Socioeconomic and Demographic Determinants of Readmission Rates in Congestive Heart Failure Patients: Insights From the Nationwide Readmissions Database.

Background Congestive heart failure (CHF) is a leading cause of hospitalizations and readmissions, placing a significant burden on the healthcare system. Identifying factors associated with readmission risk is crucial for developing targeted interventions and improving patient outcomes. This study aimed to investigate the impact of socioeconomic and demographic factors on 30-day and 90-day readmission rates in patients primarily admitted for CHF. Methods The study was carried out using a cross-sectional study design, and the data were obtained from the Nationwide Readmissions Database (NRD) from 2016 to 2020. Adult patients with a primary diagnosis of CHF were included. The primary outcomes were 30-day and 90-day all-cause readmission rates. Multivariable logistic regression was used to identify factors independently associated with readmissions, including race, ethnicity, insurance status, income level, and living arrangements. Results A total of 219,904 patients with a primary diagnosis of CHF were used in the study. The overall 30-day and 90-day readmission rates were 17.3% and 23.1%, respectively. In multivariable analysis, factors independently associated with higher 30-day readmission risk included Hispanic ethnicity (OR 1.18, 95% CI 1.03-1.35), African American race (OR 1.15, 95% CI 1.04-1.28), Medicare insurance (OR 1.24, 95% CI 1.12-1.38), and urban residence (OR 1.11, 95% CI 1.02-1.21). Higher income was associated with lower readmission risk (OR 0.87, 95% CI 0.79-0.96 for highest vs. lowest quartile). Similar patterns were observed for 90-day readmissions. Conclusion Socioeconomic and demographic factors, including race, ethnicity, insurance status, income level, and living arrangements, significantly impact 30-day and 90-day readmission rates in patients with CHF. These findings highlight the need for targeted interventions and policies that address social determinants of health and promote health equity in the management of CHF. Future research should focus on developing and evaluating culturally sensitive, community-based strategies to reduce readmissions and improve outcomes for high-risk CHF patients.

Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections.

INTRODUCTION: Alcoholic hepatitis (AH) is a serious complication of alcohol consumption with high morbidity and mortality, particularly in the United States where alcohol-related liver diseases rank as one of the leading causes of preventable death. Our study aims to analyze the morbidity and mortality of AH across racial groups and project hospitalization trends up to 2028, thereby informing public health initiatives. METHODS: We conducted a cross-sectional study utilizing data from the Nationwide Inpatient Sample (NIS) spanning 2012 to 2021. The study population comprised hospitalizations identified using specific ICD-9-CM and ICD-10-CM codes for AH. We assessed hospitalizations, in-hospital mortality rates, length of stay (LOS), and morbidities related to alcoholic hepatitis adjusting for sociodemographic factors and hospital characteristics. Statistical analyses were performed using Stata and R software, employing logistic and linear regression analyses, and SARIMA models for forecasting. RESULTS: Our results indicated a predominantly White cohort (68%), with a notable increase in AH hospitalizations among Hispanics (129.1% from 2012 to 2021). Racial disparities were observed in inpatient mortality, liver transplant accessibility, and the occurrence of in-hospital complications. The study forecasts a continued rise in hospitalizations across all racial groups, with Hispanics experiencing the sharpest increase. CONCLUSION: Our study reveals a disproportionate rise in the AH burden among Hispanics with projections indicating a persistent upward trend through 2028. These findings highlight the need for targeted public health strategies and improved healthcare access to mitigate the increasing AH burden and address disparities in care and outcomes.

Hospitalization of patients with nutritional anemia in the United States in 2020.

Background: Nutritional anemia is highly prevalent and has triggered a globally recognized public health concern worldwide. Objective: To better understand the prevalence of anemia and the state of nutritional health in developed countries to inform global nutritional health and better manage the disease. Method: We employed the Healthcare Cost and Utilization Project (HCUP)-2020 National Inpatient Health Care Data (NIS), administered by The Agency for Healthcare Research and Quality. Nutritional anemia was diagnosed according to the International Classification of Diseases, 10th Revision (ICD-10). Matching analysis and multivariate regression were used to adjust for patient and hospital characteristics. Controls were obtained by stratifying and matching for age and sex. Results: The 2020 HCUP-NIS database encompassed a survey over 6.4 million hospitalized patients, among which 1,745,350 patients diagnosed with anemia, representing approximately 26.97% of the hospitalized population, over 310,000 were diagnosed with nutritional anemia, and 13,150 patients were hospitalized for nutritional anemia as primary diagnosis. Hospitalization rate for nutritional anemia exhibited an increased age-dependent increase nationwide, especially among females, who displayed 1.87 times higher than males. Notably, in comparison to the control group, individuals of the Black race exhibit a higher prevalence of nutritional anemia (case group: 21.7%, control group: 13.0%, p < 0.001). In addition, hospitalization rates were higher among low-income populations, with lower rates of private insurance (case group: 18.7%, control group: 23.5%, p < 0.001) and higher rates of Medicaid insurance (case group: 15.4%, control group: 13.9%, p < 0.001). In areas characterized by larger urban centers and advanced economic conditions within the urban-rural distribution, there was an observed increase in the frequency of patient hospitalizations. Iron deficiency anemia emerged as the predominant subtype of nutritional anemia, accounting for 12,214 (92.88%). Secondary diagnosis among patients hospitalized for nutritional anemia revealed that a significant number faced concurrent major conditions like hypertension and renal failure. Conclusion: In economically prosperous areas, greater attention should be given to the health of low-income individuals and the older adult. Our findings hold valuable insights for shaping targeted public health policies to effectively address the prevalence and consequences of nutritional anemia based on a overall population health.

Debunking the July Effect in lung transplantation recipients.

Objective: The "July Effect" is a theory that the influx of trainees from July to September negatively impacts patient outcomes. We aimed to study this theoretical phenomenon in lung transplant recipients given the highly technical nature of thoracic procedures. Methods: Adult lung transplant hospitalizations were identified within the National Inpatient Sample (2005-2020). Recipients were categorized as academic Q1 (July to September) or Q2-Q4 (October to June). In-hospital mortality, operator-driven complications (pneumothorax, dehiscence including wound dehiscence, bronchial anastomosis, and others, and vocal cord/diaphragm paralysis, all 3 treated as a composite outcome), length of stay, and inflation-adjusted hospitalization charges were compared between both groups. Multivariable logistic regression was performed to assess the association between academic quarter and in-hospital mortality and operator-driven complications. The models were adjusted for recipient demographics and transplant characteristics. Subgroup analysis was performed between academic and nonacademic hospitals. Results: Of 30,788 lung transplants, 7838 occurred in Q1 and 22,950 occurred in Q2-Q4. Recipient demographic and clinical characteristics were similar between groups. Dehiscence (n = 922, 4% vs n = 236, 3%), post-transplant cardiac arrest (n = 532, 2% vs n = 113, 1%), and pulmonary embolism (n = 712, 3% vs n = 164, 2%) were more common in Q2-Q4 versus Q1 recipients (all P < .05). Other operator-driven complications, in-hospital mortality, and resource use were similar between groups (P > .05). These inferences remained unchanged in adjusted analyses and on subgroup analyses of academic versus nonacademic hospitals. Conclusions: The "July Effect" is not evident in US lung transplantation recipient outcomes during the transplant hospitalization. This suggests that current institutional monitoring systems for trainees across multiple specialties, including surgery, anesthesia, critical care, nursing, and others, are robust.

Bigger pies, bigger slices: Increased hospitalization costs for lung transplantation recipients in the non-donation service area allocation era.

OBJECTIVE: On November 24, 2017, lung transplant allocation switched from donation service area to a 250-nautical mile radius policy to improve equity in access to lung transplantation. Given the growing consideration of healthcare costs, we evaluated changes in hospitalization costs after this policy change. METHODS: Lung transplant hospitalizations were identified within the National Inpatient Sample from 2005 to 2020. Recipients were categorized as donation service area era (August 2015 to October 2017) or non-donation service area era (December 2017 to February 2020). Median total hospitalization costs (inflation adjusted) were compared by era nationally and regionally. Multivariable generalized linear regression was performed to determine if the removal of the donation service area was associated with total hospitalization costs. The model was adjusted for recipient demographics, Charlson Comorbidity Index, hospitalization region, transplant type (single, double), and use of extracorporeal membrane oxygenation, ex vivo lung perfusion, and mechanical ventilation. RESULTS: We analyzed 12,985 lung transplant recipients (median age of 61 years, 66% were male): 7070 in the donation service area era and 5915 in the non-donation service area era. Demographics were not different between recipients in both eras. Non-donation service area era recipients had greater extracorporeal membrane oxygenation use, mechanical ventilation (<24 hours), and longer length of stay than donation service area era recipients. Median total hospitalization costs for non-donation service area versus donation service area era recipients increased by $24,198 ($157,964 vs $182,162, percentage change = 15.32%, P < .001). Median costs increased in East North Central ($42,281) and Mountain ($35,521) regions (both P < .01). After adjustment, median costs for non-donation service area versus donation service area era recipients still increased ($19,168, 95% CI, 145-38,191, P = .048). CONCLUSIONS: Hospitalization costs for lung transplant hospitalizations have increased from 2015 to 2020. The transition from donation service area-based allocation to the non-donation service area system may have contributed to this increase after 2017 by increasing access to transplant for sicker recipients.

Prediction of In-Hospital Mortality Following Vertebral Fracture Fixation in Patients With Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis: Machine Learning Analysis.

BACKGROUND: Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are distinct pathological entities that similarly increase the risk of vertebral fractures. Such fractures can be clinically devastating and frequently portend significant neurological injury, thus making their prevention a critical focus. Of particular significance, spinal fractures in patients with AS or DISH carry a considerable risk of mortality, with reports on 1-year injury-related deaths ranging from 24% to 33%. As such, the purpose of this study was to conduct machine learning (ML) analysis to predict postoperative mortality in patients with AS or DISH using the Nationwide Inpatient Sample Healthcare Cost and Utilization Project (HCUP-NIS) database. METHODS: HCUP-NIS was queried to identify adult patients carrying a diagnosis of AS or DISH who were admitted for spinal fractures and underwent subsequent fusion or corpectomy between 2016 and 2018. Predictions of in-hospital mortality in this cohort were then generated by three independent ML algorithms. RESULTS: An in-hospital mortality rate of 5.40% was observed in our selected population, including a rate of 6.35% in patients with AS, 2.81% in patients with DISH, and 8.33% in patients with both diagnoses. Increasing age, hypertension with end-organ complications, spinal cord injury, and cervical spinal fractures each carried considerable predictive importance across the algorithms utilized in our analysis. Predictions were generated with an average area under the curve of 0.758. CONCLUSIONS: This study's application of ML algorithms to predict in-hospital mortality among patients with AS or DISH identified a number of clinical risk factors relevant to this outcome. CLINICAL RELEVANCE: These findings may serve to provide physicians with an awareness of risk factors for in-hospital mortality and, subsequently, guide management and shared decision-making among patients with AS or DISH.

Disparities in mortality among acute myeloid leukemia-related hospitalizations.

Racial and socioeconomic disparities have become apparent in acute myeloid leukemia (AML) outcomes. We conducted a retrospective cohort study of hospitalizations for adults with a diagnosis of AML from 2009 to 2018 in the Nationwide Inpatient Sample (NIS). We categorized patients' ages in groups of <60 years and ≥60 years and stratified them by reported race/ethnicity. Exposures of interest were patient sociodemographics, hospital characteristics, and Elixhauser-comorbidity Index. Outcome of interest was in-hospital death. Statistical analyses included survey logistic regression to generate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to quantify the independent associations between patient characteristics and mortality. Of 622,417 AML-related hospitalizations, 57.6% were in patients ≥60 years. The overall rate of in-hospital death was 9.4%. Compared to patients <60, older patients experienced a higher rate of in-hospital death. In both age groups and in all ethnicities, mortality decreased over time. Differences in mortality were observed based on gender, payer, hospital location, and teaching status. For hospitalizations in patients ≥60, NH-Black race was associated with inferior in-hospital death outcomes (OR 1.17; CI 1.08-1.28). Urban teaching hospitals were associated with a 38% increase (OR 1.38; CI 1.06-1.80) in inpatient mortality in patients <60 and a 15% decrease (OR 0.85; CI 0.77-0.95) in inpatient mortality in patients ≥60. Our results highlight the increased need to recognize the role of race/ethnicity and socioeconomic factors and their contribution to disparate outcomes in AML.

Trends in Inpatient Utilization of Head Computerized Tomography Scans in the United States: A Brief Cross-Sectional Study.

Background Although computed tomography (CT) has revolutionized the field of medicine due to its incredible diagnostic capabilities, the trends regarding the usage of CT scans, especially in the field of neuroscience, are not very clear. We aim to find the trends in the usage of inpatient head CT scans in the United States using a robust database.  Methods We queried the national inpatient usage of head CT scans in the United States from 1997 to 2014 using a robust national database. The trends in usage were analyzed based on age, gender, insurance types, and patients' income.  Results During the study period, we recorded a total of 5,309,329 head CT scans, of which 51% were female. The total number of head CT scans in the United States dropped significantly from 527,026 cases to 181,095 cases (p=0.000). The decrease was with a steep slope from 1997 to 2002, and since then the decreasing slope turned to a steady state. The decrease in head CT scans was significant in all age groups (p = 0.001), more significant in uninsured payers (-79.4%, p=0.000), and prominent in low-income patients (-70.5 %, p=0.000). Conclusions Our study showed that national inpatient usage of CT scans of the head significantly decreased during the past two decades. This decrease is presumably multifactorial: reducing the number of unnecessary radiations, increased appropriateness audits by the government, payers' payment reductions, and integrated electronic platforms.

Violence against pregnant women and adverse maternal/ fetal outcomes in the United States: racial/ethnic disparities.

Violence against women is relatively common, and violence during pregnancy is of special concern due to potential risk of maternal and neonatal complications. Previous studies using diagnostic codes to determine prevalence and health outcomes of violence against women used ICD-9 data and lack a standard of consistency. Data from the 2002 to 2018 National Inpatient Sample (NIS) was used to analyze pregnancy-related hospitalizations of women aged 15-49 years. International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) was utilized in the NIS until the third quarter of 2015, after which it transitioned to ICD-10-CM format. The exposure was violence against women whereas outcomes included preterm birth, intrauterine fetal demise, miscarriage, fetal growth restriction, hypertensive disorders of pregnancy, and gestational diabetes. Temporal trends analyses were performed using Joinpoint regression technique and adjusted survey logistic regression models were conducted to examine the association between exposure and outcomes. Certain sociodemographic characteristics including age 35-49 (2.88/1,000 hospitalizations), non-Hispanic White (2.66/1,000) and non-Hispanic Black (2.61/1,000) racial/ethnic groups, and lowest quartile income (2.91/1,000) were associated with higher prevalence of violence. There was an overall increase in hospitalizations over the study period, the most significant being among non-Hispanic White patients (AAPC 18 percent, 95 percent CI = 10.3, 26.3). When compared to those with no exposure, individuals of all ethnic groups exposed to violence had increased risk of all adverse maternal/fetal outcomes. Higher prevalence of violence was associated with certain sociodemographic characteristics. Disparities in maternal/fetal adverse outcome risk were noted between ethnic groups. Additional studies are needed to ensure accuracy of violence data using diagnostic codes.

National Trends in Hospitalization, Surgical Resection, and Comorbidities in Pediatric Inflammatory Bowel Disease in the United States, 2002-2015.

Background and Objective: Therapeutic options for pediatric inflammatory bowel disease (PIBD) have dramatically changed over the last 20 years. However, the impact of modern medical management on PIBD outcomes remains unclear. We aimed to fill this gap in the literature by using a large, validated, national database, to study the change in hospitalization rates, surgical rates, and postoperative complications in PIBD over the last decade. Methods: The National Inpatient Sample (NIS) Database and ICD-9-CM codes were utilized to identify inpatient admissions with a primary or secondary diagnosis of pediatric Crohn's disease (CD) or ulcerative colitis (UC) from 2002-2015. Trends in hospitalizations, comorbidities (including malnutrition and weight loss), surgical procedures, and postoperative complications were examined using joinpoint regression analysis, a statistical modeling approach to evaluate the extent to which the rate of a condition changes over time. Results: There were 119,282 admissions for PIBD during the study period. The annual incidence of hospitalization increased significantly over time for both CD (average annual percent change [AAPC] 6.0%) and UC (AAPC 7.2%). The rate of intestinal resection decreased in CD patients (AAPC -6.4%) while postoperative complications remained unchanged. However, comorbidities increased significantly in CD patients (AAPC 6.8%). For pediatric UC patients, postoperative complications (AAPC 6.7%), and comorbidities (AAPC 10.2%) increased significantly over time while intestinal resection rates remained stable. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Conclusion and Global Health Implications: Annual incidence of hospitalization and comorbidities continue to increase in PIBD. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Our findings emphasize the critical need for prevention and novel therapeutic options for this vulnerable patient population.

Assessment of hospitalization rates, factors associated with hospitalization and in-patient mortality in pediatric patients with cystic fibrosis.

INTRODUCTION: Cystic fibrosis (CF), an inherited autosomal recessive disease that results in the accumulation of mucus and damage primarily to the respiratory and digestive tracts is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. In the United States, it has been estimated that CF occurs in 1 out of 3500 infants. The objective of this study was to explore the patient and hospital characteristics associated with CF hospitalizations and inpatient mortality in pediatric CF patients. METHODS: Utilizing the National Inpatient Sample database from 2008 to 2017, a retrospective cohort study was conducted to analyze the hospitalization rates, associated factors, and the inpatient mortality of CF patients 0-17 years of age. Hospitalizations with a diagnosis of CF were identified with ICD-9-CM and ICD-10-CM codes. Adjusted survey logistic regression models were utilized to determine factors associated with CF hospitalizations and in-hospital deaths in CF patients. RESULTS: There were a total of 98,660 (about 0.2%) CF hospitalizations in patients 17 years of age or younger during the study period. Non-Hispanic (NH) White CF patients had the highest prevalence of CF (26.30 per 10,000 hospitalizations). The prevalence of inpatient deaths were highest among those identified as NH-Others and NH-Blacks (71.35 and 68.83 per 10,000 CF hospitalizations, respectively. When compared with NH-White category, those belonging to NH-Black, Hispanic and Other racial/ethnic sub-group had reduced odds of being hospitalized with CF. DISCUSSION: Despite our finding of an increased likelihood of being hospitalized for CF among NH-White and male pediatric patients, no association between race or sex and CF inpatient death was observed when adjusted for covariates. More research is needed to determine the impact of sex and race on CF mortality rates.

Risk Factors, Trends, and Preventive Measures for 30-Day Unplanned Diabetic Ketoacidosis Readmissions in the Pediatric Population.

Background There has been a steady rise in types 1 and 2 diabetes mellitus among the youth in the USA from 2001 to 2017. Diabetic ketoacidosis (DKA) is a common and preventable presentation of both types of diabetes mellitus. According to the Centers for Disease Control and Prevention's (CDC) United States Diabetes Surveillance System, during 2004-2019 an increase in DKA hospitalization rates by 59.4% was noted, with people aged less than 45 years having the highest rates. Readmissions reflect the quality of disease management, which is integrally tied to care coordination and communication with the patient and their families. This study analyzes the trends and risk factors contributing to 30-day unplanned DKA readmissions in the pediatric age group and looks into possible preventive measures to decrease them. Methods A retrospective study was performed using the National Readmission Database (NRD) from January 1, 2017, to December 1, 2017. Pediatric patients aged 18 years and younger with the primary diagnosis of DKA were included using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code E10.10. All statistical analysis was performed using IBM SPSS Statistics for Windows, version 1.0.0.1327 (IBM Corp., Armonk, NY, USA). Pearson's chi-square test was used for categorical variables and Mann-Whitney U test was used for continuous variables. To independently determine the predictors of readmission within each clinical variable, multiple logistic regressions with values presented as odds ratios (OR) with 95% confidence intervals (CI) were performed. Results A weighted total of 19,519 DKA-related pediatric index admissions were identified from the 2017 NRD. Of these pediatric patients, 831 (4.3%) had 30-day DKA readmission. The median age of a child for readmission was 16 years with an interquartile range of 0 to 18 years. A sharp rise in 30-day DKA readmissions was noted for ages 16 years and over. Females in the 0-25th percentile median household income category, with Medicaid covered, large metropolitan areas with at least 1 million residents, and metropolitan teaching hospitals were found to have a statistically significant higher percentage of readmissions. The mean length of stay for those who had a DKA readmission was 2.06 days, with a standard deviation of 1.84 days. The mean hospital charges for those who had a DKA readmission were $ 20,339.70. The 30-day DKA readmission odds were seen to be increased for female patients, Medicaid-insured patients, admissions at metropolitan non-teaching hospitals, and children from 0-25th percentile median household income category. Conclusion There has not been much of a change in the trend and risk factors contributing to the 30-day unplanned DKA readmissions over the years despite the steady rise in cases of diabetes mellitus. The length of stay for those who did not get readmitted within 30 days was longer than for those who did. This could reflect more comprehensive care and discharge planning that may have prevented them from readmission. Diabetes mellitus is a chronic disease that demands a team effort from the patient, family, healthcare personnel, insurance companies, and lawmakers. There is scope for a lot of improvement with the way our patients are being managed, and a more holistic approach needs to be devised.

Trends and Risk Factors for Leishmaniasis among Reproductive Aged Women in the United States.

BACKGROUND AND OBJECTIVE: Leishmaniasis, a neglected tropical disease, is endemic in several regions globally, but commonly regarded as a disease of travelers in the United States (US). The literature on leishmaniasis among hospitalized women in the US is very limited. The aim of this study was to explore trends and risk factors for leishmaniasis among hospitalized women of reproductive age within the US. METHODS: We analyzed hospital admissions data from the 2002-2017 Nationwide Inpatient Sample among women aged 15-49 years. We conducted descriptive statistics and bivariate analyses for factors associated with leishmaniasis. Utilizing logistic regression, we assessed the association between sociodemographic and hospital characteristics with leishmaniasis disease among hospitalized women of reproductive age in the US. Joinpoint regression was used to examine trends over time. RESULTS: We analyzed 131,529,239 hospitalizations; among these, 207 cases of leishmaniasis hospitalizations were identified, equivalent to an overall prevalence of 1.57 cases per million during the study period. The prevalence of leishmaniasis was greatest among older women of reproductive age (35-49 years), Hispanics, those with Medicare, and inpatient stay in large teaching hospitals in the Northeast of the US. Hispanic women experienced a statistically significant increased odds of leishmaniasis diagnosis (OR, 1.80; 95% CI, 1.19-4.06), compared to Non-Hispanic (NH) White women. Medicaid and Private Insurance appeared to serve as a protective factor in both unadjusted and adjusted models. We did not observe a statistically significant change in leishmaniasis rates over the study period. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Although the prevalence of leishmaniasis among women of reproductive age appears to be low in the US, some risk remains. Thus, appropriate educational, public health and policy initiatives are needed to increase clinical awareness and timely diagnosis/treatment of the disease.

Further evidence that endometriosis is related to tubal and ovarian cancers: A study of 271,444 inpatient women.

OBJECTIVE: To evaluate associations between endometriosis and tubal and ovarian cancers in a large population-based study. METHODS: The Health Care Cost and Utilization Project - National Inpatient Sample databases from 2005 to 2014 were used in this study. Data on patients with a diagnosis of tubal or ovarian cancer and endometriosis (overall and subtypes including adenomyosis and pelvic endometriosis) using International Classification of Diseases, Ninth Edition, Clinical Modification codes were extracted. Logistic regression analysis was performed to evaluate associations between tubal and ovarian cancers and endometriosis. Adjustment was made for age, race, median income level, payment plan, hospital location and obesity. RESULTS: Of 38,800,139 women aged >18 years who were hospitalized between 2005 and 2014, 271,444 women with adenomyosis and/or pelvic endometriosis, 4289 women with tubal cancer and 133,253 women with ovarian cancer were identified. The rate of tubal cancer was three-fold higher in women with endometriosis compared with women without endometriosis (0.03 % vs 0.01 %). The odds ratio (OR) adjusted for age, race, obesity, income and insurance type was 4.02 [95 % confidence interval (CI) 3.17-5.11; p < 0.01]. The rate of tubal cancer was higher in women with adenomyosis (0.04 % vs 0.01 %; adjusted OR 4.88, 95 % CI 3.66-6.50; p < 0.01) and women with pelvic endometriosis (0.02 % vs 0.01 %; adjusted OR 2.80, 95 % CI 1.84-4.27; p < 0.01) compared with women without these conditions. Similar associations were found between ovarian cancer and pelvic endometriosis and ovarian cancer and adenomyosis. CONCLUSION: Both pelvic endometriosis and adenomyosis are strongly associated with tubal and ovarian cancers.

Hospitalization outcomes and racial disparities in cervical cancer patients: An analysis of the national inpatient sample data from 2002 to 2014.

BACKGROUND: Little is known about outcomes in patients after being hospitalized for care of cancer or comorbid conditions and the disparity between African-American and White cervical cancer patients. METHODS: Using the national inpatient sample (HCUP-NIS) database of the Healthcare Cost and Utilization Project between 2002-2014, we included 5217 African-American and 21,752 White patients hospitalized with a primary diagnosis of cervical cancer. We examined racial differences in hospitalization outcomes; length of stay (LOS) in hospital, mortality in hospital, post-operative complications in patients who underwent hysterectomy and discharge disposition. Patients were matched on age at primary diagnosis, insurance status, residential region, and median income of residential area, modified Deyo comorbidity index, stage of disease and treatment. Categorical outcomes were analyzed by conditional logistic regression accounting for matched study design and odds ratios (95%CI) were reported. LOS was analyzed using t-test and beta estimate for difference in means was reported. RESULTS: The LOS was significantly lower for Whites compared to African-American cervical cancer patients when matched on demographic only (ß=-0.41, p-value<0.0005, presentation + demographic (ß=-0.41, p-value<0.0006) and treatment + presentation + demographic variables (ß=-0.46, p-value<0.0001). White cervical cancer patients were commonly discharged to other intermediate nursing facility (OR = 1.30, 95%CI = 1.20-1.41, matched on demographic only; OR = 1.31, 95%CI = 1.21-1.43, matched on presentation + demographic; and OR = 1.32, 95%CI = 1.22-1.43), matched on treatment + presentation + demographic). Similar trends were seen in both older (≥65 years) and younger (<65 years) patients, when stratified by age. CONCLUSION: Disparities in hospitalization outcomes in cervical patients are not observed when different characteristics of African-American and White cervical patients are accounted for and matched.

Outcomes associated with Clostridium difficile infection in patients with chronic liver disease.

Patients with chronic liver disease (CLD) have frequent exposure to Clostridium difficile infection (CDI) risk factors but the incidence and aetiology of CDI on this population is poorly understood. The aim of this study was to assess the incidence, disease presentation and outcomes of CDI in patients with underlying CLD. The Health Care and Utilization Project National Inpatient Sample (HCUP-NIS) 2009 dataset was used to identify patients with CLD who developed CDI along with matched non-CLD patients with CDI. Using the NIS dataset, the incidence rate of CDI was 189.4/10 000 discharges in CLD patients vs. 83.7/10 000 discharges in the non-CLD matched cohort (P < 0.001). Compared with non-CLD, comorbidity-matched controls with CDI, CLD patients with CDI had higher likelihood of in-hospital mortality (8.8% vs. 18.6%, P < 0.001), increased length of stay by 1.19 days (P < 0.001) and increased total costs by $8632 (P < 0.001). In separate analyses using a tertiary case database of hospitalised patients in Houston, Texas (2006-2016) with CLD and CDI (n = 41) compared with patients with CDI but not CLD (n = 111), CLD patients had significantly higher Charlson comorbidity index (P < 0.0001) but similar risk factors for CDI and CDI-related disease presentation compared with non-CLD patients. In conclusion, CDI-related risk factors were almost universally present in the CLD population. CDI resulted in worse outcomes in this population.

Healthcare Data Analytics for Parkinson's Disease Patients: A Study of Hospital Cost and Utilization in the United States.

Parkinson's Disease (PD), a prevalent problem, especially for the aged populations, is a progressive but non-fatal nervous system disorder. PD patients have special motor as well as non-motor symptoms over time. There are several limitations in the study of PD such as unavailability of data, proper diagnosis and treatment methods. These limitations significantly reduce the quality of PD patient life quality, either directly or indirectly. PD also imposes great financial burdens to PD patients and their family. This project aims to analyze the most common reasons for PD patient hospitalization, review complications that occur during inpatient stays, and measure the costs associated with PD patient characteristics. Using the HCUP NIS data, comprehensive data analysis has been performed. The results are customized visualized using Tableau and other software systems. The preliminary findings sheds light into how to improve the life quality of PD patients.

Incidence and lifetime costs of injuries in the United States.

BACKGROUND: Standardized methodologies for assessing economic burden of injury at the national or international level do not exist. OBJECTIVE: To measure national incidence, medical costs, and productivity losses of medically treated injuries using the most recent data available in the United States, as a case study for similarly developed countries undertaking economic burden analyses. METHOD: The authors combined several data sets to estimate the incidence of fatal and non-fatal injuries in 2000. They computed unit medical and productivity costs and multiplied these costs by corresponding incidence estimates to yield total lifetime costs of injuries occurring in 2000. MAIN OUTCOME MEASURES: Incidence, medical costs, productivity losses, and total costs for injuries stratified by age group, sex, and mechanism. RESULTS: More than 50 million Americans experienced a medically treated injury in 2000, resulting in lifetime costs of $406 billion; $80 billion for medical treatment and $326 billion for lost productivity. Males had a 20% higher rate of injury than females. Injuries resulting from falls or being struck by/against an object accounted for more than 44% of injuries. The rate of medically treated injuries declined by 15% from 1985 to 2000 in the US. For those aged 0-44, the incidence rate of injuries declined by more than 20%; while persons aged 75 and older experienced a 20% increase. CONCLUSIONS: These national burden estimates provide unequivocal evidence of the large health and financial burden of injuries. This study can serve as a template for other countries or be used in intercountry comparisons.

Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009.

AIM: To examine temporal trends in the epidemiology and outcomes of in-hospital cardiopulmonary resuscitation (CPR) recipients at a population level. METHODS: Retrospective analysis of temporal trends in CPR incidence, survival to discharge, discharge disposition, hospital length of stay, and cost of hospitalization for CPR recipients (age ≥ 18 years) captured in the Nationwide Inpatient Sample (2000-2009) in the United States. RESULTS: Between years 2000 and 2009, CPR incidence increased by 33.7%, from 1 case per 453 to 1 case per 339 hospitalized patients (annual percentage increase: 4.3%, 95% CI: 3.4-5.2%, p<0.001). Compared to CPR recipients in years 2000-2001, those in 2008-2009 were more often younger (age<65 years: 33.4% vs. 40.0%), non-white (29.3% vs. 36.4%), and higher comorbidity scores (score ≥ 4: 22.2% vs. 27.1%) (all p<0.001). Rates of neurologic compromise, mechanical ventilator, and feeding tube use increased by 37.7, 28.2, and 58.5%, respectively (all p<0.001). Adjusted rate of survival to discharge increased by 41.3% (20.6-29.1%, p<0.001). Compared to survivors in 2000, those discharged in 2009 were more often discharged to hospice (0.4% vs. 7.1%, p<0.001); a 35% decrease in discharge to home was noted (36.4% vs. 23.8%, p<0.001). Mean cost of hospitalization per day increased for both survivors ($2742-$3462, p=0.006) and decedents ($3159-$4212, p<0.001). CONCLUSIONS: The rate of in-hospital CPR in the U.S. increased, and CPR recipients have become younger and sicker over time. Survival to discharge has improved by 41.3%. Functional outcomes after in-hospital CPR appear to have worsened, with considerable clinical and economic implications.