underwriting

2009 H1N1 Mortality in AI/AN

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Deaths Related to 2009 Pandemic Influenza A (H1N1) Among American Indian/Alaska Natives — 12 States, 2009

The AI/AN population is culturally diverse and spread among approximately 560 federally recognized tribal communities in 34 states and multiple urban areas (2). Health disparities between the AI/AN population and other racial/ethnic populations are well documented (3). Mortality rates and trends for respiratory diseases indicate that AI/ANs are at increased risk for death resulting from pneumonia and influenza (4,5). Although AI/AN death rates varied among the 12 participating states in this study, the aggregate AI/AN H1N1-related death rate from 12 states was four times higher than that of all other racial/ethnic groups combined.

The higher mortality rate among AI/ANs observed in this investigation is consistent with reports of increased influenza-related morbidity and mortality among indigenous populations in other parts of the world during the current H1N1 pandemic and also is consistent with observations from previous pandemics (1,2). After the influenza pandemic of 1918–19, U.S. government investigators reported that influenza-related mortality rates among AI/ANs were four times higher than the rates observed among persons in general urban populations (2).

The factors that produce a higher influenza mortality rate among AI/ANs are unknown but might include higher prevalence of underlying chronic illness such as diabetes. The age-specific prevalence of diabetes in AI/AN adults is two to three times higher than for all U.S. adults (6). In addition, AI/ANs are twice as likely to have unmet medical needs because of cost (7). AI/ANs also have the highest poverty rate (30%), which is twice the national rate and three times the rate for whites among households with children aged <18 years (8), suggesting that delayed access to medical care and living conditions associated with poverty might contribute to their higher influenza mortality rate.

Reduce DM Risk With…Coffee?

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Medical News: Tea, Coffee Seem to Protect Against Diabetes – in Endocrinology, Diabetes from MedPage Today

Drinking lots of coffee and tea every day — even decaf — might keep diabetes away, new research shows.

In a meta-analysis of 18 studies, drinking three to four cups of coffee per day was associated with a 25% lower risk of diabetes than drinking two cups or less per day (RR 0.76, 95% CI 0.69 to 0.82), according to Rachel Huxley, PhD, of the George Institute for International Health in Sydney, Australia, and colleagues.

There were similar results for decaf coffee and tea.

Acute Kidney Injury = Higher Mortality

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Medical News: Acute Kidney Injury Linked to Mortality – in Nephrology, General Nephrology from MedPage Today

Lafrance and Miller looked at VA data involving 864,933 U.S. veterans (4.9% female) who survived at least 90 days after a hospital discharge. Of those, 82,711 had acute kidney injury that did not require dialysis.

Through a mean follow-up of 2.34 years, the rate of death was higher in patients with acute kidney injury — 29.8% versus 16.1%.

After adjustment for demographics, comorbidities, medication use, primary diagnosis of admission, length of stay, mechanical ventilation, and postdischarge kidney function (estimated glomerular filtration rate), patients with acute kidney injury were 41% more likely to die during follow-up (HR 1.41, 95% CI 1.39 to 1.43).

The mortality risk increased significantly with greater severity of acute kidney injury (P<0.001 for trend), reaching a hazard ratio of 1.59 (95% CI 1.54 to 1.65) for those with stage III injury.

The risk of dying during follow-up was reduced, but still elevated, in patients with lower baseline kidney function, older patients, and those with diabetes.

Even among patients whose kidney function declined by 10% or less from the baseline assessment — who were considered to have recovered or to have maintained function — acute kidney injury was still associated with significantly higher mortality (HR 1.47, 95% CI 1.43 to 1.51).