scholarly journals Assessing the geographical distribution of comorbidity among commercially insured individuals in South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cristina Mannie ◽  
Hadi Kharrazi
Keyword(s):  
Public Health ◽  
South Africa ◽  
Geographical Distribution ◽  
Healthcare Utilization ◽  
Risk Score ◽  
Disease Burden ◽  
Risk Scores ◽  
Individual Risk ◽  
Average Risk ◽  
Healthcare Needs

Abstract Background Comorbidities are strong predictors of current and future healthcare needs and costs; however, comorbidities are not evenly distributed geographically. A growing need has emerged for comorbidity surveillance that can inform decision-making. Comorbidity-derived risk scores are increasingly being used as valuable measures of individual health to describe and explain disease burden in populations. Methods This study assessed the geographical distribution of comorbidity and its associated financial implications among commercially insured individuals in South Africa (SA). A retrospective, cross-sectional analysis was performed comparing the geographical distribution of comorbidities for 2.6 million commercially insured individuals over 2016–2017, stratified by geographical districts in SA. We applied the Johns Hopkins ACG® System across the insurance claims data of a large health plan administrator in SA to measure comorbidity as a risk score for each individual. We aggregated individual risk scores to determine the average risk score per district, also known as the comorbidity index (CMI), to describe the overall disease burden of each district. Results We observed consistently high CMI scores in districts of the Free State and KwaZulu-Natal provinces for all population groups before and after age adjustment. Some areas exhibited almost 30% higher healthcare utilization after age adjustment. Districts in the Northern Cape and Limpopo provinces had the lowest CMI scores with 40% lower than expected healthcare utilization in some areas after age adjustment. Conclusions Our results show underlying disparities in CMI at national, provincial, and district levels. Use of geo-level CMI scores, along with other social data affecting health outcomes, can enable public health departments to improve the management of disease burdens locally and nationally. Our results could also improve the identification of underserved individuals, hence bridging the gap between public health and population health management efforts.

scholarly journals Assessing the clinical utility of genetic risk scores for targeted cancer screening

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Carly A. Conran ◽  
Zhuqing Shi ◽  
William Kyle Resurreccion ◽  
Rong Na ◽  
Brian T. Helfand ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
High Risk ◽  
Risk Score ◽  
Genetic Risk ◽  
Clinical Utility ◽  
Low Risk ◽  
Risk Scores ◽  
Average Risk ◽  
Genetic Risk Scores

Abstract Background Genome-wide association studies have identified thousands of disease-associated single nucleotide polymorphisms (SNPs). A subset of these SNPs may be additively combined to generate genetic risk scores (GRSs) that confer risk for a specific disease. Although the clinical validity of GRSs to predict risk of specific diseases has been well established, there is still a great need to determine their clinical utility by applying GRSs in primary care for cancer risk assessment and targeted intervention. Methods This clinical study involved 281 primary care patients without a personal history of breast, prostate or colorectal cancer who were 40–70 years old. DNA was obtained from a pre-existing biobank at NorthShore University HealthSystem. GRSs for colorectal cancer and breast or prostate cancer were calculated and shared with participants through their primary care provider. Additional data was gathered using questionnaires as well as electronic medical record information. A t-test or Chi-square test was applied for comparison of demographic and key clinical variables among different groups. Results The median age of the 281 participants was 58 years and the majority were female (66.6%). One hundred one (36.9%) participants received 2 low risk scores, 99 (35.2%) received 1 low risk and 1 average risk score, 37 (13.2%) received 1 low risk and 1 high risk score, 23 (8.2%) received 2 average risk scores, 21 (7.5%) received 1 average risk and 1 high risk score, and no one received 2 high risk scores. Before receiving GRSs, younger patients and women reported significantly more worry about risk of developing cancer. After receiving GRSs, those who received at least one high GRS reported significantly more worry about developing cancer. There were no significant differences found between gender, age, or GRS with regards to participants’ reported optimism about their future health neither before nor after receiving GRS results. Conclusions Genetic risk scores that quantify an individual’s risk of developing breast, prostate and colorectal cancers as compared with a race-defined population average risk have potential clinical utility as a tool for risk stratification and to guide cancer screening in a primary care setting.

scholarly journals Construction of an exome-wide risk score for schizophrenia based on a weighted burden test

2017 ◽  
Author(s):  
David Curtis
Keyword(s):  
Risk Score ◽  
Rare Variants ◽  
Risk Scores ◽  
Individual Risk ◽  
Data Sets ◽  
Weighted Sum ◽  
Polygenic Risk ◽  
Whole Exome ◽  
Sequencing Studies ◽  
Burden Test

SummaryPolygenic risk scores obtained as a weighted sum of associated variants can be used to explore association in additional data sets and to assign risk scores to individuals. The methods used to derive polygenic risk scores from common SNPs are not suitable for variants detected in whole exome sequencing studies. Rare variants which may have major effects are seen too infrequently to judge whether they are associated and may not be shared between training and test subjects. A method is proposed whereby variants are weighted according to their frequency, their annotations and to the genes they affect. A weighted sum across all variants provides an individual risk score. Scores constructed in this way are used in a weighted burden test and are shown to be significantly different between schizophrenia cases and controls using a five-way cross validation procedure. This approach represents a first attempt to summarise exome sequence variation into a summary risk score, which could be combined with risk scores from common variants and from environmental factors. It is hoped that the method could be developed further.

scholarly journals Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against

2017 ◽  
Vol 44 (2) ◽  
pp. 86-90 ◽  
Author(s):  
Keymanthri Moodley ◽  
Stuart Rennie
Keyword(s):  
Public Health ◽  
South Africa ◽  
Male Circumcision ◽  
Resource Constraints ◽  
Cultural Practice ◽  
Public Health Response ◽  
Genital Mutilation ◽  
Ethical Implications ◽  
Healthcare Needs ◽  
Health Response

Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world’s first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of severe resource constraints have been raised. In this paper, we explore some of the ethical implications of penile transplants as a clinical and public health response to the adverse consequences of traditional male circumcision. Given the current fiscal deficits in healthcare and public health sectors, how can one justify costly, high-technology interventions for conditions affecting a small section of the population? Since botched traditional male circumcisions are preventable, is a focus on penile transplantation as a form of treatment reasonable? Finally, do such interventions create undue expectations and false hope among a highly vulnerable and stigmatised group of young men? In this paper, we argue that given limited healthcare resources in South Africa and competing healthcare needs, prevention is a more appropriate response to botched traditional circumcisions than penile transplants.

scholarly journals MetS Risk Score: A Clear Scoring Model to Predict a 3-Year Risk for Metabolic Syndrome

2018 ◽  
Vol 50 (09) ◽  
pp. 683-689 ◽  
Author(s):  
Tian-Tian Zou ◽  
Yu-Jie Zhou ◽  
Xiao-Dong Zhou ◽  
Wen-Yue Liu ◽  
Sven Van Poucke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Risk Score ◽  
Validation Cohort ◽  
Medical Center ◽  
Characteristic Curve ◽  
Model Development ◽  
Predictive Performance ◽  
Risk Scores ◽  
Individual Risk

AbstractAlthough several risk factors for metabolic syndrome (MetS) have been reported, there are few clinical scores that predict its incidence. Therefore, we created and validated a risk score for prediction of 3-year risk for MetS. Three-year follow-up data of 4395 initially MetS-free subjects, enrolled for an annual physical examination from Wenzhou Medical Center were analyzed. Subjects at enrollment were randomly divided into the training and the validation cohort. Univariate and multivariate logistic regression models were employed for model development. The selected variables were assigned an integer or half-integer risk score proportional to the estimated coefficient from the logistic model. Risk scores were tested in a validation cohort. The predictive performance of the model was tested by computing the area under the receiver operating characteristic curve (AUROC). Four independent predictors were chosen to construct the MetS risk score, including BMI (HR=1.906, 95% CI: 1.040–1.155), FPG (HR=1.507, 95% CI: 1.305–1.741), DBP (HR=1.061, 95% CI: 1.002–1.031), HDL-C (HR=0.539, 95% CI: 0.303–0.959). The model was created as –1.5 to 4 points, which demonstrated a considerable discrimination both in the training cohort (AUROC=0.674) and validation cohort (AUROC=0.690). Comparison of the observed with the estimated incidence of MetS revealed satisfactory precision. We developed and validated the MetS risk score with 4 risk factors to predict 3-year risk of MetS, useful for assessing the individual risk for MetS in medical practice.

scholarly journals Primary care risk stratification in COPD using routinely collected data: a secondary data analysis

2019 ◽  
Vol 29 (1) ◽  
Author(s):  
Matthew Johnson ◽  
Lucy Rigge ◽  
David Culliford ◽  
Lynn Josephs ◽  
Mike Thomas ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Stratification ◽  
Data Quality ◽  
Risk Score ◽  
Secondary Care ◽  
Risk Scores ◽  
Average Risk ◽  
Primary Care Data ◽  
Copd Patients ◽  
Dose Index

AbstractMost clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratification database algorithm using the DOSE index (Dyspnoea, Obstruction, Smoking and Exacerbation) with routinely collected primary care data, aiming to calculate up to three repeated risk scores per patient over five years, each separated by at least one year. Among 10,393 patients with diagnosed COPD, sufficient primary care data were present to calculate at least one risk score for 77.4%, and the maximum of three risk scores for 50.6%. Linked secondary care data revealed primary care under-recording of hospital exacerbations, which translated to a slight, non-significant cohort average risk score reduction, and an understated risk group allocation for less than 1% of patients. Algorithmic calculation of the DOSE index is possible using primary care data, and appears robust to the absence of linked secondary care data, if unavailable. The DOSE index appears a simple and practical means of incorporating risk stratification into the routine primary care of COPD patients, but further research is needed to evaluate its clinical utility in this setting. Although secondary analysis of routinely collected primary care data could benefit clinicians, patients and the health system, standardised data collection and improved data quality and completeness are also needed.

scholarly journals Genomic prediction of coronary heart disease

2016 ◽  
Author(s):  
Gad Abraham ◽  
Aki S Havulinna ◽  
Oneil G Bhalala ◽  
Sean G Byars ◽  
Alysha M de Livera ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Risk Score ◽  
Meta Analysis ◽  
Risk Scores ◽  
Individual Risk ◽  
Clinical Risk ◽  
Framingham Risk ◽  
Chd Risk ◽  
Genomic Risk

Background Genetics plays an important role in coronary heart disease (CHD) but the clinical utility of a genomic risk score (GRS) relative to clinical risk scores, such as the Framingham Risk Score (FRS), is unclear. Methods We generated a GRS of 49,310 SNPs based on a CARDIoGRAMplusC4D Consortium meta-analysis of CHD, then independently tested this using five prospective population cohorts (three FINRISK cohorts, combined n=12,676, 757 incident CHD events; two Framingham Heart Study cohorts (FHS), combined n=3,406, 587 incident CHD events). Results The GRS was strongly associated with time to CHD event (FINRISK HR=1.74, 95% CI 1.61-1.86 per S.D. of GRS; Framingham HR=1.28, 95% CI 1.18-1.38), and was largely unchanged by adjustment for clinical risk scores or individual risk factors, including family history. Integration of the GRS with clinical risk scores (FRS and ACC/AHA13 score) improved prediction of CHD events within 10 years (meta-analysis C-index: +1.5-1.6%, P<0.001), particularly for individuals ≥60 years old (meta-analysis C-index: +4.6-5.1%, P<0.001). Men in the top 20% of the GRS had 3-fold higher risk of CHD by age 75 in FINRISK and 2-fold in FHS, and attaining 10% cumulative CHD risk 18y earlier in FINRISK and 12y earlier in FHS than those in the bottom 20%. Furthermore, high genomic risk was partially compensated for by low systolic blood pressure, low cholesterol level, and non-smoking. Conclusions A GRS based on a large number of SNPs substantially improves CHD risk prediction and encodes decades of variation in CHD risk not captured by traditional clinical risk scores.

Abstract 3264: Remarkable Differences in calculating the Cardiovascular Risk according the Framingham-, Procam- and ESC Risk-Scores. First Results of the DETECT Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sigmund Silber ◽  
Barbara M Richartz ◽  
Frauke Jarre ◽  
David Pittrow ◽  
Jens Klotsche ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Score ◽  
High Risk Group ◽  
Risk Scores ◽  
Individual Risk ◽  
High Risk Patients ◽  
Number Of Patients ◽  
Risk Patients ◽  
The Individual

The identification of high-risk patients is of utmost importance for an intensive and effective primary prevention program. Currently, three different scores are used to identify high-risk patients: In the USA, the Framingham risk score, in Germany the Procam risk score and in Europe the European Society of Cardiology ESC) recommended ESC risk score. There is, however, little knowledge how these three risk scores compare to each other in the same population. Therefore we calculated the individual risk of 7519 pats with no known cardiovascular disease according to these three scoring systems. In the DETECT study, 55 518 patients in 3188 primary care offices were enrolled. A representative subgroup of 7,519 randomly chosen patients participated in a cohort sub-study. According to the Framingham-Procam- and ESC-Score, the individual 10-year-risk was determined and patients were _ategorized into groups of high, medium or low risk. The mean 10-year cardiovascular risk is estimated by the PROCAM score at 4.4%, with the ESC score at 8.8% and with the Framingham-Score at 11.5%. The number of patients assigned to a group differs most for the high risk group (please see table ). Unexpectedly, major discrepancies were observed in the same pats, if the Framingham, Procam- or ESC score was used, especially in the identification of high-risk pats. Follow-up will show, which of these risk scores will best predict the actual occurrence of cardiovascular events. Results:

scholarly journals Assessing the Clinical Utility of Genetic Risk Scores for Targeted Cancer Screening

2020 ◽  
Author(s):  
Carly Ann Conran ◽  
Zhuqing Shi ◽  
William Kyle Resurreccion ◽  
Rong Na ◽  
Brian T. Helfand ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
High Risk ◽  
Risk Score ◽  
Genetic Risk ◽  
Clinical Utility ◽  
Low Risk ◽  
Risk Scores ◽  
Average Risk ◽  
Genetic Risk Scores

Abstract Background: Genome-wide association studies have identified thousands of disease-associated single nucleotide polymorphisms (SNPs). A subset of these SNPs may be additively combined to generate genetic risk scores (GRSs) that confer risk for a specific disease. Although the clinical validity of GRSs to predict risk of specific diseases has been well established, there is still a great need to determine their clinical utility by applying GRSs in primary care for cancer risk assessment and targeted intervention.Methods: This clinical study involved 281 primary care patients without a personal history of breast, prostate or colorectal cancer who were 40-70 years old. DNA was obtained from a pre-existing biobank at NorthShore University HealthSystem. GRSs for colorectal cancer and breast or prostate cancer were calculated and shared with participants through their primary care provider. Additional data was gathered using questionnaires as well as electronic medical record information. A t-test or Chi-square test was applied for comparison of demographic and key clinical variables among different groups.Results: The median age of the 281 participants was 58 years and the majority were female (66.6%). One hundred one (36.9%) participants received 2 low risk scores, 99 (35.2%) received 1 low risk and 1 average risk score, 37 (13.2%) received 1 low risk and 1 high risk score, 23 (8.2%) received 2 average risk scores, 21 (7.5%) received 1 average risk and 1 high risk score, and no one received 2 high risk scores. Before receiving GRSs, younger patients and women reported significantly more worry about risk of developing cancer. After receiving GRSs, those who received at least one high GRS reported significantly more worry about developing cancer. There were no significant differences found between gender, age, or GRS with regards to participants’ reported optimism about their future health neither before nor after receiving GRS results.Conclusions: Genetic risk scores that quantify an individual’s risk of developing breast, prostate and colorectal cancers as compared with a race-defined population average risk have potential clinical utility as a tool for risk stratification and to guide cancer screening in a primary care setting.

Risk score – valuable tool for individual risk assessment?

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
B Osswald ◽  
G Thomas ◽  
U Tochtermann ◽  
V Gegouskov ◽  
D Badowski-Zyla ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Risk Score ◽  
Individual Risk ◽  
Individual Risk Assessment

Clostridium difficileinfection: epidemiology, disease burden and therapy

2013 ◽  
Vol 154 (30) ◽  
pp. 1188-1193 ◽  
Author(s):  
László Gulácsi ◽  
Adrienne Kertész ◽  
Irén Kopcsóné Németh ◽  
János Banai ◽  
Endre Ludwig ◽  
...  
Keyword(s):  
Public Health ◽  
Health Economics ◽  
Disease Burden ◽  
Hungarian Literature ◽  
Medline Database ◽  
The Cost ◽  
Vancomycin Treatment

Introduction:C. difficile causes 25 percent of the antibiotic associated infectious nosocomial diarrhoeas. C. difficile infection is a high-priority problem of public health in each country. The available literature of C. difficile infection’s epidemiology and disease burden is limited. Aim: Review of the epidemiology, including seasonality and the risk of recurrences, of the disease burden and of the therapy of C. difficile infection. Method: Review of the international and Hungarian literature in MEDLINE database using PubMed up to and including 20th of March, 2012. Results: The incidence of nosocomial C. difficile associated diarrhoea is 4.1/10 000 patient day. The seasonality of C. difficile infection is unproved. 20 percent of the patients have recurrence after metronidazole or vancomycin treatment, and each recurrence increases the chance of a further one. The cost of C. difficile infection is between 130 and 500 thousand HUF (430 € and 1665 €) in Hungary. Conclusions: The importance of C. difficile infection in public health and the associated disease burden are significant. The available data in Hungary are limited, further studies in epidemiology and health economics are required. Orv. Hetil., 2013, 154, 1188–1193.

Sign in / Sign up

Export Citation Format

Share Document