The Addition of the Charlson Comorbidity Index to the GRACE Risk Prediction Index Improves Prediction of Outcomes in Acute Coronary Syndrome

Patients with cardiovascular disease have increased risk of poor outcomes when coexisting illnesses are present. Clinicians, administrators, and health services researchers utilize risk adjustment indices to stratify patients for various outcomes. The GRACE Risk Prediction Index (GRPI) was developed to risk stratify patients who experienced an acute coronary syndrome (ACS) event. GRPI does not account for the presence of comorbid conditions. The objective of this study was to compare the ability of the GRPI and the Charlson Comorbidity Index (CCI), used independently or combined, to predict mortality or secondary coronary events in patients admitted for ACS. Data were obtained from an academic health system's ACS registry. Outcomes included inpatient and 6-month postdischarge mortality and occurrence of secondary cardiovascular events or revascularization procedures. Logistic regression derived C statistics for CCI, GRPI, and CCI-GRPI predictive models for each outcome. Likelihood ratio tests determined the contribution of CCI when added to GRPI models. Complete data were available for 1202 patients. The GRPI model had the greatest C statistic when predicting inpatient mortality (0.73); the GRPI-CCI combined model C statistic was 0.81 when predicting death during the follow-up period; and C statistics for all 3 models were similar in predicting secondary events (0.57?0.60). The likelihood ratio analysis demonstrated that adding CCI to GRPI models was beneficial primarily for predicting secondary events. CCI is a useful addition to GRPI when predicting future cardiac-related events or mortality after an ACS event. It is an acceptable alternative to the GRPI model if data to construct GRPI are not available. (Population Health Management 2014;17:54?59)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140179/1/pop.2012.0117.pd

Comparison of Patient Outcomes Before and After Switching From Warfarin to a Direct Oral Anticoagulant Based on Time in Therapeutic Range Guideline Recommendations

This cohort study evaluates stroke and major bleeding rates before and after switching from warfarin to a direct oral anticoagulant (DOAC) in patients grouped by pre-switch time-in-therapeutic range guideline thresholds

Work‐Related Outcomes After a Myocardial Infarction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90385/1/phco.24.16.1515.50946.pd

Mapping Geographic Areas of High and Low Drug Adherence in Patients Prescribed Continuing Treatment for Acute Coronary Syndrome After Discharge

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90283/1/phco.31.10.927.pd

The Relationship between Childhood Obesity, Low Socioeconomic Status, and Race/Ethnicity: Lessons from Massachusetts

Background: Previous studies have shown race/ethnicity, particularly African American and/or Hispanic status, to be a predictor of overweight/obese status in children. However, these studies have failed to adjust for low socioeconomic status (SES). This study assessed whether race/ethnicity remained an independent predictor of childhood obesity when accounting for variations in SES (low-income) among communities in Massachusetts. Methods: This study was based on 2009 summarized data from 68 Massachusetts school districts with 111,799 students in grades 1, 4, 7, and 10. We studied the relationship between the rate of overweight/obese students (mean?=?0.32; range?=?0.10?0.46), the rate of African American and Hispanic students (mean?=?0.17; range?=?0.00?0.90), and the rate of low-income students (mean?=?0.27; range?=?0.02?0.87) in two and three dimensions. The main effect of the race/ethnicity rate, the low-income rate, and their interaction on the overweight and obese rate was investigated by multiple regression modeling. Results: Low-income was highly associated with overweight/obese status (p?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140341/1/chi.2015.0029.pd

Temporality, consumption, and conflict: exploring user-based injustices in European low-carbon transitions

The urgency of climate change means that low-carbon transitions are needed in large socio-technical systems such as energy and transportation. These transitions must be rapid, but also fair. An emerging body of evidence suggests that users have important roles in transitions, yet much previous research has examined user involvement while assuming it to be largely a positive force. This goes against a growing amount of evidence within sociotechnical studies that highlight the potentially obstructive or negative role that users may play in transitions and innovation. In this study, we pose a critical question: In what ways may users perpetuate injustices within a transition? To answer this question, we provide conceptual background on energy justice and user adoption of low-carbon energy and mobility technologies. We then analyse users and energy injustices in three low-carbon transitions – solar energy in Germany, electric vehicles in Norway, and smart meters in Great Britain – based on empirical data from interviews, focus groups, and internet forums. Our main contribution is to show how users in low-carbon transitions are not always positively engaged, or even neutral, but can introduce and contribute to inequality and exclusion

The relationship between education and food consumption in the 1995 Australian national nutrition survey

Objective: To assess the relationship between education and the intake of a variety of individual foods, as well as groups of foods, for Australian men and women in different age groups. Design: Cross-sectional national survey of free-living men and women. Subjects: A sample of 2501 men and 2739 women aged 18 years and over who completed the National Nutrition Survey (NNS) 1995. Methods: Information about the frequency of consumption of 88 food items was obtained using a food-frequency questionnaire in a nation-wide nutrition survey. Irregular and regular consumers of foods were identified according to whether they consumed individual foods less than or more than once per month. The relationship between single foods and an index of education (no post-school qualifications, vocational, university) was analysed via contingency table chi-square statistics for men and women. Food group variety scores were derived by assigning individual foods to conventional food group taxonomies, and then summing the dichotomised intake scores for individual foods within each food group. Two-way analyses of variance (education by age groups) were performed on food variety scores for men and women, separately. Results: While university-educated men and women consumed many individual foods more regularly than less-educated people, they were less likely to be regular consumers of several meat products. The relationship between education and food consumption was less apparent when individual food scores were aggregated into food group scores. University-educated men and women exhibited higher scores on total food group variety than the other educational groups. Conclusions: Higher education is associated with the regular consumption of a wider variety of foods. Aggregation of individual food consumption indices into food variety scores may mask the apparent effects of educational background on food consumption.<br /

Health‐Related Quality of Life in Patients 7 Months After a Myocardial Infarction: Factors Affecting the Short Form‐12

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90293/1/phco.22.17.1616.34121.pd