Online only: Public health extras: May/June 2010
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## Chronic kidney disease hits younger, poor minorities

Chronic kidney disease afflicts a large number of younger minority adults receiving medical care in settings that typically serve uninsured or under-insured people, while low-income, minority adults with moderate to severe forms of the disease are up to four times more likely to progress to kidney failure than whites.

A study published online March 11 in the Clinical Journal of the American Society of Nephrology found chronic kidney disease afflicted a large fraction of young adults ages 20–39, most of whom were racial or ethnic minorities. The study, based on more than 15,000 adults with non-dialysis dependent chronic kidney disease, found the vast majority were poor, with 40 percent either uninsured or enrolled in Medicaid. And blacks, Hispanics, Asians and Pacific Islanders with chronic kidney disease had two-to-four times the risk of developing severe end-stage renal disease as whites.

“That represents a significant disparity that warrants greater study about the causes, consequences and preventive measures appropriate for people in this demographic,” said study co-author Andy I. Choi, MD, MAS, of the University of California, San Francisco’s Division of Nephrology. He and the study’s other authors called for targeted researching within medical settings that serve the uninsured and under-insured to find ways to improve overall survival among the urban poor. Chronic kidney disease affects an estimated 26 million Americans, or one in nine adults, according to the American Society of Nephrology.

## Tobacco use linked to worse head, neck cancers

In cases where head and neck cancer are linked to human papillomavirus, or HPV, a recent study found patients had worse outcomes if they were current or former tobacco users.

The study, published in the Feb. 15 issue of Clinical Cancer Research, found that current smokers were five times more likely to have their cancer return than patients who had never smoked. While past studies have shown HPV-positive head and neck cancers tend to respond better to current treatments, the new study found smokers and even former smokers were more likely to have cancer recur after treatment.

The study was based on 124 patients with advanced cancer of the tonsils or the base of the tongue. Of the HPV-positive patients who had never used tobacco, 6 percent had a recurrence of cancer. But 19 percent of former tobacco users and 35 percent of current tobacco users had a cancer recurrence. All of the HPV-negative patients in the study were smokers, and among them 50 percent had a cancer recurrence.

Almost 36,000 Americans will be diagnosed with head and neck cancers this year, and 7,600 will die of the disease, according to the American Cancer Society. The study’s authors said their findings suggest more aggressive treatment regimens may be in order for current or former smokers.

## Hospital-acquired infections continue to cause problems

The two most common conditions caused by hospital-acquired infections — pneumonia and sepsis — killed 48,000 people and increased health care costs by $8.1 billion in 2006, according to a recent study.

Published in the Feb. 22 Archives of Internal Medicine, the study was based on an analysis of 69 million discharge records from hospitals in 40 states and looked at infections that developed after a person was hospitalized. They found that nearly 20 percent of people who developed sepsis after surgery died as a result of the infection. Sepsis is a serious bloodstream infection that is linked to a lack of sanitation during surgery.

The study also found that people who developed pneumonia after surgery stayed in the hospital an extra 14 days and more than 10 percent of them died.

“In many cases, these conditions could have been avoided with better infection control in hospitals,” said Ramanan Laxminarayan, PhD, principal investigator for Extending the Cure, a project examining antibiotic resistance. “Infections that are acquired during the course of a hospital stay cost the United States a staggering amount in terms of lives lost and health care costs. Hospitals and other health care providers must act now to protect patients from this growing menace.”

*   Copyright The Nation’s Health, American Public Health Association