EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 13, 2003
To contact Roland Sturm, Ph.D., call Warren Robak at 301/451-6913.

PREVALENCE OF SEVERE OBESITY INCREASING FASTER THAN OBESITY IN THE UNITED STATES

CHICAGO—The number of clinically severe obese people in the United States is increasing faster than the obese population, according to an article in the October 13 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Various studies in the United States have documented that a substantial portion of Americans are overweight (body mass index, or BMI of 25 or higher) or obese (BMI of 30 or higher), according to the article. Severely obese people who are 100 to 200 pounds or more overweight experience different health problems and challenges than most obese people. Many physician offices and hospitals are not equipped for severely obese patients, who may not fit standard imaging equipment, operating tables or wheel chairs.

Roland Sturm, Ph.D., of the RAND Corporation, Santa Monica, Calif., investigated trends in the severely obese population between 1986 and 2000.

Dr. Sturm analyzed data from the Behavioral Risk Factor Surveillance System, a telephone survey of adults conducted between 1986 and 2000. The survey included a question about weight, and researchers calculated BMIs (calculated as weight in kilograms divided by the square of height in meters) of participants based on their self-reported weight and height. Participants were ranked by BMI: BMI of 30 or greater (obese), BMI of 35 or higher, BMI of 40 or higher (referred to as morbid obesity, roughly corresponding to 100 pounds overweight), BMI of 45 or higher, and BMI of 50 or higher (sometimes referred to as super obesity).

Dr. Sturm found that between 1986 and 2000, the prevalence of BMIs of 40 or greater quadrupled from about one in 200 American adults to one in 50. The prevalence of BMIs of 50 or greater increased by a factor of five, from about one in 2,000 to one in 400. The prevalence of obesity (BMI of 30 or greater) roughly doubled from about one in ten to one in five.

"…the most dramatic part of the 'obesity epidemic' has remained hidden, namely, that the prevalence of clinically severe obesity (a BMI of 40 or greater) is increasing twice as fast as the prevalence of obesity," writes Dr. Sturm. "Because weight underreporting increases with a respondent's actual weight, these estimates (based on respondent self-reported weight) are most likely to underestimate this trend," he writes.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 13, 2003
To contact Kathleen McDavid, Ph.D., M.P.H., call Maureen Culbertson at 770/488-6457. To contact editorialist Victor R. Grann, M.D., M.P.H., call Annie Bayne at 212/305-3900.

CANCER PATIENTS WITHOUT INSURANCE HAVE LOWER SURVIVAL RATES

CHICAGO—Uninsured cancer patients in Kentucky have lower three-year survival rates for colorectal, breast, prostate and lung cancer compared with insured cancer patients, according to an article in the October 13 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Colorectal cancer, lung cancer, breast cancer and prostate cancer represent a substantial portion of disease in Kentucky and the United States, according to the article. In 2002, these four cancers are expected to account for approximately 54 percent of the 21,100 new cases of invasive cancer predicted for Kentucky. Researchers have an opportunity to study cancer survival as it is associated with insurance status in Kentucky because the state cancer registry routinely collects information on insurance status and vital status on all registered patients.

Kathleen McDavid, Ph.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues used the Kentucky Cancer Registry to examine cancer survival and health insurance status for prostate, breast, colorectal, and lung cancer.

The researchers used data from men and women aged 18 to 99 years old with colorectal, lung, breast or prostate cancer who were registered between 1995 and 1998 with the Kentucky Cancer Registry, Lexington. These patients were followed up through 1999.

The researchers found:

• For patients with prostate cancer, the proportion of patients who survived three years was 98 percent for the insured, and 83 percent for the uninsured.
• For patients with breast cancer, three-year survival was 91 percent for the insured, and 78 percent for the uninsured.
• For patients with colorectal cancer, three-year survival was 71 percent for the insured and 53 percent for the uninsured.
• For patients with lung cancer, three-year survival was 23 percent for the insured and 13 percent for the uninsured.

"The present study is one of the few U.S. studies to include all adults and insurance types for a state population-based cancer survival analysis focused on common cancers," write the authors. "In this study, patients with colorectal, lung, breast, and prostate cancers who had private insurance had the best survival, while those of unknown insurance type always fared worst."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 13, 2003
To contact Ronald Glaser, Ph.D., call David Crawford at 614/293-3737.

IMMUNE RESPONSE TO FLU SHOT DIFFERENT IN PEOPLE WITH MILD SYMPTOMS OF DEPRESSION

CHICAGO—Immune system responses may differ between people with symptoms of depression compared to those without depressive symptoms, according to an article in the October issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.

According to the article, the immune system can be triggered in a variety of ways, including by infections or injuries. One way the immune system reacts to trauma or infection is by triggering an inflammatory response, which helps direct infection fighting white blood cells to the involved site. This process is mediated by the production of molecules called pro-inflammatory cytokines, including interleukin 6 (IL-6). A wide variety of conditions associated with aging including cardiovascular disease, osteoporosis, arthritis, type 2 diabetes mellitus, certain cancers, Alzheimer disease and periodontal disease, have been linked to chronic activation of the inflammatory response. Elevated levels of proinflammatory cytokines have also been liked to depressive disorders, and stress.

Ronald Glaser, Ph.D., of The Ohio State University, Columbus, and colleagues studied changes in plasma (blood) IL-6 levels in patients in response to a standard influenza virus vaccination (flu shot). The researchers used the vaccination as a stressor or "challenge" to the immune system to assess whether the immune system response was related to depressive symptoms.

The researchers obtained blood samples from 119 older adults (average age, 71 years old) immediately before the administration of an annual influenza vaccination, and again ten days to two weeks later. Participants also completed a questionnaire that asked about depressive symptoms each time blood was taken.

The researchers found that "the number of depressive symptoms in this sample was low or average." They also found that "participants with more depressive symptoms had higher levels of IL-6 before and after vaccination than did those who reported fewer symptoms; moreover, individuals reporting more depressive symptoms also showed enhancement of IL-6 levels 2 weeks later, while there was little change in plasma IL-6 levels among those reporting few or no symptoms," the authors write.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 13, 2003
To contact Mark Olfson, M.D., M.P.H., call Leslie Boen at 212/305-4966.

AS ANTIDEPRESSANT MEDICATION TREATMENT INCREASES SUICIDE RATES DECREASE AMONG ADOLESCENTS

CHICAGO—Increases in antidepressant medication use are associated with decreases in rates of suicide among older adolescents and adolescent males, according to an article in the October issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.

Despite declining suicide rates in the United States, suicide is still the third-leading cause of death among adolescents aged 15 to 19 years old, and the fourth-leading cause for adolescents aged 10 to 14 years old, according to the article. Recent increases in antidepressant medication use among adolescents may be partially responsible for the decline.

Mark Olfson, M.D., M.P.H., of Columbia University, New York, and colleagues explored possible relationships between changes in rates of suicides among adolescents and changes in antidepressant prescriptions to adolescents between 1990 and 2000.

The researchers calculated the number of antidepressant prescriptions filled by youths aged 10 to 19 years old in 588 ZIP code regions in the United States using data from the nation's largest pharmacy benefit management organization. The number of suicides that occurred in the same ZIP codes was determined using data from the national suicide mortality files. The researchers also used regional and sociodemographic data from the 1990 and 2000 U.S. Census and Area Resource Files, including the number of psychiatrists, child psychiatrists, and pediatricians per capita for each region studied.

The researchers found that in 1990 and in 2000, there was a positive association between regional antidepressant use and suicide, indicating that regions that had high rates of antidepressant use among adolescents also had higher suicide rates. However, the authors also found a "significant adjusted negative relationship between regional change in antidepressant medication treatment and suicide during the study period."

The researchers also found "A one percent increase in adolescent use of antidepressants was associated with a decrease of 0.23 suicides per 100,000 adolescents per year." These significant inverse trends in antidepressant medication treatment and suicide rates were present for older adolescents (age 15-19) and males but not for younger adolescents or females. "Compared with younger adolescents who commit suicide, older adolescents who commit suicide are more likely to have a diagnosable disorder, including depression, and so these patients may be more likely to benefit from antidepressants," the researchers write.

EMBARGOED UNTIL 3 P.M. (CT), MONDAY, OCTOBER 13, 2003
To contact Thomas B. Newman, M.D., M.P.H., call Janet Basu at 415/476-2557. To contact editorialist David Bishai, M.D., M.P.H., Ph.D., call Tim Parsons at 410/955-7619.

PROPOSAL TO REQUIRE CHILD RESTRAINT SEATS IN AIRPLANES COULD CAUSE MORE DEATHS THAN IT PREVENTS

CHICAGO—A proposal requiring that children under two years old have their own airplane seats and use child restraint systems (CRSs, similar to children's car seats), may cause an increase in deaths if enough families respond by switching from air travel to car travel, according to an article in the October issue of The Archives of Pediatric & Adolescent Medicine, one of the JAMA/Archives journals.

According to the article, the U.S. Federal Aviation Administration (FAA) will soon propose a regulation mandating the use of CRSs for all children flying in an aircraft. The proposal will require children younger than 2 years old to sit in a seat of their own instead of on their parent's lap.

Thomas B. Newman, M.D., M.P.H., of the University of California, San Francisco, School of Medicine, and colleagues performed a risk and economic analysis to estimate the number of child air crash deaths that might be prevented by the proposed regulation, the threshold proportion of families switching from air travel to car travel above which the projected harms of the policy would exceed its projected benefits, and how little the extra seats for young children would have to cost for the policy to approach the cost effectiveness of other available injury prevention strategies.

The researchers estimated that CRS use could prevent about 0.4 child air crash deaths per year in the United States. Increased deaths caused by car travel could exceed deaths prevented by CRSs if the proportion of families switching from air to car travel exceeded about 5 percent to 10 percent.

Because of this finding, the researchers assumed that no families would switch from air travel to car travel when they calculated the cost of the policy per death prevented. They found that the cost per death prevented by a mandatory CRS policy would increase by about $6.4 million for every one dollar increase in the cost of a round trip ticket for a child. "For example, if the additional cost per round trip were $200 per young child, the cost per death prevented, ignoring car crash deaths, would be about $1.3 billion," write the researchers.

"Using available data on the risk of fatalities from air travel and the survivability of crashes and reasonable assumptions for relative risks of death for restrained and unrestrained young children involved in crashes, we found that the number of deaths that could be prevented in the United States with mandatory CRS use in commercial aircraft is small - probably less than 1 and almost certainly less than 2 per year," write the authors. "The number of deaths that could be prevented by mandatory CRS use is limited because the number of deaths of unrestrained young children in survivable crashes is already low."

EMBARGOED UNTIL 3 P.M. (CT), MONDAY, OCTOBER 13, 2003
To contact Andres Martin, M.D., M.P.H., call Karen Peart at 203/432-1326.

SPENDING ON PSYCHOTROPIC DRUGS FOR YOUTHS INCREASED IN THE LATE 1990S

CHICAGO—Increases in the number of children and adolescents being prescribed psychotropic medications, and increases in use of new, costlier drugs resulted in an increase in spending on psychotropic drugs in the late 1990s for youths in the United States, according to an article in the October issue of The Archives of Pediatric & Adolescent Medicine, one of the JAMA/Archives journals.

According to the article, the use of psychotropic medications (drugs used to treat mental disorders including depression and schizophrenia) in children has become a highly visible issue for both policymakers and the public, but reliable estimates of the extent of their use in youths are not available.

Andres Martin, M.D., M.P.H., of Yale University School of Medicine, New Haven, Conn., and colleagues examined trends in psychotropic medication use and costs for children and adolescents between January 1, 1997, and December 31, 2000.

The researchers analyzed pharmacy claims for mental health users 17 years old and younger (n=83,039) from a national database covering 1.74 million privately insured youths.

The researchers found that overall use of psychotropic drugs increased from 59.5 percent of mental health outpatients in 1997 to 62.3 percent in 2000, a 4.7 percent increase. The largest changes in use were for atypical antipsychotics including drugs to treat anxiety disorders, schizophrenia, and bi-polar disorder (138.4 percent), other antidepressants (42.8 percent) and selective serotonin reuptake inhibitors (18.8 percent). The average prescription price increased by 17.6 percent ($7.90 per prescription), a shift attributed to costlier medications in the same category (55.1 percent of the increase, or $4.35) and inflation (44.9 percent of the increase or $3.55).

The researchers also found that almost half (46.7 percent) of the $2.7 million gross sales difference was accounted for by only 3 of the 39 drugs identified - amphetamine compound, risperidone and sertraline - all atypical antidepressants.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 13, 2003
To contact Jerome H. Liu, M.D., M.S.H.S., call Rachel Champeau at 301/794-2270.

MORE SURGERIES PERFORMED IN CALIFORNIA IN 2000 THAN IN 1990

CHICAGO—More people underwent inpatient surgery in California in 2000 than in 1990, and the average length of hospital stay decreased over that ten year period, according to an article in the October issue of The Archives of Surgery, one of the JAMA/Archives journals.

The practice of inpatient surgery has changed significantly over the past decade, due in part to advancements in medical technology, increase in managed care organization enrollment, and more attention being paid to quality of care, medical errors and patient safety, according to the article.

Jerome H. Liu, M.D., M.S.H.S., of the University of California, Los Angeles, and colleagues investigated trends in inpatient surgery in California. The researchers analyzed California inpatient discharge data for January 1, 1990 through December 31, 2000 representing 503 nonfederal acute care hospitals. They used information from all inpatients undergoing general, vascular and cardiothoracic (heart or chest) surgery.

The researchers found that between January 1, 1990 and December 31, 2000, 1.64 million surgical procedures were performed in California. The number of procedures increased 20.4 percent from 135,795 in 1990 to 163,468 in 2000. Patients tended to be older and had more co-existing diseases in 2000 compared to 1990. The adjusted rate of deaths occurring in hospitals decreased from 3.9 percent in 1990 to 2.58 percent in 2000, and length of hospital stay for patients having surgery decreased for all operations analyzed.