Louisiana State University Hospital-Based Longitudinal Study

(LSUHLS)

Gang Hu, MD, MPH, PhD, FAHAPennington Biomedical Research Center

• Louisiana State University Health Care Services Division (LSUHCSD) operates 7 public hospitals and affiliated clinics in different areas in Louisiana which provide quality medical care to residents of Louisiana, regardless of their income or insurance coverage.

• Overall, LSUHCSD facilities have served about 1.6 million unique patients (35% of the Louisiana population) since 1990, and approximately 300,000 patients annually. About 46% of LSUHCSD patients qualify for free care, about 10% of patients are self-pay, about 20% of patients are covered by Medicaid, about 14% of patients have Medicare, and about 10% of patients are covered by commercial insurance.

• The LSU Health Care Services Division, the division responsible for the management of the LSUHCSD clinical facilities, has access to the administrative data, the anthropometric data, the laboratory data, the treatment data, and the clinical diagnosis data of these facilities.

• All these data are available in electronic form since 1990 for both inpatients and outpatients (the LSUHCSD Disease Management Evaluation Database [DMED]).

• Using L-DMED, we have established the Louisiana State University Hospital-based Longitudinal Study (LSUHLS) in collaboration LSUHCSD, especially Dr. Horswell and his team.

General information of LSUHLS – diabetic patients cohort (N=104,428)- Male (41.4%) versus Female (58.6%)

- African (56.6%), - White (39.7%), - Asian (0.6%), - Hispanic (1.3%), - Other (1.8%)

- Creatinine, N=91,602- GFR, N= 91,602- Albumin:creatinine, N=76,150- Urea Nitrogen, N=82,201- Albumin, N= 76,154- CRP, N=5550- other

Lab measurements- HbA1C,N= 65,651- Fasting G, N=11,503- 2-h glucose, N= 1196- random G, N= 80,608- WBC, N= 77,400- RBC, N= 77,809- Uric acid, N= 9986

Drug treatments (from 2008), - DM, N=47,698- HBP, N=47,698- Statin, N=47,698- Other, N=47,698

- TC, N= 70,632- TG, N= 70,467- HDL, N= 70,096- LDL, N= 70,090- ALT, N= 75,654- AST, N= 75,460- TBIL, N=74,631- GGT, N=3276

Incident cases during follow-up - Cancer, N= 6973 - Hypertension, N= 56,356 - Stroke, N= 5613 - Heart failure, N= 14,615 - CHD, N= 18,515 - Kidney disease, N= 16,317 - Dementia, N= 1,079 - Parkinson disease, N= 379 - Peripheral arterial disease, N= 8139 - Other diseases based on ICD codes

Mean follow-up 4.54 years

Mean value of age, 51.2 yearsType 1 (6.0%), Type 2 (94.0%)

Known diseases before diabetes diagnosis - Cancer, N= 3857 - Hypertension, N= 32,376 - Stroke, N= 1715 - Heart failure, N= 5269 - CHD, N= 7844 - Kidney disease, N= 2722 - Dementia, N= 176 - Parkinson disease, N=105 - Peripheral arterial disease, N= 2189

History of diseases

Smoking, N= 54,063Income, N= 75,059Insurance, N=104,428BMI, N= 51,082BP, N= 53,716

General information of LSUHLS - gestational women cohort (N=75,563)

Race- African (64.9%)- White (24.0%)- Asian (1.1%)- Hispanic (3.2%)- Other (6.8%)

- TC, N=8,973- TG, N= 8,716- HDL, N=8,514- LDL, N= 8,528- U-Creatinine, N=40,218- Urea Nitrogen, N=32,611

Smoking, N= 75,778Income, N= 17,932Height, N=26,800Weight, N=27,900BMI, N= 26,749BP, N= 28,048

Lab measurements- Fasting glucose, N=3,393- 1-h glucose, N= 2,469- 2-h glucose, N= 2,458- 3-h glucose, N= 2,330- HbA1C, N= 4,225

Incident cases during follow-up - Diabetes, N= 2,404 - Hypertension, N= 7,897 - Stroke, N= 294 - CHD, N= 518

Mean follow-up 8.5 years

Mean value of age, 24.3 yearsGDM, N = 3648

Known diseases before GDM - Diabetes, N= 801 - Hypertension, N= 1,735 - Stroke, N= 66 - CHD, N= 136

History of diseases

LSUHLS Update (Manuscripts)• Li W, Wang Y, Chen L, Horswell R, Xiao K, Besse J, Johnson J, Ryan DH, Hu

G. Increasing prevalence of diabetes in Louisiana from 2000 to 2009. Diabetes Research and Clinical Practice 2011; 94: 262-268.

• Wang Y, Chen L, Xiao K, Horswell R, Besse J, Johnson J, Ryan DH, Hu G. Increasing prevalence of gestational diabetes mellitus in Louisiana, 1997-2009. Journal of Women’s Health 2012; 21: 319-325.

• Wang Y, Chen L, Horswell R, Xiao K, Besse J, Johnson J, Ryan DH, Hu G. Racial disparities in the association between gestational diabetes mellitus and risk of type 2 diabetes. Journal of Women’s Health 2012; Mar 2. [Epub ahead of print].

• Hu G, Horswell R, Wang Y, Li W, Besse J, Xiao K, Heymsfield S, Ryan DH, Katzmarzyk PT. Body mass index and the risk of dementia among Louisiana low income diabetic patients. PLoS One, revised manuscript.

• Zhang YR, Li W, Wang Y, Chen L, Horswell R, Xiao K, Besse J, Johnson J, Ryan DH, Hu G. Increasing prevalence of hypertension in Louisiana from 2000 to 2009. Submitted manuscript.

LSUHLS Update (Manuscripts)

• Wang Y, Katzmarzyk PT, Horswell R, Li W, Xiao K, Besse J, Xie W, Johnson J, Heymsfield S, Ryan DH, Hu G. Ethnic disparities in diabetic complications in Louisiana. Submitted manuscript.

• Chen L, Wang Y, Xiao K, Horswell R, Johnson J, Hu G. Risk of hypertension after the gestational diabetes: findings from a large multi-ethnicity cohort study in Louisiana. Manuscript – under submission.

• Wang Y, Katzmarzyk PT, Horswell R, Li W, Heymsfield S, Ryan DH, Hu G. Kidney function and the risk of cardiovascular disease among Louisiana low income diabetic patients. Manuscript – preparation.

Sex-specific prevalence of diabetes in LSU hospitals

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Li W et al. Diabetes Res Clin Pract 2011; 94:262-8.

Race/ethnicity-specific prevalence of diabetes in LSU hospitals

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Li W et al. Diabetes Res Clin Pract 2011; 94:262-8.

Race/ethnicity-specific prevalence of GDM in LSU hospitals

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Wang Y et al. J Womens Health 2012;21:319-25.

Sex-specific prevalence of hypertension in LSU hospitals

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Zhang Y et al. Submitted manuscript.

Race/ethnicity-specific prevalence of hypertension in LSU hospitals

Zhang Y et al. Submitted manuscript.

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Age-standardized incident rates of diabetes complications (n = 89,353)

- LSUHLS

White Black

Male Female Male Female

CHD 99.3 (96.1-103) 62.0 (59.8-64.3) 49.8 (47.9-51.7) 44.4 (43.1-45.8)

Heart Failure 53.5 (51.3-55.7) 41.9 (40.1-43.7) 42.5 (40.7-44.3) 38.4 (37.1-39.6)

Stroke 21.5 (20.3-22.8) 20.7 (19.6-21.9) 19.5 (18.3-20.6) 18.5 (17.6-19.3)

ESRD 16.3 (15.1-17.5) 13.6 (12.6-14.5) 20.3 (19.1-21.5) 14.2 (13.5-14.5)

ESRD, End-stage Renal Disease.

Wang Y et al. Submitted manuscript.

Kidney function, treatments and risk of CVD among diabetic patients – LSUHLS

- Intramural Project 1

The aims of this project are:

•1) To determine if there are racial differences in the associations of albuminuria and GFR with the risks of incident CHD, stroke, CVD, and heart failure between white and African American patients with T2D;

•2) To determine if different cardiovascular drugs use can reduce the risk and slow the progression of chronic kidney disease (CKD) and further decrease the risks of incident CHD, stroke, CVD, and heart failure among patients with T2D.

LSU ICON Core Services utilized:•Medical Information Core – Ron Horswell’s group

•Design & Analysis Core – Gang Hu’s group

•Medical Consultants Core – Shannon McNabb/ LSU physicians

Project PI and co-investigators:•Principal Investigator: Gang Hu, MD, PhD

•Co-Investigators: Ronald Horswell, Yujie Wang, Wenhui Zhao, Wei Li, Donna Ryan, Peter T. Katzmarzyk

Timeline for completion:•Year 1: a) update the database; b) analyze the kidney function markers and the risks of CHD, stroke and heart failure;

•Year 2: a) update the database; b) analyze the treatments to improve kidney function and further decrease later CVD risk.

Racial disparities in the association of gestational diabetes mellitus and risk of CVD

- Intramural Project 2The aims of this project are:

•1) To address whether women with prior GDM have increased risks of incident CHD and stroke during follow-up, and whether increased risks of CHD and stroke are indirectly associated with prior GDM-induced increased risks of T2D, HBP, dyslipidemia, and metabolic syndrome during follow-up or directly associated with prior GDM independent of major CHD risk factors;

•2) To examine whether women with prior GDM have increased risks of incident T2D, and hypertension during follow-up;

•3) To assess whether the association between prior GDM and the risks of CHD, stroke, T2D, and hypertension is different between African American women and white American women.

LSU ICON Core Services utilized:•Medical Information Core – Ron Horswell’s group

•Design & Analysis Core – Gang Hu’s group

•Medical Consultants Core – Shannon McNabb / LSU physicians

Project PI and co-investigators:•Principal Investigator: Gang Hu, MD, PhD

•Co-Investigators: Yujie Wang, Wei Li, Liwei Chen, Donna Ryan, Ronald Horswell

Timeline for completion:•Year 1: a) update the database; b) analyze the association between GDM and the risks of hypertension and MS;

•Year 2: a) update the database; b) analyze the association between GDM and risks of CHD and stroke.

Future plans and suggestions• Assess the association between using different glucose-

lowering drugs (oral hypoglycemic agents, Insulin glargine, and other human insulin) among DM patients with the risks of

a) CHD, stroke, CVD and heart failure;

b) different types of cancers.

• Assess the association of different treatment goals with the risks of CVD and heart failure among DM patients

a) HbA1C <7%

b) Blood pressure <130/80 mm Hg

c) LDL <100 mg/dl

d) Smoking cessation, etc.

Suggestions

• LSUHLS links to external data sources

- LA Tumor Registry

- LA/National Death register

• Validity of several diseases diagnoses in LSU hospitals

- Myocardial infarction - Stroke

- Heart failure - Dementia

- Kidney disease - Parkinson

Acknowledgement for these collaborators

My team • Yujie Wang• Wei Li• Jin Guan• Nan Li• Yurong Zhang• Wenhui Zhao

School of Public Health, LSUHSC

• Liwei Chen• Ke Xiao• Qingzhao Yu

LSU HCSD and Clinics •Ron Horswell•Jay Besse •Jolene Johnson

PBRC and LSU LCON•Peter T. Katzmarzyk•Ron Horswell•Donna Ryan•Steven B. Heymsfield•Shannon McNabb