To assess water-related risk factors of Buruli ulcer, a case-control study of 102 patients (51 cases and 51 controls) was undertaken by matching age group, sex, and bacille Calmette-Guerin (BCG) vaccination history in Ghana. The factors used here for matching have previously been implicated as factors of Buruli ulcer, an emerging infectious disease. This is the first study to delineate a set of previously suspected, water-related risk factors, in a case-control study matching for age group, sex, and BCG vaccination status. The results of both bivariate and multivariate analyses presented a significantly high odds ratio (OR) only for swimming in rivers on a habitual basis (OR = 18.00, P < 0.01) among the major water-related risk factors. Use of water from rivers and ponds for drinking, cooking, bathing, and washing purposes were not significant risk factors. Our data suggest that swimming, or activities on riverbanks associated with it, is a risk factor.
BackgroundCompared with other racial and ethnic groups, African Americans are disproportionately burdened by high rates of deaths due to diabetes. Insurance coverage and access to primary care are critical for prevention and chronic disease management.PurposeTo examine the difference in age-adjusted diabetes mortality rates in African Americans before and after Medicaid expansion.MethodsUsing ICD-10 Cause List E10–E14, age-adjusted diabetes mortality rates among African Americans were extracted from the Centers for Disease Control and Prevention's Compressed Mortality File. Sufficient and reliable data were available for 36 states and the District of Columbia. With a 95% confidence interval, two periods were analyzed: pre-Medicaid expansion - years 2008, 2009, 2010 and post-Medicaid expansion - years 2014, 2015, 2016. Three-year means for both periods were calculated for each state. Differences for each state are presented and contextualized as a state that opted in or out of expanding Medicaid coverage.ResultsThere was a slight reduction in diabetes mortality in African Americans (41.14/100,000 pre-expansion and 38.94/100,000 post-expansion). We found variability across states – regardless of expansion status. Differences in rates ranged from a decrease of 15.43/100,000 to an increase of 9.53/100,000. Out of all states that met our criteria, 24 states expanded coverage; age-adjusted diabetes death rates declined in 16 of those states. There were also reductions in eight states that did not expand coverage.ConclusionFuture research is needed to explore if Medicaid expansion is associated with reductions in diabetes mortality in the African American community.
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