Louisiana State University Hospital-Based Longitudinal Study (LSUHLS)

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• Louisiana State University Hospital-Based
  Longitudinal Study (LSUHLS)
• Gang Hu, MD, MPH, PhD, FAHA
• Pennington Biomedical Research Center

2

• 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.

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• 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.

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• General information of LSUHLS diabetic patients
  cohort (N104,428)
• Male (41.4) versus Female (58.6)
• - African (56.6), - White (39.7), - Asian
  (0.6), - Hispanic (1.3), - Other (1.8)

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

• - Creatinine, N91,602
• GFR, N 91,602
• Albumincreatinine, N76,150
• Urea Nitrogen, N82,201
• Albumin, N 76,154
• CRP, N5550
• other

• Lab measurements
• - HbA1C,N 65,651
• - Fasting G, N11,503
• - 2-h glucose, N 1196
• - random G, N 80,608
• - WBC, N 77,400
• - RBC, N 77,809
• Uric acid, N 9986

• - 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, N74,631
• GGT, N3276

Drug treatments (from 2008), - DM, N47,698 -
HBP, N47,698 - Statin, N47,698 - Other, N47,698
Smoking, N 54,063 Income, N 75,059 Insurance,
N104,428 BMI, N 51,082 BP, N 53,716
Mean follow-up 4.54 years
History of diseases

• 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

• 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, N105
• - Peripheral arterial disease, N 2189

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General information of LSUHLS - gestational women
cohort (N75,563)
GDM, N 3648
Mean value of age, 24.3 years
Race - African (64.9) - White (24.0) - Asian
(1.1) - Hispanic (3.2) - Other (6.8)

• - TC, N8,973
• - TG, N 8,716
• - HDL, N8,514
• LDL, N 8,528
• U-Creatinine, N40,218
• Urea Nitrogen, N32,611

Smoking, N 75,778 Income, N 17,932 Height,
N26,800 Weight, N27,900 BMI, N 26,749 BP, N
28,048

• Lab measurements
• - Fasting glucose, N3,393
• - 1-h glucose, N 2,469
• - 2-h glucose, N 2,458
• 3-h glucose, N 2,330
• HbA1C, N 4,225

Mean follow-up 8.5 years
History of diseases

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

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

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• 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.

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Sex-specific prevalence of diabetes in LSU
hospitals
Li W et al. Diabetes Res Clin Pract 2011
94262-8.
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Race/ethnicity-specific prevalence of diabetes in
LSU hospitals
Li W et al. Diabetes Res Clin Pract 2011
94262-8.
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Race/ethnicity-specific prevalence of GDM in LSU
hospitals
Wang Y et al. J Womens Health 201221319-25.
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Sex-specific prevalence of hypertension in LSU
hospitals
Zhang Y et al. Submitted manuscript.
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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
ESRD, End-stage Renal Disease.
Wang Y et al. Submitted manuscript.
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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.

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• LSU ICON Core Services utilized
• Medical Information Core Ron Horswells group
• Design Analysis Core Gang Hus 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.

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Racial disparities in the association of
gestational diabetes mellitus and risk of CVD-
Intramural Project 2

• The 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.

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• LSU ICON Core Services utilized
• Medical Information Core Ron Horswells group
• Design Analysis Core Gang Hus 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.

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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 lt7
• b) Blood pressure lt130/80 mm Hg
• c) LDL lt100 mg/dl
• d) Smoking cessation, etc.

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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

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Acknowledgement for these collaborators

• 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

• 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