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Fragmentation of medical information places patients at risk for medical errors, adverse events, and increased costs. This retrospective observational study quantifies the burden of fragmentation among adult patients seeking care at multiple acute health care sites across the state of Massachusetts. Patients visiting multiple sites accounted for more than half of the acute care visits over the study period and were significantly more likely to be hospitalized, have a psychiatric diagnosis, and incurred higher healthcare charges than patients who were consistently seen at the same site of care. These findings provide one basis for assessing the value of an integrated electronic health information system.
A nationwide cohort study was performed to assess the risk of renal cell cancer after hysterectomy using data on 181 601 women who had undergone hysterectomy and 645 442 matched women without hysterectomy, by linking nationwide Swedish health care registers. Women with hysterectomy were shown to have a significantly increased risk of renal cell cancer. The risk of renal cancer was age dependent, and the highest risk was found within 10 years of surgery among those who underwent hysterectomy before age 44 years. Given current trends in gynecologic surgery where women are offered hysterectomy at younger ages, this has important implications and may influence future occurrence of renal cell cancer.
Sugar-sweetened beverage (SSB) taxes are increasingly being considered as one strategy for addressing the obesity epidemic. Finkelstein et al sought to investigate the differential impact of targeted SSB taxes on higher- and lower-income households using a national sample of households that scan in and transmit their store-bought food and beverage purchases. A 20% and 40% tax on SSBs generates mean (SE) reductions of 7.0 (1.9) and 12.4 (3.4) kcal/d per person, respectively. Estimated mean (SE) weight losses resulting from a 20% and 40% tax on all SSBs are 0.32 (0.09) and 0.59 (0.16) kg/y per person, respectively. The 40% tax on SSBs, which costs a mean (SE) of $28.48 ($0.87) per household per year, would generate $2.5 billion ($77.5 million) in tax revenue, with the largest share coming from high-income households. These findings demonstrate that large taxes on SSBs have the potential to positively influence weight outcomes, especially for middle-income households. These taxes would also generate substantial revenue that could be used to fund obesity prevention programs or for other causes.
There is relatively little information about the comparative safety of opioids. In a propensity-matched cohort analysis, Solomon et al estimated the relative risk (RR) for major safety events among Medicare beneficiaries. Compared with hydrocodone, the risk of cardiovascular events was elevated for codeine (RR, 1.63) after 180 days, the risk of fracture was significantly reduced for tramadol (RR, 0.21) and propoxyphene (RR, 0.54), and all-cause mortality was elevated after 30 days for oxycodone (RR, 2.43) and codeine (RR, 2.05). The results suggest that the rates of safety events among older adults using opioids for nonmalignant pain vary significantly by agent.
Solomon et al examined the comparative safety of nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs), cyclooxygenase 2 selective NSAIDs (coxibs), and opioids among Medicare beneficiaries from Pennsylvania and New Jersey, who initiated an nsNSAID, coxib, or opioid treatment and were matched on propensity scores. Compared with nsNSAIDs, coxibs and opioids exhibited elevated relative risk for cardiovascular events. Gastrointestinal bleeding risk was reduced for coxib users but was similar for opioid users. Use of coxibs and nsNSAIDs had a similar risk for fracture; however, fracture risk was elevated with opioid use. In addition, use of opioids but not coxibs raised the risk of all-cause mortality compared with nsNSAIDs. The comparative safety of analgesics varies depending on the safety event studied. Opioids exhibited elevated relative risk for many safety events compared with nsNSAIDs.
Kaplan-Meier curve for the cumulative incidence of all-cause mortality.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2010;170(22):1960. doi:10.1001/archinternmed.2010.463