Prediction model for COVID-19 patient visits in the ambulatory setting.

Objective: Healthcare systems globally were shocked by coronavirus disease 2019 (COVID-19). Policies put in place to curb the tide of the pandemic resulted in a decrease of patient volumes throughout the ambulatory system. The future implications of COVID-19 in healthcare are still unknown, specifically the continued impact on the ambulatory landscape. The primary objective of this study is to accurately forecast the number of COVID-19 and non-COVID-19 weekly visits in primary care practices. Materials and Methods: This retrospective study was conducted in a single health system in Delaware. All patients' records were abstracted from our electronic health records system (EHR) from January 1, 2019 to July 25, 2020. Patient demographics and comorbidities were compared using t-tests, Chi square, and Mann Whitney U analyses as appropriate. ARIMA time series models were developed to provide an 8-week future forecast for two ambulatory practices (AmbP) and compare it to a naïve moving average approach. Results: Among the 271,530 patients considered during this study period, 4,195 patients (1.5%) were identified as COVID-19 patients. The best fitting ARIMA models for the two AmbP are as follows: AmbP1 COVID-19+ ARIMAX(4,0,1), AmbP1 nonCOVID-19 ARIMA(2,0,1), AmbP2 COVID-19+ ARIMAX(1,1,1), and AmbP2 nonCOVID-19 ARIMA(1,0,0). Discussion and Conclusion: Accurately predicting future patient volumes in the ambulatory setting is essential for resource planning and developing safety guidelines. Our findings show that a time series model that accounts for the number of positive COVID-19 patients delivers better performance than a moving average approach for predicting weekly ambulatory patient volumes in a short-term period.

Twenty-Year Observational Study Shows Rising Alcohol-Attributable Death Profiles in the U.S. and Delaware.

The U.S. alcohol-attributable mortality burden makes it the third-leading cause of preventable deaths. This 1999-2018 observational study used the Tenth Revision of the International Classification of Diseases codes and the alcohol-related disease impact (ARDI) causes of death records to track alcohol's mortality burden. The Centers for Disease Control and Prevention keeps Wide-Ranging Online Data for Epidemiologic Research (WONDER) death certificates for the U.S. community. Evidence indicates that the U.S. ARDI mortality rates progressively trended upward (53.73%). Men were three times as likely as women to die, but female mortality rate changes (90.03%) advanced more rapidly than males. The study also revealed that the changes in alcohol-related death rate percentages for middle-age groups increased faster. In contrast, the African American/Black (AA/B) community's age-adjusted mortality rate change patterns first declined and then increased. The alcohol-attributable mortality rate (1999 to 2018) difference for AA/B was -6.35%. Delaware's population is around one million, and about 23% is African American/Black. The subgroup analysis for Delaware's population was robust and showed alcohol-attributable mortality rates above national averages. This trend was apparent for both gender and race. In conclusion, for both the U.S. and Delaware, alcohol use disorder is a risk factor for mortality, especially for males.

Delaware's 1999-2017 Leading Causes of Death Information Illustrates Its Obesity and Obesity-Related Life-Limiting Disease Burdens.

Using commercially available but powerful big data analytics, this non-clinical obesity and underlying causes of death observational study, analyzed the very large US Centers for Disease Control and Prevention's (CDC) State of Obesity records, the CDC WONDER data, and the US census records. Compared to the 1999-to-2017 US obesity rate increase of 29.8%, an uncontrolled increase in Delaware's obesity rate (81.7%) was observed. During the same time period, CDC WONDER death certificate archives disclosed that there was a 60.53% surge in crude Delawarean mortality rate when obesity was listed as a single underlying cause of death. When any mention of obesity was documented on the death certificate, Delaware's 1999-2017 crude mortality rate advanced by 75.69% and its age-adjusted rate rose by 53.18%. Likewise, except for one year, Delaware's African American/Black population experienced higher crude mortality rate averages but however, between the years of 1997 and 2017, its Caucasian/White inhabitants had an enormous 87.34% death rate increase. With additional available CDC mortality data, Delaware males saw substantially larger age-adjusted death rate increases (79.87%) than their female counterparts (28.92%). Diabetes, circulatory system diseases, and neoplasms (cancer), are three common obesity comorbidities. For these three conditions, Delaware's 1999-2017 mortality rate figures mimic the falling national patterns of mortality rate averages, when each disease is listed as the single underlying cause of death, including observations where there are disproportionate numbers of cases that affect the African American/Black race.

1997-2017 Leading Causes of Death Information Due to Diabetes, Neoplasms, and Diseases of the Circulatory System, Issues Cautionary Weight-Related Lesson to the US Population at Large.

In the US, cardiovascular disease, cancer, and diabetes are in the top ten leading causes of death categories. The diseases compromise US life-expectancy and account for significant US health-care costs. This observational study investigates the US population's 1997-2017 Centers for Disease Control and Prevention (CDC) WONDER ICD-10 mortality records to extract the prevalence rates for leading causes of death by diabetes, neoplasms (cancers), and diseases of the circulatory system. The variables of race and age are examined for each disease in order to evaluate demographic and age-group risks. To document the public health burden from these three chronic conditions, mortality data from CDC WONDER was analyzed using MS-Excel and Statistical Analysis System (SAS) software. The general trend of deaths by diabetes, neoplasms, and diseases of the circulatory system has been progressively decreasing nationally; however, a significantly higher trend in mortality rates is observed for the Black or African American populations. Furthermore, over the 1997-2017 observational period, the crude mortality rates for the 45-54 (middle-age) and lower age-groups are below national mortality rate averages but are troublingly increasing for diabetes and notably, for the diseases of the circulatory system, the (younger) 25-34 age-group had a crude mortality rate increase of 6.78%.