Dataset Information

Bariatric surgery implementation trends in the USA from 2002 to 2012.

ABSTRACT: Many beneficial health care interventions are either not put into practice or fail to diffuse over time due to complex contextual factors that affect implementation and diffusion. Bariatric surgery is an example of an effective intervention that recently experienced a plateau and decrease in rates, with minimal documented justification for this trend. While there are conceptual models that provide frameworks of general innovation implementation and diffusion, few studies have tested these models with data to measure the relative effects of factors that affect diffusion of specific health care interventions.A literature review identified factors associated with implementation and diffusion of health care innovations. These factors were utilized to construct a conceptual model of diffusion to explain changes in bariatric surgery over time. Six data sources were used to construct measures of the study population and factors in the model that may affect diffusion of surgery. The population included obese and morbidly obese patients from 2002 to 2012 who had bariatric surgery in 15 states. Multivariable models were used to identify environmental, population, and medical practice factors that facilitated or impeded diffusion of bariatric surgery over time.It was found that while bariatric surgery rates increased over time, the speed of growth in surgeries, or diffusion, slowed. Higher cumulative number of surgeries and higher proportion of the state population in age group 50-59 slowed surgery growth, but presence of Medicare centers of excellence increased the speed of surgery diffusion. Over time, the factors affecting the diffusion of bariatric surgery fluctuated, indicating that diffusion is affected by temporal and cumulative effects.The primary driver of diffusion of bariatric surgery was the extent of centers of excellence presence in a state. Higher cumulative surgery rates and higher proportions of older populations in a state slowed diffusion. Surprisingly, measures of the presence of champions were not significant, perhaps because these are difficult to measure in the aggregate. Our results generally support the conceptual model of diffusion developed from the literature, which may be useful for examining other innovations, as well as for designing interventions to support rapid diffusion of innovations to improve health outcomes and quality of care.

SUBMITTER: Johnson EE

PROVIDER: S-EPMC4761154 | biostudies-other | 2016 Feb

REPOSITORIES: biostudies-other

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Project description:Giving the rising trends in obesity and chronic diseases in China, strategies to increase physical activity are important. Transport-related activity is a substantial source of physical activity and can be easily incorporated into the daily lives. It is a key social factor of health, which can help improve people's mental and physical health and decrease environmental pollution. However, little is known about recent trends in transportation modes and time in China. Between 2002 and 2010-2012, information about transportation behaviors of Chinese population aged 15 years or older were collected within two Chinese Nutrition and Health Surveys. A stratified multistage cluster sampling method was conducted to select participants. Sociodemographic information, transportation modes, and time were collected during face-to-face interviews. The study included 82,377 (mean age 41.2 years) and 143,075 (mean age 48.7 years) participants in the 2002 and 2010-2012 surveys respectively. The weighted prevalence of active transportation (including walking and cycling) decreased from 83.8% in 2002 to 54.3% in 2010-2012 (p < 0.001). During the same period, the number of participants using public transportation (including taking the bus, subway, or shuttle bus) has doubled (7.5% and 15.7%, respectively, for 2002 and 2010-2012, (p < 0.001)), and the proportion of inactive transportation (including driving or taking a car, motorcycle, taxi, or electric bicycle) more than tripled. Concurrently, the transportation time almost doubled with an increase of 25.9 min over the 10 years (p < 0.001). The prevalence of active transportation increased with age. Participants with higher family income and education reported a lower prevalence of active transportation. Females were more likely to use active transportation (OR (95% CI): 4.41 (4.14-4.70) and 2.50 (2.44-2.57), respectively, for 2002 and 2010-2012, where males were the reference). Before the prevalence of active transportation and physical activity gets lower, there is a need for the public health sector and the transport and land use sector to work together to develop related policies and initiatives with the aim of promoting active transportation and public transportation to increase the levels of physical activity and to decrease the risks of chronic diseases.

Project description:BACKGROUND:Diagnoses of type 1 and type 2 diabetes in youths present a substantial clinical and public health burden. The prevalence of these diseases increased in the 2001-2009 period, but data on recent incidence trends are lacking. METHODS:We ascertained cases of type 1 and type 2 diabetes mellitus at five study centers in the United States. Denominators (4.9 million youths annually) were obtained from the U.S. Census or health-plan member counts. After the calculation of annual incidence rates for the 2002-2012 period, we analyzed trends using generalized autoregressive moving-average models with 2-year moving averages. RESULTS:A total of 11,245 youths with type 1 diabetes (0 to 19 years of age) and 2846 with type 2 diabetes (10 to 19 years of age) were identified. Overall unadjusted estimated incidence rates of type 1 diabetes increased by 1.4% annually (from 19.5 cases per 100,000 youths per year in 2002-2003 to 21.7 cases per 100,000 youths per year in 2011-2012, P=0.03). In adjusted pairwise comparisons, the annual rate of increase was greater among Hispanics than among non-Hispanic whites (4.2% vs. 1.2%, P<0.001). Overall unadjusted incidence rates of type 2 diabetes increased by 7.1% annually (from 9.0 cases per 100,000 youths per year in 2002-2003 to 12.5 cases per 100,000 youths per year in 2011-2012, P<0.001 for trend across race or ethnic group, sex, and age subgroups). Adjusted pairwise comparisons showed that the relative annual increase in the incidence of type 2 diabetes among non-Hispanic whites (0.6%) was lower than that among non-Hispanic blacks, Asians or Pacific Islanders, and Native Americans (P<0.05 for all comparisons) and that the annual rate of increase among Hispanics differed significantly from that among Native Americans (3.1% vs. 8.9%, P=0.01). After adjustment for age, sex, and race or ethnic group, the relative annual increase in the incidence of type 1 diabetes was 1.8% (P<0.001) and that of type 2 diabetes was 4.8% (P<0.001). CONCLUSIONS:The incidences of both type 1 and type 2 diabetes among youths increased significantly in the 2002-2012 period, particularly among youths of minority racial and ethnic groups. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Centers for Disease Control and Prevention.).

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Bariatric surgery implementation trends in the USA from 2002 to 2012.

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