Public Health Reports最新文献

Objective: During the past several decades, survival rates for sickle cell disease (SCD) have substantially increased, with many people now living well into middle adulthood. To understand trends in mortality and survival patterns, research has taken 2 diverging approaches to ascertaining the death status for people with SCD. Single-source approaches rely on death certificates alone to identify people with SCD who died, while multiple-source approaches first identify those with SCD and then link them to death certificates to ascertain mortality status. This study evaluated these 2 approaches in understanding SCD mortality.

Methods: We used 16 years of data (2004 through 2019) from the Sickle Cell Data Collection programs in California and Georgia. Drawing on these population-based surveillance systems and using the single- and multiple-source approaches, we constructed SCD decedent cohorts. For each approach, we examined the number of decedents with SCD, differences in demographic characteristics, and differential causes of death.

Results: The single-source approach identified 1788 deaths among people with SCD, while the multiple-source approach identified 2524 such deaths, an increase of 41%. While many of the demographic characteristics were similar between the approaches, the multiple-source approach identified the average age of death to be 3.5 years greater than that of the single-source approach. While the multiple-source approach identified more decedents with SCD, the death records contained a higher percentage of nonspecific cause-of-death codes relative to the single-source approach.

Conclusions: Researchers should be aware of the differences between the single- and multiple-source approaches when analyzing and interpreting mortality patterns among people with SCD. Prior estimates based on single-source approaches may be biased.

Objectives: Since 2000, leprosy has not been notifiable in Washington State, and statewide leprosy data have not been reported. We sought to increase our understanding of leprosy epidemiology in Washington State since 2001.

Methods: We reviewed data from the National Hansen's Disease Program to identify clinically diagnosed leprosy cases from 2001 through 2023 among Washington State residents. We analyzed cases over time, by county of residence, disease type, and global birth region. We used Poisson regression to estimate rates by birth region and incidence rate ratios to compare rates among US-born residents and those from other global birth regions.

Results: We identified 131 cases of leprosy in Washington State from 2001 through 2023. Most cases were among non-US-born people (95%), males (72%), and adults aged 18 to 64 years (87%); one-third were among Micronesian or Marshallese people. As compared with US-born people (0.2 per 1 000 000 population), the leprosy rate was 1064 times (95% CI, 466-3069) higher among people born in Oceania (215 per 1 000 000 population). Incidence rate ratios for other birth regions ranged from 301 (95% CI, 43-1396) for South America to 28 (95% CI, 11-82) for Asia.

Conclusions: Focused public health interventions, including increased physician awareness of leprosy and its stigma for populations at high risk, may reduce the incidence of leprosy among Washington State residents born in Oceania, who had a disproportionately high disease rate.

Objective: Enteric diseases are a leading cause of death in low- and middle-income countries (LMICs), and wastewater surveillance is a novel approach to understanding their spread in communities. This study identifies LMICs that could benefit from the implementation of wastewater surveillance, offering field researchers, health organizations, and policymakers data-driven guidance for prioritization.

Materials and methods: We used principal component analysis (PCA) across country-level self-reported policy capabilities, estimated enteric disease prevalence, the impact of conflicts, and the status of water and sanitation infrastructure for LMICs to model clusters of highly similar countries. Each PCA cluster grouped countries with greater similarity to one another than to other clusters, allowing for targeted surveillance interventions.

Results: We modeled 7 clusters. We based recommendations ranging from actively increasing internal investment to promoting wastewater surveillance or deferring current wastewater surveillance implementation on the balance of attributes found for each cluster.

Practice implications: This country-clustering framework offers several policy and investment profiles without overwhelming complexity. Within this framework, the targeted deployment of wastewater surveillance may provide data to reduce enteric disease morbidity and mortality in LMICs.

Objectives: Understanding patterns of hospital admissions and emergency department (ED) visits among people with sickle cell disease is critical for improving care and access to care for this population. The objective of this study was to characterize acute care use among people with sickle cell disease and identify patterns of use across age groups and sex using 2018 data.

Methods: We conducted a cross-sectional study using population-based data from 8 states participating in the Centers for Disease Control and Prevention's Sickle Cell Data Collection program. The sample population consisted of children, adolescents, and adults with a confirmed or probable diagnosis of sickle cell disease, regardless of acute care use, in 2018. We analyzed data on hospital admissions, ED treat-and-release (T/R) visits, and readmissions after ED T/R or inpatient discharge, aggregated from each participating state.

Results: The 2018 cohort of the Sickle Cell Data Collection program consisted of 27 034 people; 40.2% had ≥1 hospital admission, and 57.0% had ≥1 ED T/R visit. Of the 98 617 people using acute care, 93.6% (n = 92 305) involved the ED in some capacity.

Conclusions: Hospital admissions were frequent and occurred in less than half of the study population. More than half used the ED, with most hospital admissions initiated in the ED. Our findings call for further research to better understand differences in acute care use, high rates of ED T/R visits, and treatment of sickle cell disease in an outpatient setting.

Objectives: Health Extension for Diabetes (HED) is a community-based diabetes self-management support program facilitated by trained rural health and nutrition agents who lead 8 biweekly educational sessions supported by a diabetes clinical expert. We evaluated the program using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.

Methods: Since the HED program's conception in 2017, ongoing longitudinal evaluation has measured participant knowledge, self-efficacy, and other health behaviors via pre- and postsurveys (at program completion, at 1 year, and at 2 years). We used paired-sample t tests to assess significant changes in effectiveness outcomes from pre- to postintervention.

Results: Of 1526 participants enrolled in the HED program from 2018 to 2024, 1434 (94.0%) graduated. Mean physical health-related quality-of-life scores rose from 42.8 to 45.1, and mental health scores increased from 51.4 to 52.9 (on a 100-point scale). We assessed weekly diabetes self-care activities and found improvements in general diet (from 4.1 to 5.0 days/week), specific diet (from 3.9 to 4.7 days/week), exercise (from 2.6 to 3.7 days/week), blood glucose testing (from 4.2 to 5.2 days/week), and foot care (from 3.4 to 4.6 days/week). Average diabetes knowledge increased from 76.4% to 85.0%, and self-efficacy increased from 7.1 to 8.2 on a 10-point scale. Participants had reductions in weight (-3.4 pounds), body mass index (from 34.3 kg/m² to 33.7 kg/m²), and self-reported hemoglobin A_1c (from 7.5% to 7.0%). All pre- to postsurvey changes were significant at α = .05.

Conclusions: The HED program offers a scalable and sustainable approach to community-based diabetes self-management support. Program expansion and replication should leverage key implementation strategies identified via this RE-AIM framework evaluation.

Objectives: Suicidal behaviors present public health challenges worldwide. Surveillance and research aimed at preventing suicidal behaviors often rely on administrative data. Existing systematic reviews examine the validity of methods for identifying suicidal outcomes in administrative datasets but do not include codes based on the International Classification of Diseases, Tenth Revision (ICD-10), despite their widespread use for >2 decades. This rapid review evaluates methods for identifying suicidal behaviors using ICD-10 codes.

Methods: We searched PubMed and PsycINFO to identify relevant studies worldwide. Studies were included if they measured suicidal behaviors, used ICD-10 codes, validated the behaviors against a gold standard, and provided measures of accuracy (eg, specificity, sensitivity). We extracted data on study populations, data sources, ICD-10 codes used, gold-standard comparators, and accuracy measures from included studies.

Results: Of 2246 studies identified, 9 met our inclusion criteria. For methods identifying suicide attempts, sensitivity ranged from 19% to 45%, specificity from 47% to 99%, positive predictive value from 21% to 82%, and negative predictive value from 65% to 92%. For methods identifying self-harm, sensitivity ranged from 12% to 85%, specificity from 98% to 100%, positive predictive value from 64% to 100%, and negative predictive value from 86% to 87%. Only sensitivity was reported for suicide death (range, 78%-97%).

Conclusions: Findings indicate that sensitivity and positive predictive value for identifying suicide attempts using ICD-10 codes are low. Studies and surveillance methods relying on these codes might substantially underestimate rates of suicidal behaviors. ICD-10 codes may provide higher accuracy for identifying self-harm and other nonfatal suicidal behaviors than codes from the International Classification of Diseases, Ninth Revision.