Your Body, Your Life: News from the Medical Campus

PTSD associated with longer hospitalizations and greater mental-health-care use

What’s up?
Researchers from the Boston University School of Medicine and Boston Medical Center (BMC) have found that post-traumatic stress disorder (PTSD) is associated with more hospitalizations, longer hospitalizations, and greater use of mental-health-care resources in English-speaking patients at urban primary care clinics.

Anand Kartha, an assistant professor of medicine at MED, says prior studies suggest that trauma exposure and PTSD have considerable impact on health-care use and costs. Most of this research has focused on male veterans and female sexual assault victims; the impact on health-care use in other populations is uncertain.

What was found:
Among the study participants, the researchers found that 80 percent had one or more exposures to trauma. Compared to participants with no trauma exposure, those exposed to trauma were significantly more likely to be male, unmarried, and have substance dependence and depression. They also had more mental health visits than those with no trauma exposure.

Among the participants, 22 percent had current symptoms of PTSD. Compared to participants without PTSD, those with PTSD were significantly more likely to be female, to have an annual income of $20,000 or less, and to have substance dependence and depression. Participants with PTSD also had more hospitalizations and mental health visits.

Why it matters:
According to the researchers, among urban primary care patients PTSD is associated with greater use of health-care resources, both mental health visits and hospitalizations. “Unexpectedly, trauma exposure by itself was not associated with increased health-care utilization apart from mental health visits, a finding which was attenuated after adjusting for PTSD,” says Kartha. “This may be due to the fact that the nontraumatized to whom we are comparing the traumatized patients have a complex social milieu leading to high utilization.”

Word to the wise:
“PTSD has a cost beyond the specific mental health symptoms,” says senior author Jane Liebschutz, a MED associate professor of medicine and social and behavioral sciences and a primary care physician at BMC. “PTSD may be on the causal pathway between trauma experiences and negative health consequences. These findings are relevant in light of the PTSD prevalence not only in our returning veterans, but in areas of urban poor.”

Where to find more:
The research was published in the April 2008 issue of Medical Care.

Researchers develop new method to test for lung cancer

What’s up?
MED researchers have developed a new “clinicogenomic model” to accurately test for lung cancer. The model combines a specific gene expression for lung cancer as well as clinical risk factors.

What was found:
Studying current and former smokers undergoing bronchoscopies for suspicion of lung cancer, the researchers compared the likelihood of the subjects having lung cancer using the biomarker, the clinical risk factors, and a combination of the two, which created a clinicogenomic model. They found patients using the clinicogenomic model had increased sensitivity, specificity, positive value, and negative predictive value of their cancer compared to the other methods.

“Our data suggest that the clinicogenomic model might serve to identify patients who would benefit from further invasive testing, thereby expediting the diagnosis and treatment for their malignancy,” says Avrum Spira, a MED assistant professor of medicine and pathology. Spira is a pulmonary and critical care medicine physician at BMC and one of the founders of Allegro Diagnostics, Inc., a molecular diagnostics company that plans to market the gene expression biomarker.

Why it matters:
Lung cancer is the leading cause of cancer death in the United States and in the world, with more than one million deaths worldwide annually. Between 85 and 90 percent of subjects with lung cancer in the United States are current or former smokers; 10 to 20 percent of heavy smokers develop the disease.

Word to the wise:
A previous study by the same researchers reported a gene expression biomarker capable of distinguishing cytologically normal large airway epithelial cells from smokers with lung cancer and those who do not have lung cancer. However, the biomarker has limited sensitivity, depending on the stage and the location of the cancer.

What’s next:
According to the researchers, this prediction model could expedite more invasive testing and appropriate therapies for smokers with lung cancer, as well as reduce invasive diagnostic procedures for individuals who do not have lung cancer.

Where to find more:
These findings currently appear online in the March 31, 2008, issue of the journal Cancer Prevention Research.

Bad teeth pose heart disease risk in younger men

What’s up?
In a recent study, Goldman School of Dental Medicine researchers show that periodontal disease is a risk factor for coronary heart disease in men less than 60 years old, independent of established cardiovascular risk factors.

What was found:
Thomas Dietrich, an SDM associate professor in the department of health policy and health services research, says the team found that chronic periodontitis is associated with incidence of coronary heart disease among younger men, independent of established cardiovascular risk factors. The team evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident coronary heart disease (which includes angina, myocardial infarction, or fatal coronary heart disease) among 1,203 men in the VA Normative Aging and Dental Longitudinal Studies. The subjects were followed up with comprehensive medical and dental examinations every 3 years for up to 35 years.

A total of 364 men were diagnosed with coronary heart disease, and 109 men died from the disease. Researchers took into account factors including age, body mass index, smoking, alcohol intake, cholesterol, and blood pressure.

Why it matters:
“This is the first study to find a significant association between chronic periodontitis and the risk of coronary heart disease, even after adjusting for important confounding factors,” says Dietrich. Chronic periodontitis is a highly prevalent inflammatory disease of the periodontium and an important cause of tooth loss. After complete tooth loss, the risk for total and fatal coronary heart disease is elevated.

Word to the wise:
Several cohort studies found an association between chronic periodontitis and the risk of coronary heart disease, independent of a variety of potential confounders. However, other studies did not find significant associations after adjustments for important confounding factors. These inconsistencies have led to concerns and uncertainties about the validity of the periodontitis-coronary heart disease association and its strength.

Where to find more:
The research was published April 1 in Circulation, a publication of the American Heart Association.

Kimberly Cornuelle can be reached at kcornuel@bu.edu.