 outpatients with chronic heart failure (CHF). RESULTS: One-year mortality among the 724,270-outpatient NSAID cohort was 1.6% (n = 11,766). Using a baseline model of age, race, and gender (c-index = 0.716), we found that the Deyo measure improved the prediction of mortality (c-index = 0.765), and the pharmacy comorbidity score further improved the prediction (c-index = 0.782), an increase of 25.8%. Using both, we found further improvement (c-index = 0.792). Among the CHF cohort, 9.7% (n = 25,251) died within 1 year. Performance of the baseline model controlling for age, race, and gender (c index = 0.620) improved with addition of the pharmacy comorbidity score (c index = 0.689), compared with the addition of the Deyo measure (c index = 0.651), an increase of 55.1%. Together, they slightly improved prediction in CHF patients (c index = 0.695). CONCLUSIONS: The updated and extended Rx-Risk-V is useful for case-mix adjustment of mortality in an outpatient population.

Aged↗
PubMed2006

Is there a race-based disparity in the survival of veterans with HIV?

BACKGROUND: Disparities in survival for black patients with HIV in the United States have been reported. The VA is an equal access health care system. OBJECTIVE: To determine whether such disparities are present in the VA health care system. DESIGN: Retrospective cohort study using national VA administrative databases. PATIENTS: Two thousand three hundred and four white and 3,641 black HIV-infected patients first hospitalized for HIV between October 1, 1996 and September 30, 2000. MEASUREMENTS: Thirty-day mortality after first hospitalization with HIV, and subsequent long-term survival. Follow-up ended at death or September 30, 2002. Data were adjusted for age, sex, HIV disease severity, non-HIV-related comorbidities, primary discharge diagnosis, hepatitis C status, and facility effects. RESULTS: The mean follow-up was 3.2 years. Overall survival was similar for black patients compared with white patients (adjusted hazard ratio 1.09, P=.09). Hospital mortality was 7.0% for black and 6.4% for white patients (P=.35). Adjusted hospital mortality for black patients was similar to that of white patients (odds ratio 1.20, P=.10). Long-term survival after hospitalization did not significantly differ by race (adjusted hazard ratio 1.07, P=.21, for black patients compared with white patients). CONCLUSIONS: Survival during and after first hospitalization with HIV in the VA did not significantly differ for white and black patients, possibly indicating similar effectiveness of care for HIV. Further research is needed to understand the reasons for the lack of disparities for VA patients with HIV and whether the VA's results could be replicated.

Adult↗
PubMed2005

Comparison of a single infusion of zoledronic acid with risedronate for Paget's disease.

BACKGROUND: The advent of bisphosphonates advanced therapy for Paget's disease, but more effective and convenient agents are needed to increase adherence. Zoledronic acid, a bisphosphonate administered as a single intravenous infusion, might meet these needs. METHODS: In two identical, randomized, double-blind, actively controlled trials of 6 months' duration, we compared one 15-minute infusion of 5 mg of zoledronic acid with 60 days of oral risedronate (30 mg per day). The primary efficacy end point was the rate of therapeutic response at six months, defined as a normalization of alkaline phosphatase levels or a reduction of at least 75 percent in the total alkaline phosphatase excess. The results of the studies were pooled. RESULTS: At six months, 96.0 percent of patients receiving zoledronic acid had a therapeutic response (169 of 176), as compared with 74.3 percent of patients receiving risedronate (127 of 171, P<0.001). Alkaline phosphatase levels normalized in 88.6 percent of patients in the zoledronic acid group and 57.9 percent of patients in the risedronate group (P<0.001). Zoledronic acid was associated with a shorter median time to a first therapeutic response (64 vs. 89 days, P<0.001). Higher response rates in the zoledronic acid group were consistent across all demographic, disease-severity, and treatment-history subgroups and with changes in other bone-turnover markers. The physical-component summary score of the Medical Outcomes Study 36-item Short-Form General Health Survey, a measure of the quality of life, increased significantly from baseline at both three and six months in the zoledronic acid group and differed significantly from those in the risedronate group at three months. Pain scores improved in both groups. During post-trial follow-up (median, 190 days), 21 of 82 patients in the risedronate group had a loss of therapeutic response, as compared with 1 of 113 patients in the zoledronic acid group (P<0.001). CONCLUSIONS: A single infusion of zoledronic acid produces more rapid, more complete, and more sustained responses in Paget's disease than does daily treatment with risedronate.

Administration, Oral↗
PubMed2005

Survival in hepatitis C and HIV co-infection: a cohort study of hospitalized veterans.

BACKGROUND & AIMS: Previous studies reported increased morbidity and mortality related to liver disease among human immunodeficiency virus (HIV)-infected patients with hepatitis C co-infection. However, the long-term effect of hepatitis C virus (HCV) co-infection on the mortality of HIV-infected patients remains unclear. METHODS: By using national Veterans Affairs (VA) databases, we performed a retrospective cohort study of HIV patients hospitalized between October 1991 and September 2000. Mortality rates and hazard rate ratios (HRRs) for mortality were calculated for the entire cohort as well as after excluding patients with pre-existing liver disease, with follow-up through September 2001 after discharge. Multivariable adjustment for differences in demographics, comorbidities, and HIV disease severity was performed. Separate analyses were performed for patients identified during the highly active antiretroviral therapy (HAART) era. RESULTS: We identified 18,081 patients, of whom 5320 patients had dual HCV/HIV infection and 12,761 patients had HIV monoinfection. The number of deaths per 100 patient-years was 7.33 in the dual infection group and 14.13 in the HIV monoinfection group during 22,054 and 40,655 person-years of follow-up, respectively. The mortality rate ratio between HCV/HIV dual infection and HIV monoinfection was .53. In Cox multiple regression, the dual HCV/HIV infection group had an adjusted HRR for mortality of .55 compared with the HIV monoinfection group (95% CI, .51-.58, P < .0001), after controlling for age, race, sex, year of diagnosis, and HIV disease severity. These findings persisted in several sensitivity analyses. However, in the HAART era, if patients with liver disease at baseline were excluded, the HRR for mortality was .83 (95% CI, .73-.94, P = .003). CONCLUSIONS: Co-infection with hepatitis C is associated with a significant decrease in the mortality of HIV-infected patients. However, this effect was less pronounced during the HAART era.

AIDS-Related Opportunistic Infections↗
PubMed2005

National adherence to evidence-based guidelines for the prescription of nonsteroidal anti-inflammatory drugs.

BACKGROUND & AIMS: Our objective was to assess adherence to evidence-based guidelines by providers of the Department of Veterans Affairs nationwide. METHODS: This was a cross-sectional study among veterans prescribed a nonsteroidal anti-inflammatory drug (NSAID) from January 1, 2002, to December 31, 2002. Prescription data were linked to inpatient and outpatient medical records and death files. The population was characterized as high risk based on the following: age 65 years or older, concurrent corticosteroid or anticoagulant use, history of peptic ulcer, and high average daily dose of NSAIDs. Adherence was defined as the prescription of a traditional NSAID with gastroprotection or a coxib in high-risk NSAID users. Univariate and multivariate analyses assessed the potential predictors of adherence. RESULTS: Three hundred three thousand seven hundred eighty-seven met our definition of high risk. Most (97.3%) were male; 55.6% were white, 9.6% black, and 34.8% of other/unknown race. Age 65 years or older was the largest high-risk subset (87.1%). Overall, only 27.2% of high-risk veterans (n = 82,766) were prescribed an adherent strategy. Among veterans with at least 2 risk factors, adherence was 39.7%; among those with 3 risk factors, adherence was 41.8%. Predictors of adherence included history of upper gastrointestinal events, anticoagulant use, rheumatologic disease, high Deyo comorbidity index score, use of low-dose salicylates, and concurrent corticosteroid use. Predictors of nonadherence included prescriptions > or =90 days and high average daily dose of NSAIDs. CONCLUSIONS: Adherence to evidence-based guidelines for safe prescription of NSAIDs in the Department of Veterans Affairs is low (27.2%). The likelihood of adherence is further decreased if veterans are prescribed NSAIDs for > or=90 days.

Aged↗
PubMed2005

Association of psychiatric disorders and sleep apnea in a large cohort.

STUDY OBJECTIVES: We conducted the present study to determine whether psychiatric disorders are commonly associated with sleep apnea in Veterans Health Administration beneficiaries. METHOD: The Veterans Health Administration maintains several centralized databases containing healthcare data for more than 4 million veterans. We reviewed data from 1998 to 2001 and identified patient records having International Classification of Diseases-Ninth Edition-Clinical Modification codes indicating sleep apnea and various psychiatric conditions. Subsequently, we compared age, sex, ethnicity, and prevalence of comorbid psychiatric conditions for Veterans Health Administration beneficiaries with and without sleep apnea. RESULTS: Out of 4,060,504 unique cases, 118,105 were identified as having sleep apnea (estimated prevalence of 2.91%). Mean age at the time of diagnosis was 57.6 years. Psychiatric comorbid diagnoses in the sleep apnea group included depression (21.8%), anxiety (16.7%), posttraumatic stress disorder (11.9%), psychosis (5.1), and bipolar disorders (3.3%). Compared with patients not diagnosed with sleep apnea, a significantly greater prevalence (P < .0001) was found for mood disorders, anxiety, posttraumatic stress disorder, psychosis, and dementia in patients with sleep apnea. CONCLUSIONS: Sleep apnea is associated with a higher prevalence of psychiatric comorbid conditions in Veterans Health Administration beneficiaries. This association suggests that patients with psychiatric disorders and coincident symptoms suggesting sleep-disordered breathing should be evaluated for sleep apnea.

Adult↗
PubMed2005

The effect of HIV coinfection on the risk of cirrhosis and hepatocellular carcinoma in U.S. veterans with hepatitis C.

OBJECTIVES: This study was conducted to determine whether HIV coinfection increases the risk of cirrhosis in HCV-infected patients in the HAART and pre-HAART eras. Further, the risk of hepatocellular carcinoma was also examined. METHODS: This retrospective cohort study was conducted among HCV-infected veterans who were seen at one of the 172 Veterans Health Administration hospitals between October 1, 1991 and September 30, 2000. Patients with prerecorded advanced liver disease were excluded. Incidence rates, cumulative incidence, and Cox proportional hazard ratios were calculated. RESULTS: There were 26,641 patients with HCV-only and 4,761 patients with HCV-HIV coinfection. The unadjusted incidence rate of cirrhosis was lower in patients with coinfection than HCV-only (p < 0.01). After controlling for demographics and confounders (including alcoholism and chronic hepatitis B), coinfection was not significantly associated with cirrhosis. However, there was an increased risk of cirrhosis in patients with coinfection compared to HCV-only during the pre-HAART era (before October 1, 1996) (hazard ratio = 1.48, 1.06-2.07, p= 0.02), but not among patients who entered the cohort during the HAART era. The unadjusted incidence rate of hepatocellular carcinoma in patients with coinfection and HCV-only was 1.3 and 2/1,000 person-years, respectively (p= 0.04). In the multivariate model, coinfection was not associated with hepatocellular carcinoma (hazard ratio = 0.84, p= 0.40). CONCLUSIONS: Coinfection was a significant risk factor for cirrhosis only during the pre-HAART era and was not associated with hepatocellular carcinoma, irrespective of time period.

Adult↗
PubMed2005

Fundoplication and the risk of esophageal cancer in gastroesophageal reflux disease: a Veterans Affairs cohort study.

BACKGROUND AND AIMS: It has been proposed that fundoplication can reduce the risk of esophageal cancer in patients with gastroesophageal reflux disease (GERD). In this cohort study, we assessed the effect of fundoplication on the incidence of esophageal cancer. METHODS: We identified all Veterans Affairs (VA) patients with GERD who had fundoplication between 1986 and 1990 and matched (1-2) to controls with GERD and no fundoplication and to controls with no GERD. We calculated incidence rates for esophageal cancer through October 2002 and examined the effect of fundoplication on the risk of esophageal cancer using Kaplan-Meier survival analysis and Cox proportional hazard analysis. We calculated and adjusted for the propensity score for receiving fundoplication. RESULTS: We identified 946 patients who had fundoplication, 1,892 patients who had GERD without fundoplication, and 5,676 patients with no GERD. The mean age was 55 yr and 97.5% were men in all three groups. During a follow-up of 11,156 patient-years (PY), there were eight cases of esophageal cancer (72/100,000) in the fundoplication group. During a follow-up of 20,115 PY, there were eight cases of esophageal cancer (40/100,000) in the GERD without fundoplication group. During a follow-up of 59,439 PY, no patients in the group with no GERD developed esophageal cancer. The Kaplan-Meier analysis showed no significant difference in cumulative esophageal cancer rates between the fundoplication group and the GERD no-fundoplication group. The adjusted hazard ratio of esophageal cancer with fundoplication was 1.88 (95% CI: 0.70-5.03). CONCLUSIONS: GERD is a risk factor for esophageal cancer, but there is insufficient evidence that fundoplication reduces that risk.

Adult↗
PubMed2005

Surprisingly high prevalence of anxiety and depression in chronic breathing disorders.

STUDY OBJECTIVES: The objectives of this study were to assess the prevalence, screening, and recognition of depression and anxiety in persons with chronic breathing disorders, including COPD. DESIGN: Cross-sectional study. SETTING: The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC). PARTICIPANTS: A large sample of 1,334 persons with chronic breathing disorder diagnoses who received care at the MEDVAMC. MEASUREMENTS: The prevalence of anxiety and depression was measured in a large sample of persons with a chronic breathing disorder diagnosis who received care at the MEDVAMC, using the Primary Care Evaluation of Mental Disorders (PRIME-MD) screening questions. The positive predictive value of the PRIME-MD questions was then determined. The prevalence of anxiety and depressive diagnoses in patients determined to have COPD was then measured, using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). RESULTS: Of patients screened with the PRIME-MD, 80% screened positive for depression, anxiety, or both. The predictive value of a positive phone screen for either depression or anxiety was estimated to be 80%. In the subsample of patients who had COPD and received a diagnosis using the SCID, 65% received an anxiety and/or depressive disorder diagnosis. Of those patients, only 31% were receiving treatment for depression and/or anxiety. CONCLUSIONS: It is troubling that a mere 31% of COPD patients with depression or anxiety are being treated, particularly given their high prevalence in this population. Practical screening instruments may help increase the recognition of anxiety and depression in medical patients, as suggested by the excellent positive predictive value of the PRIME-MD in our study.

Aged↗
PubMed2004

Cirrhosis and hepatocellular carcinoma in HIV-infected veterans with and without the hepatitis C virus: a cohort study, 1992-2001.

BACKGROUND: Because they develop slowly and infrequently, the incidence and relative risk of cirrhosis and hepatocellular carcinoma (HCC) in patients with the human immunodeficiency virus (HIV) only and in patients coinfected with the hepatitis C virus (HCV) are not known. METHODS: By using national Veterans Health Administration administrative databases, we conducted a retrospective cohort study. Excluding patients with preexisting liver disease, 11,678 HIV-only and 4761 coinfected patients hospitalized between October 1, 1991, and September 30, 2000, were included. Incidence rates and adjusted hazard ratios (HRs) for nonalcoholic cirrhosis and HCC after discharge were calculated through September 30, 2001. RESULTS: The incidence rates of cirrhosis in the HIV-only and coinfected groups were 1.47 and 15.88 per 1000 person-years, respectively. In a Cox multivariate proportional hazards regression model, coinfected patients had an adjusted HR for cirrhosis of 9.24 compared with HIV-only patients (95% confidence interval, 6.92-12.33; P<.001). The incidence rates of HCC in the HIV-only and coinfected groups were 0.20 and 1.32 per 1000 person-years, respectively. In a Cox multivariate proportional hazards regression model, coinfected patients had an adjusted HR for HCC of 5.35 compared with HIV-only patients (95% confidence interval, 2.34-12.20; P<.001). Among patients identified during the highly active antiretroviral therapy era, the HR for cirrhosis was 19.06 (95% confidence interval, 10.14-35.85; P<.001), while the HR for HCC was 5.07 (95% confidence interval, 1.72-14.99; P = .003). CONCLUSIONS: To our knowledge, this study is the largest longitudinal study to examine the incidence of nonalcoholic cirrhosis and HCC in HIV-only and HCV-coinfected patients. Hepatitis C virus coinfection dramatically promotes the development of HCC (5-fold) and of cirrhosis (10- to 20-fold), and is especially associated with cirrhosis in the highly active antiretroviral therapy era. Treatment of HCV in HIV-infected patients, while often unsuccessful, should be considered.

Adult↗
PubMed2004

Death of an Arabian Jew.

A 69-year-old Judean man presents with chronic low-grade fever, pedal edema, and abdominal pain. His condition deteriorates over several weeks with the appearance of shortness and foulness of breath, pruritus, convulsions of every limb, and gangrene of the genitalia. Just before he dies, he orders dozens of the leading men of his kingdom imprisoned and instructs his sister to kill them all after he is gone. Who is he and what is the likely cause of his death?

Famous Persons↗
PubMed2004

Sleep apnea in a high risk population: a study of Veterans Health Administration beneficiaries.

BACKGROUND AND PURPOSE: In the present study we attempt to determine the prevalence of International Classification of Disease-ninth revision, Clinical Modification (ICD-9 CM) coded sleep apnea with cardiovascular and metabolic co-morbidities in Veterans Health Administration (VHA) beneficiaries. PATIENTS AND METHODS: Using VHA administrative databases, we gathered available medical information on more than 4 million veterans using the VHA during the period between 1998 and 2001. We identified database entries for codes indicating sleep apnea using the ninth revision of the Clinical Modification of the International Classification of Diseases (ICD-9 CM); and tabulated demographic data including age, gender, ethnicity, and cardiovascular and metabolic co-morbidities. RESULTS: We found 118,105 unique cases (out of 4,060,504) with sleep apnea ICD-9 CM codes (prevalence of 2.91%). Mean age at diagnosis was 57.6 with more than 38% older than 65 years. Comorbid diagnoses in this group included hypertension (60.1%), obesity (30.5%), diabetes mellitus (32.9%), cardiovascular disease (including MI and angina) (27.6%), heart failure (13.5%), and cerebrovascular accident (including Transient Ischemic Attack (TIA)) (5.7%). CONCLUSIONS: We found a high prevalence of diagnosed sleep apnea among VHA beneficiaries. Additionally, cardiovascular and metabolic conditions were common in these patients.

Adult↗
PubMed2004

Gastroesophageal reflux among different racial groups in the United States.

BACKGROUND & AIMS: White people in the United States are several-fold more affected by esophageal adenocarcinoma than black people. It remains unknown whether this racial discrepancy reflects a higher prevalence of gastroesophageal reflux disease (GERD) symptoms or a higher degree of esophageal damage. METHODS: A cross-sectional survey followed by endoscopy was performed among employees at a VA medical center. The association between race and GERD symptoms and erosive esophagitis was analyzed in logistic regression analyses controlling for demographic, clinical, and histologic variables. RESULTS: A total of 496 of 915 people (54%) returned interpretable questionnaires, and endoscopy was performed in 215 participants. The mean age was 45 years, and 336 (68%) were women. Racial distribution was 43% black, 34% white, and 23% other races. Heartburn occurring at least weekly was reported in 27%, 23%, and 24% of these racial groups, respectively. The age-adjusted prevalence of heartburn or regurgitation was not significantly different among the groups. Erosive esophagitis was found in 50 of 215 participants (23%); 31 of these cases were mild. Only one person had Barrett's esophagus (0.4%). For weekly heartburn or regurgitation, black participants had significantly less frequent erosive esophagitis than white participants (24% vs. 50%; P = 0.03). With multiple adjustments, black participants had a persistently lower risk of esophagitis (adjusted odds ratio, 0.22-0.46; P < 0.001). CONCLUSIONS: White and black people in the United States have a similarly high prevalence of GERD symptoms. However, black people have a lower prevalence of esophagitis for the same frequency of GERD symptoms. Barrett's esophagus was rare in this study, even among those with frequent symptoms.

Adolescent↗