CHICAGO—Exposure to ozone at levels below Environmental Protection Agency (EPA) air quality standards can significantly increase the risk for respiratory symptoms for children with severe asthma, according to an article in the October 8 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, children with asthma are particularly vulnerable to the adverse health effects of high levels of air pollution, with a significantly increased risk of respiratory symptoms, asthma medication use, and reduced lung function. Studies of children with asthma living in regions with levels of pollution within or near compliance with EPA air quality standards suggest that the current standards do not protect these more vulnerable members of the population.

Janneane F. Gent, Ph.D., of the Yale University School of Medicine, New Haven, Conn., and colleagues examined the effects of ozone and fine particulate matter (2.5 micrometers [um] or less [PM2.5]) at levels below EPA standards on daily respiratory symptoms and rescue medication use among children with asthma.

The study included 271 children younger than 12 years with physician-diagnosed, active asthma residing in southern New England. Exposure to concentrations of ozone and PM2.5 from April 1 through September 30, 2001 was assessed using ozone (peak 1-hour and 8-hour) and 24-hour PM2.5.

"In copollutant models, ozone level but not PM2.5 was significantly associated with respiratory symptoms and rescue medication use among children using maintenance medication; a 50-parts per billion increase in 1-hour ozone was associated with increased likelihood of wheeze (by 35 percent) and chest tightness (by 47 percent). The highest levels of ozone (1-hour or 8-hour averages) were associated with increased shortness of breath and rescue medication use. No significant, exposure-dependent associations were observed for any outcome by any pollutant among children who did not use maintenance medication," the researchers write.

CHICAGO—Medical injuries in hospitals pose risks to patients and result in increased expenses, according to an article in the October 8 issue of The Journal of the American Medical Association (JAMA).

Medical injuries can occur during all stages of the complicated process of care, vary widely in nature, and are relatively infrequent, according to background information in the article. The lack of standard classification, in addition to definitional issues, in large part explains why so little is known about the prevalence, adverse outcomes, and effective prevention of medical injuries.

Chunliu Zhan, M.D., Ph.D., of the Agency for Healthcare Research and Quality (AHRQ), Rockville, Md., and Marlene R. Miller, M.D., M.Sc., of Johns Hopkins University, Baltimore, examined the excess length of stay (LOS), costs, and deaths attributable to medical injuries during hospitalization.

The primary source of data for this study was the 2000 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) developed by the AHRQ. The AHRQ Patient Safety Indicators (PSIs) were used to identify medical injuries in 7.45 million hospital discharge abstracts for inpatient stays from 994 acute-care general hospitals across 28 states, approximating a 20 percent stratified sample of acute care hospitals in the United States.

The researchers found that excess length of stay attributable to medical injuries ranged from 0 days for injury to a neonate to 10.89 days for postoperative sepsis (the presence of bloodstream infection), excess charges ranged from $0 for obstetric trauma (without vaginal instrumentation) to $57,727 for postoperative sepsis, and excess mortality ranged from 0 percent for obstetric trauma to 21.96 percent for postoperative sepsis. "Following postoperative sepsis, the second most serious event was postoperative wound dehiscence [re-opening of a sutured or repaired surgical incision], with 9.42 extra days in the hospital, $40,323 in excess charges, and 9.63 percent attributable mortality. Infection due to medical care was associated with 9.58 extra days, $38,656 in excess charges, and 4.31 percent attributable mortality," the authors write.

CHICAGO—An estimated one in three individuals born in the year 2000 will develop diabetes, according to a study published in the October 8 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, diabetes is a serious and costly disease. "The prevalence of diagnosed diabetes among U.S. adults has increased by 40 percent in 10 years from 4.9 percent in 1990 to 6.9 percent in 1999. It is estimated that the number of individuals in the United States with diagnosed diabetes will increase by 165 percent between 2000 and 2050, with the fastest increase occurring in older and minority subpopulations."

K.M. Venkat Narayan, M.D., and colleagues from the Centers for Disease Control and Prevention, Atlanta, analyzed data from the National Health Interview Survey (1984 - 2000) to estimate age, sex and race/ethnicity-specific lifetime risk of diabetes for those individuals born in 2000. Data from the U.S. Census Bureau and from a previous study of diabetes were used to estimate death rates specific to age, sex, and race/ethnicity for the individuals with and without diabetes. The researchers also estimated age at diagnosis, duration with diabetes, and how many years of life could be lost due to diabetes, as well as quality-adjusted life-years (QALYs). The QALYs is a calculation to show the quality of life lost due to diabetes.

"The estimated lifetime risk of developing diabetes for individuals born in 2000 is 32.8 percent for males and 38.5 percent for females," the authors report. Women have a higher lifetime risk for diabetes at all ages, the study finds. "The highest estimated lifetime risk for diabetes is among Hispanics (males, 45.4 percent and females, 52.5 percent). Individuals diagnosed as having diabetes have large reductions in life expectancy. For example, we estimate that if an individual is diagnosed at age 40 years, men will lose 11.6 life-years and 18.6 quality-adjusted life-years and women will lose 14.3 life-years and 22.0 quality-adjusted life-years."

"For individuals born in the United States in 2000, we estimate the lifetime risk of diagnosed diabetes mellitus to be roughly one in three for males and two in five for females," the authors state. The lifetime risk of diabetes is the same or higher than many other conditions, according to the authors. "For example, the lifetime risk of diabetes is considerably higher than the widely publicized one in eight risk for breast cancer among U.S. women. At age 40 years, the residual lifetime risk of diabetes is roughly one in three for men and women, and is nearly as high as that for coronary heart disease (one in two for men and one in three for women)."

ONE IN THREE AMERICANS WILL HAVE DIABETES BY THE YEAR 2050