JAMA : the journal of the American Medical Association
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Data from two pharmaceutical marketing research databases, the National Prescription Audit and the National Disease and Therapeutic Index, were used to study trends in outpatient use of cholesterol-lowering drugs in the United States from 1978 through 1988. Retail pharmacies dispensed an estimated 4.4 million prescriptions for cholesterol-lowering drugs in 1978. This declined to 2.6 million in 1983 and increased dramatically to nearly 13 million in 1988. ⋯ From 1978 through 1988, an average 54% of individuals using cholesterol-lowering drugs were 60 years of age or older. The 13 million prescriptions for cholesterol-lowering drugs in 1988 represent a maximum estimate of 13 million treated individuals. This number compares with the 60 million Americans with high cholesterol levels who are candidates for dietary advice, and, if cholesterol levels do not improve, for combined diet and drug intervention.
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A case-control design was used to investigate the effects of preexisting chronic conditions on in-hospital mortality in adult trauma patients. Cases consisted of all trauma deaths (n = 3074) that occurred in 1983 in any of the 331 acute care hospitals in California. Three to four control patients (injured survivors) were matched to each case patient on the basis of injury severity, age, and individual hospital (n = 9869). ⋯ The presence of cirrhosis (relative odds = 4.5), congenital coagulopathy (relative odds = 3.2), ischemic heart disease (relative odds = 1.8), chronic obstructive pulmonary disease (relative odds = 1.8), and diabetes (relative odds = 1.2) all significantly increased the risk of dying. These data provide statistical evidence to support the recommendation of the American College of Surgeons that the presence of underlying disease be considered in decisions to triage and transfer patients to trauma centers. They also underscore the importance of underlying disease in the case-mix adjustment of case-fatality rates and the identification of unexpected deaths for quality assurance review.