US veterans administration diabetes risk (VADR) national cohort: cohort profile

Avramovic, Sanja; Alemi, Farrokh; Lopez, Priscilla; Hayes, Richard B.; Thorpe, Lorna E.; Schwartz, Mark D.

doi:10.1136/bmjopen-2020-039489

Cited by 17 publications

(18 citation statements)

References 22 publications

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“…The Veterans Administration Diabetes Risk (VADR) cohort was developed using the Veterans Affairs EHR VINCI system, described elsewhere ( 28 ). This dynamic retrospective cohort included 4.1 million patients who are U.S. veterans with at least two primary care service visits at least 30 days apart prior to cohort entry (between 1 January 2008 and 31 December 2018).…”

Section: Methodsmentioning

confidence: 99%

Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples

et al. 2022

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OBJECTIVE We examined whether relative availability of fast-food restaurants and supermarkets mediates the association between worse neighborhood socioeconomic conditions and risk of developing type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS As part of the Diabetes Location, Environmental Attributes, and Disparities Network, three academic institutions used harmonized environmental data sources and analytic methods in three distinct study samples: (1) the Veterans Administration Diabetes Risk (VADR) cohort, a national administrative cohort of 4.1 million diabetes-free veterans developed using electronic health records (EHRs); (2) Reasons for Geographic and Racial Differences in Stroke (REGARDS), a longitudinal, epidemiologic cohort with Stroke Belt region oversampling (N = 11,208); and (3) Geisinger/Johns Hopkins University (G/JHU), an EHR-based, nested case-control study of 15,888 patients with new-onset T2D and of matched control participants in Pennsylvania. A census tract–level measure of neighborhood socioeconomic environment (NSEE) was developed as a community type-specific z-score sum. Baseline food-environment mediators included percentages of (1) fast-food restaurants and (2) food retail establishments that are supermarkets. Natural direct and indirect mediating effects were modeled; results were stratified across four community types: higher-density urban, lower-density urban, suburban/small town, and rural. RESULTS Across studies, worse NSEE was associated with higher T2D risk. In VADR, relative availability of fast-food restaurants and supermarkets was positively and negatively associated with T2D, respectively, whereas associations in REGARDS and G/JHU geographies were mixed. Mediation results suggested that little to none of the NSEE–diabetes associations were mediated through food-environment pathways. CONCLUSIONS Worse neighborhood socioeconomic conditions were associated with higher T2D risk, yet associations are likely not mediated through food-environment pathways.

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Section: Methodsmentioning

confidence: 99%

Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples

et al. 2022

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“…Rule-based algorithms developed for EHR were used to define diabetes and hypertension, as fully described elsewhere [ 11 , 12 ]. Briefly, burden estimates were defined by combining: ICD-9-CM and ICD-10-CM diagnostic codes, lab results or vitals, or relevant medications (Additional file 1 : Table S1).…”

Section: Methodsmentioning

confidence: 99%

Diabetes and hypertension among South Asians in New York and Atlanta leveraging hospital electronic health records

Beasley

Conderino

et al. 2021

Diabetol Metab Syndr

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Background Diabetes and hypertension disparities are pronounced among South Asians. There is regional variation in the prevalence of diabetes and hypertension in the US, but it is unknown whether there is variation among South Asians living in the US. The objective of this study was to compare the burden of diabetes and hypertension between South Asian patients receiving care in the health systems of two US cities. Methods Cross-sectional analyses were performed using electronic health records (EHR) for 90,137 South Asians receiving care at New York University Langone in New York City (NYC) and 28,868 South Asians receiving care at Emory University (Atlanta). Diabetes was defined as having 2 + encounters with a diagnosis of diabetes, having a diabetes medication prescribed (excluding Acarbose/Metformin), or having 2 + abnormal A1C levels (≥ 6.5%) and 1 + encounter with a diagnosis of diabetes. Hypertension was defined as having 3 + BP readings of systolic BP ≥ 130 mmHg or diastolic BP ≥ 80 mmHg, 2 + encounters with a diagnosis of hypertension, or having an anti-hypertensive medication prescribed. Results Among South Asian patients at these two large, private health systems, age-adjusted diabetes burden was 10.7% in NYC compared to 6.7% in Atlanta. Age-adjusted hypertension burden was 20.9% in NYC compared to 24.7% in Atlanta. In Atlanta, 75.6% of those with diabetes had comorbid hypertension compared to 46.2% in NYC. Conclusions These findings suggest differences by region and sex in diabetes and hypertension risk. Additionally, these results call for better characterization of race/ethnicity in EHRs to identify ethnic subgroup variation, as well as intervention studies to reduce lifestyle exposures that underlie the elevated risk for type 2 diabetes and hypertension development in South Asians.

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“…16,17,24-28 This is particularly relevant to ORN development which may be impacted by comorbidities for which Veterans are particularly enriched such as peripheral vascular disease and diabetes mellitus. 26,28…”

Section: Discussionmentioning

confidence: 99%

Early detection of mandible osteoradionecrosis risk in a high comorbidity Veteran population

Wilde

Kansara

Sapienza

et al. 2022

Preprint

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Objective: Osteoradionecrosis (ORN) of the mandible is a devastating complication of external beam radiation therapy (EBRT) for head and neck squamous cell carcinoma (HNSCC). We sought to ascertain ORN risk in a Veteran HNSCC population treatment with definitive or adjuvant EBRT and followed prospectively. Study design: Retrospective analysis of prospective cohort. Setting: Tertiary care Veterans Health Administration (VHA) medical center. Methods: Patients with HNSCC who initiated treatment at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) are prospectively tracked for quality of care purposes through the end of the cancer surveillance period (5 years post treatment completion). We retrospectively analyzed this patient cohort and extracted clinical and pathologic data for 164 patients with SCC of the oral cavity, oropharynx, larynx and hypopharynx who received definitive or adjuvant EBRT (2016-2020). Results: Most patients were dentate and 80% underwent dental extractions prior to EBRT of which 16 (16%) had complications. The rate of ORN was 3.7% for oral cavity SCC patients and 8.1% for oropharyngeal SCC patients. Median time to ORN development was 156 days and the earliest case was detected at 127 days post EBRT completion. All ORN patients were dentate and underwent extraction prior to EBRT start. Conclusion: ORN development can occur early following EBRT in a Veteran population with significant comorbid conditions but overall rates are in line with the general population. Prospective tracking of HNSCC patients throughout the post-treatment surveillance period is critical to early detection of this devastating EBRT complication.

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US veterans administration diabetes risk (VADR) national cohort: cohort profile

Cited by 17 publications

References 22 publications

Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples

Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples

Diabetes and hypertension among South Asians in New York and Atlanta leveraging hospital electronic health records

Early detection of mandible osteoradionecrosis risk in a high comorbidity Veteran population

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