Acute stroke therapy (intravenous alteplase) is currently administered to fewer than 2% of ischemic stroke patients in the United States. In a community and professional intervention project in non-urban east Texas, researchers were able to increase this figure to 11.25%. No significant change was noted in a comparison community. Improved delivery of acute stroke therapy is possible even in a nonurban area.
Access to health insurance influences the amount and quality of health care received, which in turn is likely to be related to survival. McDavid and colleagues studied men and women (ages, 18-99 years) with colorectal, lung, breast, or prostate cancer, who were registered from 1995 to 1998 with the Kentucky Cancer Registry and followed up through 1999. Three-year crude and relative survival proportion by 7 health insurance categories and by sex for all 4 sites were calculated. Among patients with prostate cancer, 3-year relative survival proportion was 98% for the privately insured and 83% for the uninsured; comparable figures were 91% and 78% for patients with breast cancer; 71% and 53% for patients with colorectal cancer; and 23% and 13% for patients with lung cancer. For all 4 cancers, the uninsured ranked fifth or sixth on survival, above patients with unknown insurance type or Medicaid/welfare. These findings confirm purported disparities in cancer care and point toward the need to make quality care accessible to all segments of the population.
Severe obesity (>100 lb [45 kg] overweight), which is believed to have different causes than typical weight gain, is more serious for an individual's health and creates different challenges for the health care system. Using data from the Behavioral Risk Factor Surveillance System, Sturm estimated trends for extreme weight categories between the years 1986 and 2000. The prevalence of a body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) of 40 or greater quadrupled from about 1 in 200 adult Americans to 1 in 50; the prevalence of a BMI of 50 or greater increased by a factor of 5, from about 1 in 2000 to 1 in 400. In contrast, obesity based on a BMI of 30 or greater roughly doubled during the same period, from about 1 in 10 to 1 in 5. These findings show that the prevalence of clinically severe obesity is increasing much faster than obesity.
Since the Veterans Affairs Health Care System offers health care largely without financial influences, it provides an ideal setting to identify and understand ethnic differences in health outcomes. Prakash et al collected data from consecutive male patients referred for resting electrocardiograms (ECGs) (n = 41 087) or exercise testing (n = 6213) over a period of 12 years and compared ethnic differences in survival between whites, blacks, and Hispanics after considering baseline differences in age and hospitalization status. The authors also adjusted for ECG abnormalities and cardiac risk factors, exercise test results, and cardiovascular comorbidities. This study's findings demonstrate that the health care provided to veterans referred for routine ECGs and/or exercise tests is not associated with poorer survival in ethnic minorities.
To help determine reasons for undertreatment of cardiovascular disease risk factors in patients with peripheral arterial disease (PAD), McDermott and colleagues compared perceptions regarding risks of cardiovascular events and benefits of cardiovascular disease risk factor reduction between patients with PAD, patients with coronary artery disease, and patients without atherosclerosis (no disease). All 3 groups reported that risks of myocardial infarction, stroke, and death were higher for a patient with coronary artery disease than for a patient with PAD. The authors conclude that patients with PAD underestimate the high risk of cardiovascular events associated with PAD and the benefits of cholesterol-lowering therapy.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2003;163(18):2119. doi:10.1001/archinte.163.18.2119