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Background: Individuals with diabetes may be particularly susceptible to motility-related upper gastrointestinal (UGI) symptoms such as abdominal pain or discomfort, bloating, early satiety, nausea, and vomiting. We estimated the prevalence of UGI symptoms in a population-based sample of individuals with diabetes and determined whether cases and population controls differed in prevalence of UGI symptoms and in symptom features. Methods: Individuals with diabetes (n = 483) and matched controls (n = 422) were recruited from a prior U.S. national health survey for a telephone interview on UGI symptoms. To confirm self-reported diabetes status, cases provided information on clinical management measures. Subjects were asked about UGI symptoms in the month before interview. Affirmative responses to initial questions triggered detailed questions about symptom frequency, timing, duration, and severity. Differences between cases and controls were evaluated. Results: Cases not only had a significantly (P < 0.05) higher overall prevalence of one or more UGI symptoms in the past month (50%) than controls (38%), but they also reported a significantly greater number of UGI symptoms than controls. Almost 10% of cases reported three or more UGI symptoms in the past month compared with 2% of controls. Our study also identified UGI symptom features that were more relevant to cases and showed that one UGI symptom, heartburn, co-occurred significantly more often with UGI symptoms in cases than in controls. Conclusions: Upper GI symptoms are common in individuals with diabetes and more prevalent than in controls. The symptoms are non-specific and may reflect disruptions in motility or perception. [ABSTRACT FROM AUTHOR]

Our objective was to describe the health-related quality of life (HRQoL) of individuals with diabetes with and without motility-related upper gastrointestinal symptoms compared to individuals without diabetes. A total of 483 individuals with diabetes and 422 age- and gender-matched nondiabetic controls were recruited from a prior US national health survey for a telephone interview on upper gastrointestinal symptoms. Individuals with diabetes self-reported a physician's diagnosis of diabetes and provided confirming information on clinical management measures. Subjects were asked about upper gastrointestinal symptoms in the month before interview using an instrument with demonstrated high reliability. HRQoL was measured using the SF-12 Health Survey. Individuals with diabetes reporting upper gastrointestinal symptoms scored significantly lower in HRQoL measures of physical health and mental health than either individuals with diabetes who did not report upper gastrointestinal symptoms or individuals without diabetes (P < 0.0001). Individuals with diabetes and no upper gastrointestinal symptoms had physical and mental health summary scores similar to those of individuals without diabetes. Early satiety was the strongest predictor (P < 0.0001) of differences in physical health scores between individuals with and without diabetes. Nausea was the strongest predictor (P < 0.0001) of differences in mental health scores between individuals with and without diabetes. In conclusion, this is the first US national survey to demonstrate that motility-related upper gastrointestinal symptoms are associated with a significantly lower quality of life in individuals with diabetes.

Objective: To compare the cost effectiveness of rabeprazole (RAB) and ranitidine (RAN) in acute and maintenance therapy for erosive esophagitis using symptom response, rather than endoscopic healing, as the clinical outcome., Study Design: Decision analysis was used to model the cost effectiveness of competing therapies based on the results of clinical trials of RAB versus RAN and estimates from the medical literature., Methods: The model's base case scenario compared brand-name RAB (estimated average wholesale price) with generic RAN (25% of the average wholesale price of brand-name RAN). Medical costs for hospitalizations, procedures, and office visits reflected 1998 Medicare payments. The 1-year maintenance model accounted for drug-class switching and symptomatic, rather than endoscopic, recurrences. Effectiveness was reported as the percentage of patients in whom a symptomatic recurrence was prevented. The cost per symptomatic recurrence prevented was reported as an average and an incremental cost-effectiveness ratio., Results: The per-patient cost of RAB therapy was higher than that of RAN therapy ($2020 vs $1917); RAB therapy, however, was more effective than RAN therapy in preventing symptomatic recurrences (74% vs 41%). The average cost-effectiveness ratio was lower for RAB therapy than for RAN therapy ($2748 per symptomatic recurrence prevented vs $4719 per symptomatic recurrence prevented). The cost of preventing one additional symptomatic recurrence with RAB rather than RAN was $313 (incremental cost-effectiveness ratio). Sensitivity analysis conducted on key clinical and cost variables supported the robustness of the decision model., Conclusion: This analysis demonstrates that management of esophagitis with RAB is more effective, and may be more cost effective, than management with generic RAN, despite RAB's higher per-unit cost.

Objectives: The goal of this study was to provide estimates of race- and sex-specific survival rates over a 10-year period for a cohort of 49,752 Medicare patients admitted to the hospital in 1984 with a diagnosis of pulmonary embolism., Methods: Data were derived from Medicare Provider Analysis and Review Record inpatient claims files and the National Death Index file., Results: For a primary diagnosis of pulmonary embolism, median survival times among Black men and women were 2.5 years and 5.2 years, respectively; for White men and women, the median survival times were 4.3 years and 5.9 years, respectively. Median survival times for Black men and women and White men and women with a secondary diagnosis of pulmonary embolism were 0.4 years, 0.7 years, 0.8 years, and 1.4 years, respectively. Survival rates declined with advancing age., Conclusions: Overall, survival rates among Blacks were lower than those among Whites, and men had lower survival rates than women. These survival estimates provide new insights into outcomes following pulmonary embolism in hospitalized elderly people.

Objectives: This study determined race-, age- and sex-specific trends in 30-day pulmonary embolism mortality rates., Methods: Medicare beneficiaries with a primary or secondary discharge diagnosis of pulmonary embolism from 1984 to 1991 (n = 391,991) were examined., Results: For a primary diagnosis of pulmonary embolism, mortality rates declined by 15.2% and 16.0%, respectively, for White male patients 65 to 74 years old and 75 years or older. There was a corresponding decline in mortality rates for White women. For a secondary diagnosis of pulmonary embolism, mortality rates declined by 14.7% and 9.8%, respectively, for White male patients 65 to 74 years old and 75 years or older., Conclusions: The White mortality rate declines revealed in this study did not translate, in all cases, to Black patient groups.

Background: Short-term race- and sex-specific case- fatality rates for pulmonary embolism (PE) in the elderly have not been studied previously, to our knowledge., Objectives: To examine 30-day race- and sex-specific case-fatality rates of PE in the Medicare population and to determine the risk of fatality when PE was a secondary diagnosis in 6 primary concurrent conditions and 3 surgical procedures., Methods: Case-fatality rates were determined using the Medicare Provider Analysis and Review Record tiles from 1984 through 1991. All Medicare Part A beneficiaries aged 65 years or older were included, yielding more than 400,000 patients with PE. Case-fatality rates 30 days from hospital admission were calculated for both a primary discharge diagnosis of PE and a secondary discharge diagnosis of PE., Results: Blacks with PE as a primary discharge diagnosis had an overall age-adjusted case-fatality rate of 16.1% compared with a rate of 12.9% for whites. When PE was a secondary diagnosis, blacks also had higher rates than whites (34.7% vs 30.2%). Men had a fatality rate of 13.7% whereas women had a rate of 12.8% when PE was the primary diagnosis. For a secondary diagnosis of PE, men had a rate of 32.8% compared with a rate of 28.6% for women. The risk of fatality was very high when PE was a secondary discharge diagnosis in 6 primary concurrent conditions (congestive heart failure, cancer, chronic obstructive pulmonary disease, myocardial infarction, hip fracture, and stroke) and 3 common surgical procedures (coronary artery bypass graft, hip replacement, and knee replacement) relative to the case-fatality rate when PE was not present in these conditions., Conclusions: Our results indicate that there are racial and gender differences in 30-day case-fatality rates for PE in elderly patients. The high fatality risk associated with PE as a comorbid factor among common primary concurrent conditions and procedures calls attention to the need for more effective prophylaxis of deep vein thrombosis and rapid diagnosis and treatment of PE when it occurs.