Incidence and prevalence of idiopathic inflammatory myopathies among commercially insured, Medicare supplemental insured, and Medicaid enrolled populations: an administrative claims analysis

Background: Idiopathic inflammatory myopathies (IIMs) are a rare group of autoimmune syndromes characterized by chronic muscle inflammation and muscle weakness with no known cause. Little is known about their incidence and prevalence. This study reports the incidence and prevalence of IIMs among commercially insured and Medicare and Medicaid enrolled populations in the US. Methods: We retrospectively examined medical claims with an IIM diagnosis (ICD-9-CM 710.3 [dermatomyositis (DM)], 710.4 [polymyositis (PM)], 728.81[interstitial myositis]) in the MarketScan® databases to identify age- and gender-adjusted annual IIM incidence and prevalence for 2004–2008. Sensitivity analysis was performed for evidence of a specialist visit (rheumatologist/ neurologist/dermatologist), systemic corticosteroid or immunosuppressant use, or muscle biopsy. Results: We identified 2,990 incident patients between 2004 and 2008 (67% female, 17% Medicaid enrollees, 27% aged ≥65 years). Overall adjusted IIM incidence for 2004–2008 for commercial and Medicare supplemental groups combined were 4.27 cases (95% CI, 4.09-4.44) and for Medicaid, 5.23 (95% CI 4.74-5.72) per 100,000 person-years (py). Disease sub-type incidence rates per 100,000-py were 1.52 (95% CI 1.42-1.63) and 1.70 (1.42-1.97) for DM, 2.46 (2.33-2.59) and 3.53 (3.13-3.94) for PM, and 0.73 (0.66-0.81) and 0.78 (0.58-0.97) for interstitial myositis for the commercial/Medicare and Medicaid cohorts respectively. Annual incidence fluctuated over time with the base MarketScan populations. There were 7,155 prevalent patients, with annual prevalence ranging from 20.62 to 25.32 per 100,000 for commercial/Medicare (83% of prevalent cases) and from 15.35 to 32.74 for Medicaid. Conclusions: We found higher IIM incidence than historically reported. Employer turnover, miscoding and misdiagnosing, care seeking behavior, and fluctuations in database membership over time can influence the results. Further studies are needed to confirm the incidence and prevalence of IIM

Food deserts in the prairies? supermarket accessibility and neighborhood need in Edmonton, Canada

The U.S. and U.K. literatures have discussed “food deserts,” reflecting populated, typically urban, low-income areas with limited access to full-service supermarkets. Less is known about supermarket accessibility within Canadian cities. This article uses the minimum distance and coverage methods to determine supermarket accessibility within the city of Edmonton, Canada, with a focus on high-need and inner-city neighborhoods. The results show that for 1999 both of these areas generally had higher accessibility than the remainder of the city, but six high-need neighborhoods had poor supermarket accessibility. We conclude by examining potential reasons for differences in supermarket accessibility between Canadian, U.S., and U.K. cities

Incidence and prevalence of idiopathic inflammatory myopathies among commercially insured, Medicare supplemental insured, and Medicaid enrolled populations: an administrative claims analysis

Abstract Background Idiopathic inflammatory myopathies (IIMs) are a rare group of autoimmune syndromes characterized by chronic muscle inflammation and muscle weakness with no known cause. Little is known about their incidence and prevalence. This study reports the incidence and prevalence of IIMs among commercially insured and Medicare and Medicaid enrolled populations in the US. Methods We retrospectively examined medical claims with an IIM diagnosis (ICD-9-CM 710.3 [dermatomyositis (DM)], 710.4 [polymyositis (PM)], 728.81[interstitial myositis]) in the MarketScan® databases to identify age- and gender-adjusted annual IIM incidence and prevalence for 2004–2008. Sensitivity analysis was performed for evidence of a specialist visit (rheumatologist/ neurologist/dermatologist), systemic corticosteroid or immunosuppressant use, or muscle biopsy. Results We identified 2,990 incident patients between 2004 and 2008 (67% female, 17% Medicaid enrollees, 27% aged ≥65 years). Overall adjusted IIM incidence for 2004–2008 for commercial and Medicare supplemental groups combined were 4.27 cases (95% CI, 4.09-4.44) and for Medicaid, 5.23 (95% CI 4.74-5.72) per 100,000 person-years (py). Disease sub-type incidence rates per 100,000-py were 1.52 (95% CI 1.42-1.63) and 1.70 (1.42-1.97) for DM, 2.46 (2.33-2.59) and 3.53 (3.13-3.94) for PM, and 0.73 (0.66-0.81) and 0.78 (0.58-0.97) for interstitial myositis for the commercial/Medicare and Medicaid cohorts respectively. Annual incidence fluctuated over time with the base MarketScan populations. There were 7,155 prevalent patients, with annual prevalence ranging from 20.62 to 25.32 per 100,000 for commercial/Medicare (83% of prevalent cases) and from 15.35 to 32.74 for Medicaid. Conclusions We found higher IIM incidence than historically reported. Employer turnover, miscoding and misdiagnosing, care seeking behavior, and fluctuations in database membership over time can influence the results. Further studies are needed to confirm the incidence and prevalence of IIM.</p

EcoHealth journal special supplement November 2004

Includes abstract in French and SpanishPopulation pressures and expanding agricultural and industrial development, with their resulting environmental degradation and demand for water, are likely to increase drought vulnerability on the Canadian Prairies. Coupled with increases in drought expected under climate change, the health and well-being of prairie populations may be compromised. However, little is known about the health effects of drought in this region or of possible adaptation strategies. This article assesses the available information on the health effects associated with drought and uses this information to develop an ecosystem health framework for outlining how drought may affect the prairie ecosystem and the health and well-being of Canadian Prairie populations. The article identifies multisector mitigation and adaptation strategies for reducing the harmful effects of drought on the prairie ecosystem and its populations. The literature review revealed that drought is associated with crop failure, increased atmospheric dust, and intensifying forest fire frequency, with health effects ranging from respiratory illnesses from inhaling dust or smoke, to mental health concerns arising from economic stress, particularly among farmers. Future research is needed on: the health effects associated with drought more specific to the Prairie region; the mental well-being of farmers and agricultural communities; the health effects from exposure to forest fire haze; and the health effects of reduced water supply and quality. Reducing drought vulnerability requires multisectoral collaboration, starting at the community level, to identify more sustainable water use, diverse health risks of drought, and ways of adapting to drought conditions

The association between neighborhood socioeconomic status and exposure to supermarkets and fast food outlets

This study examines whether exposure to supermarkets and fast food outlets varies with neighborhood-level socioeconomic status in Edmonton, Canada. Only market area and fast food proximity predicted supermarket exposure. For fast food outlets, the odds of exposure were greater in areas with more Aboriginals, renters, lone parents, low-income households, and public transportation commuters; and lower in those with higher median income and dwelling value. Low wealth, renter-occupied, and lone parent neighborhoods had greater exposure to fast food outlets, which was not offset by better supermarket access. The implications are troubling for fast food consumption among lone parent families in light of growing obesity rates among children

Cornering the market: restriction of retail supermarket locations

A major source of healthy foods, North American supermarkets have become larger in recent years, with new stores opening and older stores closing. Upon closure, there is evidence of some supermarket sites being placed under restrictive covenants, a practice that restricts future use of the site. The purpose is usually to limit food sales at the location, thus minimizing competition for a chain\u27s nearby stores. In Edmonton, Alberta eighteen covenants have been documented on former supermarket sites. At six of these sites, termed food desolated, there is no operating supermarket within walking distance (800 m) of the former stores. The covenants disproportionately affect senior citizens as neighbourhoods with covenants have a significantly higher percentage of seniors than those neighbourhoods without covenants. Results of a group interview with community leaders from a neighbourhood that lost a supermarket and historical case study also point to the restrictive covenants resulting in difficulties for seniors accessing healthy foo