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The replicability of cannabis use prevalence estimates in the United States.

ABSTRACT: Recent changes in cannabis policy in the United States have prompted increased interest in cannabis use estimates, and replicability of these estimates. Here, we compare prevalence estimates from two concurrent approaches: (1) standard social survey with audio computer-assisted self-interviews at respondent's home (ACASI-H), derived from the National Surveys on Drug Use and Health (NSDUH), and (2) standard health survey with ACASI assessment in a mobile health examination vehicle (ACASI-M), derived from National Health and Nutrition Examination Surveys (NHANES), 2005-2012, with essentially the same standardized items in cannabis modules. NHANES ACASI-M prevalence proportions for recently-active-cannabis-use are an estimated 130-140% larger than corresponding NSDUH ACASI-H estimates (p < 0.05). In exploratory stratified analyses, we sought to understand these NHANES-NSDUH differences, and found no differences in lifetime-history-of-cannabis-use. However, for participants living with others in the same residence, moving cannabis assessment out of the dwelling unit might promote larger recently-active-cannabis-use estimates; no NHANES-NSDUH differences were found for participants living alone. The observed discrepancies might be non-ignorable in a policy or program evaluation context. A methods research program will be needed to account for between-survey differences of the type observed here, perhaps with a focus on within-residence versus non-residence assessment as a source of variation.

SUBMITTER: Alshaarawy O

PROVIDER: S-EPMC5364066 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAtrial fibrillation (AF) prevalence estimates vary and have been based on cohorts with clinically established or diagnosed disease. Undiagnosed AF prevalence estimates are less certain as they are based on nongeneralizable convenience samples.HypothesisBecause AF is often asymptomatic, it my remain undiagnosed until the development of complications such as stroke or heart failure. Consequently, the observed prevalence of diagnosed AF from the literature may underestimate total disease burden. We therefore sought to estimate the total prevalence of both diagnosed and undiagnosed AF.MethodsWe performed a retrospective cohort study from 2012 to 2017 using data from five US medical claims data sets. Undiagnosed AF prevalence was estimated based on the observed incidence of ischemic stroke, systemic embolism (SE), and AF incidence after a stroke/SE. The diagnosed AF cohort included AF patients between Q1 2014 and Q3 2015. The undiagnosed AF cohort were patients with assumed undiagnosed AF in the year before a stroke/SE and who were newly diagnosed with AF in the 3-month poststroke/SE. Stroke/SE incidence was calculated among all AF patients and the ratio of number of undiagnosed AF patients to stroke rate was created. Age- and sex-adjusted estimates were stratified by period of assumed undiagnosed AF before poststroke/SE AF diagnosis (1 or 2 years).ResultsThe estimated US prevalence of AF (diagnosed and undiagnosed) in Q3 2015 was 5 628 000 cases, of which 591 000 cases (11%) were undiagnosed. The assumed 2-year undiagnosed AF prevalence was 23% (1 531 000) of the total prevalent patients with AF (6 568 000). Undiagnosed (vs. diagnosed) AF patients were older and had higher CHA2DS2-VASc scores. Of undiagnosed AF, 93% had CHA2DS2-VASc ≥2 and met OAC criteria.ConclusionsThese contemporary estimates demonstrate the high prevalence of undiagnosed AF in the United States. Undiagnosed AF patients are composed of primarily elderly individuals who if diagnosed, would meet criteria for stroke prevention therapy.

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The replicability of cannabis use prevalence estimates in the United States.

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