Shorts: Wildfires and heart disease, stopping MS drugs, ESRD patients, negative colonoscopies, and respiratory viruses
December 23, 2024
1. Wildfires associated with higher rates of emergency treatment for heart disease
Baltimore, June 2023 from JAMA Network Open, December 13, 2024
Researchers reviewed medical claims from Maryland and found a substantial increase in medical encounters for cardiovascular disease during six calendar days in 2023 with exceptionally bad air quality due to Canadian wildfires. They found that the likelihood that an inpatient, outpatient or emergency department encounter would be for cardiovascular disease increased by 20% compared to matched days in previous years. They defined “hot spot” bad air quality days as those with an Air Quality Index (AQI) of over 35. Many mobile weather apps now display AQI. Employers should be sure to adequately filter their incoming air, and workers should avoid outdoor work or exercise on days with poor air quality. A well-fitted mask (N95) can decrease absorption of P2.5 (soot) particles, which are associated with an increase in cardiovascular symptoms.
2. Study shows that disease can return if multiple sclerosis drugs are discontinued
Researchers randomized a small group of patients with multiple sclerosis who had been well-controlled with biologic medications to either continue the medications or discontinue them. Eight of the 45 who discontinued disease modifying medications had imaging evidence of brain inflammation, and none of those who continued the medications had evidence of inflammation.
It’s hard to do studies like this, as pharmaceutical companies are not anxious to prove that patients can stop taking maintenance medication. This is an important study, though, because these drugs are expensive and can have serious side effects. The trial was discontinued early because of the high rate of inflammatory disease in the discontinuation group. On the basis of this study, it appears that those with multiple sclerosis need to continue on long-term therapy to avoid relapses. This was published in JAMA Neurology.
3. Transfer of patients on dialysis from private insurance to Medicare slowed after the Affordable Care Act
Wang, et al JAMA Health Forum December 6, 2024
Researchers used the Colorado All Payer Claims Database to assess whether patients on private insurance were less likely to transition as allowed to Medicare after the Affordable Care Act was passed. They found that Medicare enrollment rates of those who began dialysis while on private health plans declined from 68% to 46% during a four-year period. Medicare is the secondary payer until 33 months after the initiation of dialysis. Medicare has much lower payment rates for dialysis, so quarterly costs for those on private plans were about two and one-half times as high as costs for those on Medicare. Employers should be certain that their carriers facilitate transfer of those who are on dialysis to Medicare when they are eligible.
4. Those with negative colonoscopies are at low risk for colorectal cancer
A paper in JAMA Oncology showed that those who were at low risk of colorectal cancer and had a negative colonoscopy had similar chances of having colon cancer in 20 years as those with a higher risk score in 10 years. The researchers reviewed data from almost 200,000 people from three long-running studies of health of nurses and health professionals. The authors suggest that some low-risk people who have been screened with a colonoscopy could have their next screening at an interval longer than 10 years. The authors developed a risk score that includes family history, age, body mass index, diet, exercise, and use of alcohol and aspirin. They confirmed cases of colorectal cancer with medical records and confirmed deaths with the National Death Index.
Colonoscopies are more likely to save lives in people at higher risk, although personalizing colonoscopy intervals based on risk adds complexity, and could lead to decreased frequency of colorectal cancer screening in high-risk people too. FIT tests are a cost-saving alternative to colonoscopies and can pick up almost as many cases. See this post on colorectal cancer screening from earlier this year. Shield by Guardant is a blood test to screen for colon cancer that was approved by the FDA earlier this year and is being marketed to employers. This testis not currently recommended for colorectal cancer screening by the USPSTF. Here is a previous post on this test.
5. Respiratory diseases are climbing in time for the holidays
The CDC reports that rates of emergency department visits for COVID-19, influenza and RSV are increasing nationally, although wastewater virus detection levels remain low in most of the country. Vaccinations generally take two weeks to confer immunity, so it’s still not too late to get vaccinated to protect against illness at the end of the holiday season. Here’s a link to the CDC site with maps showing wastewater levels, emergency department visits, and positive test results by state for flu, COVID-19, and RSV.