Beyond Healing: Embracing the Triple Bottom Line Approach in Post-pandemic Healthcare.

A triple bottom line (TBL) encompasses economic, social, and environmental dimensions, which provides a strategy for transforming contemporary healthcare systems. This study contextualized current TBL developments in healthcare under the spotlight of COVID-19 pandemic-related challenges and opportunities. The paper has five sections, including an introductory section that outlines the TBL concept and its relevance to healthcare. Following this, we provide an overview of the three pillars of the TBL, including its economic, social, and environmental dimensions as they relate to healthcare. This section also includes several case studies to illustrate TBL-based practices in diverse healthcare settings, focusing on how these were implemented and the outcomes and barriers to adopting such practices. In addition to showcasing current TBL practices, we review three significant challenges to TBL and highlight potential areas for future research, such as innovative practices, educational reform, and the need for the development of robust TBL metrics. The overarching conclusion is that the TBL provides a profound approach to conceptualizing contemporary healthcare to meet the urgent requirements for a more resilient, equitable, and environmentally responsible healthcare system.

Trends in Adolescent Suicide by Method in the US, 1999-2020.

Importance: Adolescent suicide in the US is a major public health problem, yet temporal trends in suicide methods by demographics are understudied. Objective: To examine national trends in suicide mortality by method (firearm, poisoning, hanging and asphyxiation, and all other means) from 1999 to 2020 by demographic characteristics. Design, Setting, and Participants: This serial cross-sectional study used national death certificate data of adolescent (aged 10-19 years) suicide decedents compiled by the National Center for Health Statistics from January 1, 1999, to December 31, 2020. Data analysis was performed from April 1, 2023, to July 9, 2023. Exposures: Age, sex, and race and ethnicity. Main Outcomes and Measures: Trends in age-standardized mortality rates and average annual percent change (AAPC) in rates were estimated by age, sex, and race and ethnicity for each suicide method. Results: This study assessed data from 47 217 adolescent suicide decedents. From 1999 to 2020, suicide by firearm (AAPC, 1.0; 95% CI, 0.1-1.9), poisoning (AAPC, 2.7; 95% CI, 1.0-4.4), hanging and asphyxiation (AAPC, 2.4; 95% CI, 0.2-4.6), and other means (AAPC, 2.9; 95% CI, 1.2-4.6) increased. Rapidly increasing rates were observed among female adolescents for poisoning (AAPC, 4.5; 95% CI, 2.3-6.7) and hanging and asphyxiation (AAPC, 5.9; 95% CI, 5.0-6.8) suicides. From 2007 to 2020, firearm suicides sharply increased among female (annual percent change [APC], 7.8; 95% CI, 6.0-9.5) and male (APC, 5.3; 95% CI, 4.3-6.3) adolescents. Firearm suicide rates increased among Black adolescents from 2012 to 2020 (APC, 14.5; 95% CI, 9.7-19.5), Asian and Pacific Islander adolescents from 2008 to 2020 (APC, 12.0; 95% CI, 9.7-14.5), American Indian and Alaska Native adolescents from 2014 to 2020 (APC, 10.6; 95% CI, 2.6-19.3), and Hispanic or Latino adolescents from 2011 to 2020 (APC, 10.2; 95% CI, 6.3-13.8). During the study period, Black adolescents had the highest average increase in hanging and asphyxiation suicides (AAPC, 4.2; 95% CI, 3.2-5.2). From 2011 to 2020, poisoning suicide deaths increased (APC, 12.6; 95% CI, 8.5-16.7) among female adolescents. Conclusions and Relevance: Suicide rates increased across all methods from 1999 to 2020. Differences were noted by sex, age, and race and ethnicity. Increasing suicide rates among racial and ethnic minoritized youth are especially concerning, and effective prevention strategies are urgently needed.

Influence of biopsychosocial factors on self-reported anxiety/depression symptoms among first-generation immigrant population in the U.S.

BACKGROUND: Despite increasing studies on mental health among immigrants, there are limited studies using nationally representative samples to examine immigrants' mental health and its potential biopsychosocial contributing factors, especially during the COVID-19 pandemic. We explored and estimated the influence of life satisfaction, social/emotional support, and other biopsychosocial factors on self-reported anxiety/depression symptoms among a nationally representative sample of first-generation immigrants in the U.S. METHODS: We conducted a secondary data analysis using the 2021 National Health Interview Survey among first-generation adults aged ≥ 18 years (n = 4295). We applied survey weights and developed multivariable logistic regression model to evaluate the study objective. RESULTS: The prevalence of daily, weekly, or monthly anxiety/depression symptoms was 10.22% in the first-generation immigrant population. There were 2.04% daily, 3.27% weekly, and 4.91% monthly anxiety/depression among the population: about 8.20%, 9.94%, and 9.60% experienced anxiety symptoms, whereas 2.49%, 3.54%, and 5.34% experienced depression symptoms daily, weekly, and monthly, respectively. The first-generation population aged 26-49 years were less likely to experience anxiety/depression daily, weekly, or monthly compared to those aged 18-25. Females (versus males) were more likely to experience anxiety/depression daily, weekly, or monthly. Those who identified as gay/lesbian had higher odds of experiencing anxiety/depression daily, weekly, or monthly compared to heterosexual persons. Relative to non-Hispanic White individuals, non-Hispanic Asian, Black/African American, and Hispanic individuals had lower odds, while other/multi-racial/ethnic groups were more likely to experience anxiety/depression daily, weekly, or monthly. A higher life satisfaction score was associated with lower odds of experiencing anxiety/depression daily, weekly, or monthly. Having social/emotional support sometimes/rarely or using healthcare within the past one/two years was associated with experiencing anxiety/depression daily, weekly, or monthly. CONCLUSIONS: The findings reveal significant burden of anxiety and depression among first-generation population in the U.S., with higher risks among subgroups like young adults, females, sexual minorities, and non-Hispanic White and other/multi-racial individuals. Additionally, individuals with lower life satisfaction scores, limited social/emotional support, or healthcare utilization in the past one or two years present increased risk. These findings highlight the need for personalized mental health screening and interventions for first-generation individuals in the U.S. based on their diversity and health-related risks.

Socioeconomic and clinical risk factors associated with moderate intensity physical activity before and during the COVID-19 pandemic.

Although moderate intensity physical activity (MIPA) improves general mental health, morbidity, and mortality, the COVID-19 pandemic may have adversely impacted individuals' ability to engage in MIPA. We examined the extent of socioeconomic factors, body mass index, anxiety/depression, and cancer diagnosis associated with MIPA before and during the COVID-19 pandemic. Multivariable logistic regression models were conducted on 4,551 U.S. adults aged 18-64 years using nationally representative samples from the 2019 and 2020 Health Information National Trends Survey datasets. The prevalence of MIPA before the pandemic was higher (77.07%) than during the pandemic (76.21%). Before the COVID-19 pandemic, lower odds of MIPA were observed for individuals with fair/poor health (OR = 0.24, 95% CI = 0.27, 0.63), obesity (OR = 0.51, 95% CI = 0.33, 0.79), anxiety/depression (OR = 0.60, 95% CI = 0.42, 0.85), or a cancer diagnosis (OR = 0.56, 95% CI = 0.32, 0.98). During the pandemic, lower odds were observed among those with obesity (OR = 0.44, 95% CI = 0.28, 0.70), anxiety/depression (OR = 0.61, 95% CI = 0.43, 0.86), less than high school education (OR = 0.33, 95% CI = 0.16, 0.70), or family income of $20,000 - $34,999 (OR = 0.42, 95% CI = 0.24, 0.74). There was a decline in MIPA during the pandemic, with certain subgroups, such as individuals of lower socioeconomic and physical and mental health status, less likely to engage in MIPA. This study highlights the need for concerted physical activity educational strategies aimed at improving access to and utilization of MIPA within subgroups to reduce MIPA disparities, particularly among disadvantaged groups during pandemics.

Immigration status-related exclusive e-cigarette use and cannabis use and their dual use disparities associated with mental health disorder symptoms.

INTRODUCTION: E-cigarette and cannabis use has been linked to various health risks, including respiratory and cardiovascular conditions. Yet, extant knowledge about the risk factors for exclusive and dual use of e-cigarettes and cannabis is limited, especially among immigrants. We examined exclusive e-cigarette and cannabis use and their dual use associated with mental health disorders among immigrants and U.S.-born. METHODS: We analyzed national cross-sectional data collected between May 13, 2021, and January 9, 2022, among adults aged >18 years (n= 4766) living in U.S. Multinomial logistic regression analyses were conducted to model the associations of exclusivity and dual-use (reference group= non-use) with anxiety/depression. RESULTS: The dual-use prevalence was higher than exclusive e-cigarette and cannabis use, especially among U.S.-born (dual use= 14.79% vs. cannabis use= 13.53% vs. e-cigarette use= 7.11%) compared to immigrants (dual use= 8.23% vs. cannabis use= 5.03% vs. e-cigarette use= 6.31%). Immigrants had lower risks of exclusive cannabis and dual use compared to U.S.-born. Anxiety/depression was associated with higher risks of exclusive cannabis use and dual use across immigration status, but was associated with exclusive e-cigarette use among only immigrants. While effect sizes of dual-use associated with anxiety/depression were higher among U.S.-born, the effect sizes of exclusive e-cigarette and cannabis use associated with anxiety/depression were higher among immigrants. CONCLUSIONS: The findings revealed significant mental health risks for e-cigarette, cannabis, and their dual use among immigrants and U.S.-born, especially among U.S.-born. These findings highlight the need for public health research and interventions to consider immigration status-related disparities in substance use.

Associations of depression with hypertension and citizenship among U.S. adults: A cross-sectional study of the interactions of hypertension and citizenship.

With the increasing prevalence of hypertension-related cardiovascular deaths and depression, this study examined the associations of depression with hypertension, citizenship status, and interaction of hypertension and citizenship status among U.S. adults. Data from the 2015-2018 National Health Interview Survey (NHIS), including 63,985 individuals, were analyzed. Depression status was the outcome, with hypertension and U.S. citizenship status as the main independent variables. Using odds ratio (OR) estimates, we evaluated the associations between hypertension and depression, and citizenship status. The result indicates that a higher proportion of U.S. adults with hypertension reported depression compared to those who did not have hypertension (42.9 % vs. 37.5 %). In terms of U.S. citizenship status, a higher proportion of U.S. citizens reported depression than non-citizens (39.6 % vs. 31.6 %). However, non-citizens with hypertension were more likely to report depression compared to U.S. citizens without hypertension (OR = 1.46; 95 % CI = 1.15, 1.86). While hypertension marginally increased the odds of depression among the general U.S. population, being a non-U.S. citizen with hypertension significantly increased the risk of depression by 46 %. The findings imply that the healthy immigrant paradox, in the context of hypertension-depression prevention and control, may not apply to non-citizens with hypertension. We therefore recommend community-based screenings and more tailored interventions to address these health disparities while taking into consideration the unique cultural norms, behaviors and healthcare barriers encountered by specific immigrant communities.

Assessment of prenatal depression among U.S. pregnant women without access to paid sick leave and regular place of care: National Health Interview Survey of U.S.-born and non-U.S.-born.

Prenatal depression is one of the most common risks during pregnancy. This study examined the prevalence and likelihood of prenatal depression association with sociodemographic factors, paid sick leave, and place of care among U.S. pregnant women. We conducted bivariate Chi-square tests to assess the statistical difference and multivariable logistic regression models to assess the association of prenatal depression using the National Health Interview Survey, cross-sectional data from 2010 to 2019 of pregnant women aged 18-44 years (N = 957). The prevalence of prenatal depression was 40.6%, 28.5%, and 27.2% among White, Black, and other racial pregnant women, respectively. Pregnant women with no regular/routine place of care had a prenatal depression prevalence rate of 58.1%, and those without access to paid sick leave had 46.9%. Also, pregnant women without access to paid sick leave were found to have an increased likelihood of reporting prenatal depression ([adjusted odds ratio] AOR = 2.50, 95% CI = 1.72-3.64), as well as those without a regular place of care (AOR = 2.43, 95% CI = 1.32-4.47). The findings identify factors that need to be addressed to minimize depression among U.S. pregnant women and establish the need for tailored interventions to address prenatal depression.

Associations between the Self-Reported Likelihood of Receiving the COVID-19 Vaccine, Likelihood of Contracting COVID-19, Discrimination, and Anxiety/Depression by Sexual Orientation.

There is limited evolving literature on COVID-19 vaccine uptake and its barriers among sexual minority populations (lesbian, gay, bisexual, transgender, and queer [LGBTQ]), despite their increased COVID-19 risk factors. We assessed the differences in intention to receive the COVID-19 vaccine by self-reported likelihood of contracting COVID-19, anxiety/depression, discrimination frequency, social distancing stress, and sociodemographic factors across sexual orientation. An online national cross-sectional survey was conducted in the United States between 13 May 2021, and 9 January 2022, among adults aged ≥18 (n = 5404). Sexual minority individuals had a lower intention of receiving the COVID-19 vaccine (65.62%) than heterosexual individuals (67.56%). Disaggregation by sexual orientation, however, showed that gay participants had a higher intention of COVID-19 vaccination (80.41%) and lesbian (62.63%), bisexual (64.08%), and non-heterosexual, non-LGB sexual minority (56.34%) respondents had lower intentions of receiving the COVID-19 vaccine than heterosexual respondents. Sexual orientation significantly moderated the association between the perceived likelihood of receiving the COVID-19 vaccine and the self-reported likelihood of contracting COVID-19, anxiety/depression symptoms, and discrimination. Our findings further underline the importance of improving vaccination efforts and access among sexual minority individuals and other vulnerable groups.

Association between COVID-19 pandemic declaration and depression/anxiety among U.S. adults.

BACKGROUND: Although studies have investigated the impact of the COVID-19 on mental health, few studies have attempted to compare the prevalence of depression/anxiety symptoms among U.S. adults before and after the COVID-19 pandemic declaration. We examined the prevalence and association between depression/anxiety symptoms and COVID-19 pandemic declaration among U.S. adult population and subgroups. METHODS: A nationally representative cross-sectional study of the Health Information National Trends Survey (HINTS 5, Cycle 4) assessing health-related information and behaviors in U.S. adults aged ≥18 years from February through June 2020. The primary dependent variable was current depression/anxiety derived from Patient Health Questionnaire-4. The main independent variable was responses before and after the COVID-19 pandemic declaration in addition to sexual identity heterosexual identity, /race/ethnicity and rural-urban commuting areas. Covariates were sociodemographic factors, and health risk behaviors. Weighted percentages, multivariable logistic regression, and Chi-square tests were used to establish the prevalence and association between current depression/anxiety and the independent variables and covariates. RESULTS: A total of 3,865 participants completed the survey and included 35.3% of the participants before the COVID-19 pandemic declaration. Most of the sample were aged 50-64 years [33.0%]; males [51.0%]; and non-Hispanic Whites [70.1%]). The post-pandemic declaration included participants, aged 35-49 years [27.0%]; females [52.6%]; and non-Hispanic Whites [59.6%]). The prevalence of depression/anxiety was higher after the COVID-19 pandemic declaration (32.2%) than before the declaration (29.9%). Higher risks of depression/anxiety symptoms after the declaration were associated with being a sexual minority ([adjusted odds ratio] AOR, 2.91 [95% confidence interval (CI), 1.38-6.14]) and having fair/poor general health (AOR, 2.91 [95% CI, 1.76-4.83]). The probability of experiencing depression/anxiety symptoms after the declaration was highest among homosexuals/lesbians/gays (65.6%) compared to bisexuals (39.6%), and heterosexuals (30.1%). CONCLUSIONS: In this study, young adults, non-Hispanic Whites, and those with fair/poor general health had a higher burden of depression/anxiety symptoms after the pandemic declaration. The development of psychological support strategies to promote wellbeing during the pandemic may reduce psychological distress in the population, especially among at-risk populations.

The Influence of COVID-19 Pandemic on the Frequent Use of E-Cigarettes and Its Association with Substance Use and Mental Health Symptoms.

BACKGROUND: Although several studies examined the association between e-cigarettes, substance use, and mental health conditions, there is limited research on whether COVID-19-related stress and health outcomes, mental health symptoms, and substance use differ by the frequency of e-cigarette use during the COVID-19 pandemic. We assessed the association of past 30-day frequent use of e-cigarettes with alcohol, cannabis, anxiety/depression, and COVID-19 impact. METHODS: We conducted a national online cross-sectional survey among a random sample of US adults aged 18 years or older (N = 5065) between 13 May 2021, and 9 January 2022. A multinomial logistic regression analysis was performed to assess the study aims. RESULTS: Of the participants, 7.17% reported once to several times per month (OSTPM), 6.95% reported once to several times per week (OSTPW), and 6.57% reported every day to several times per day (ESTPD) use of e-cigarettes in the past month. Alcohol and cannabis use ESTPD and once to several times per week/month (OSTPW/M) were associated with a higher likelihood of e-cigarette use ESTPD and OSTPW/M, respectively. Anxiety/depression was associated with e-cigarette use ESTPD and OSTPW. Individuals who considered social distancing to be stressful were more likely to use e-cigarettes ESTPD and OSTPW/M compared to those that considered social distancing as not stressful. CONCLUSION: Individuals who engaged in the frequent use of alcohol or cannabis, had depression/anxiety, and considered social distancing to be stressful were more likely to engage in frequent e-cigarette use. Improving efforts geared toward reducing the use of substances may help decrease the health risks associated with e-cigarette use.

Differences in the Perceived Likelihood of Receiving COVID-19 Vaccine.

There are limited studies on the perceived likelihood of receiving a COVID-19 vaccine among the general US population and its subpopulations. We examined the association between the perceived likelihood of receiving a COVID-19 vaccine with the self-reported likelihood of contracting COVID-19, social-distancing stress, COVID-19 diagnosis status, mental health disorders, and sociodemographic characteristics. The data were collected using a national cross-sectional survey (N = 5404) between 13 May 2021 and 9 January 2022. A multivariable logistic regression analysis was performed. Setting: United States. Participants: Adults aged ≥ 18 years. The majority of US adults (67.34%) indicated they intended to receive a COVID-19 vaccine. There was a decreased perceived likelihood of getting vaccinated associated with those aged 18-49 years (Adjusted Odds Ratio (AOR) = 0.29-59; 95% Confidence Interval (CI) = 0.20-0.85); with a less than college education (AOR = 0.37-58; 95% CI = 0.28-0.68); with no health insurance (AOR = 0.48; 95% CI = 0.40, 0.58); with no perceived likelihood of contracting COVID-19 (AOR = 0.78; 95% CI = 0.68, 0.89); and with anxiety/depression (AOR = 0.67; 95% CI = 0.59, 0.76). Black/African Americans had a lower perceived likelihood of receiving a COVID-19 vaccine (AOR = 0.84; 95% CI = 0.71, 0.98), while Asians (AOR = 1.92; 95% CI = 1.35, 2.74) and Hispanics/Latinos (AOR = 1.34; 95% CI = 1.03, 1.74) had a higher perceived likelihood compared with Whites. Individuals reporting social distancing as stressful (AOR = 1.21; 95% CI = 1.01, 1.45) were associated with an increased perceive likelihood of receiving a COVID-19 vaccine. Our study showed that younger adults, Black/African Americans, and those with a less than college education, no health insurance, or anxiety/depression may be less likely to receive vaccination. Future research should examine the explanatory mechanisms contributing to the lower perceived likelihood of vaccination among these groups, such as barriers to vaccine education or vaccine access. Public health interventions should prioritize these populations to improve vaccination rates.

Prevalence of Cannabis Use and Factors Related to Hospitalizations in the United States: A Population-Based Study Using National Inpatient Sample Between 2012 and 2018.

INTRODUCTION: Cannabis use has been associated with adverse outcomes among adults and adolescents. As more states legalize or consider legalization, it is imperative to understand cannabis-related hospitalizations among the US population. This study is aimed at understanding the prevalence of cannabis-related hospitalizations using a nationally representative sample. METHODS: Using the National Inpatient Sample (NIS) available through the Healthcare Cost and Utilization Project (HCUP), we included all hospitalizations that met the inclusion criteria of documented history of cannabis use and those with any cannabis diagnosis as the reason for hospitalization between 2012 and 2014, and 2016 and 2018 using listwise deletion methods. Cannabis use was identified based on International Classification of Disease (ICD 9 & 10) codes (304.3X, 305.2X) (F12.XXX) for 2012-2014 and 2016-2018, respectively. We included both primary and secondary diagnoses among hospitalized patients. We further analyzed the relationship between cannabis-related diagnoses, race and ethnicity cases, household income, region, age group, rural-urban demographics, and sex. RESULTS: A weighted total of 2,099,665 and 1,023,325 patients with a history of cannabis use were identified for the period of 2012-2014 and 2016-2018, respectively. The primary reason for presentation among a majority of patients was related to mental health, alcohol, HIV, trauma, burns, and toxic effects of drugs for all included years. The rate of the presentation was highest among individuals 12-24-years-old (351, 846) and 25-34-years-old (255 and 563) per 10,000 presentations between 2012-2014 and 2016-2018, respectively. The highest rate of increase by race and ethnicity was observed among Native Americans (227 and 457), Black (287 and 468), and others (125 and 214) during 2012-2014 and 2016-2018, respectively. The highest observations were in the East North Central, West North Central, Mountain, and Pacific Regions of the United States. The highest presentation rates were observed among males with no insurance coverage and populations in the lowest income quartiles. CONCLUSION: Cannabis-related hospitalization increased significantly over the years, and presentations are not isolated to areas with cannabis legalization. The high presentation rate among individuals with mental and alcohol necessitates the development of strategies to educate and mitigate potential causes of hospitalization among all age groups and races or ethnicity.

Assessment of anxiety/depression among cancer patients before and during the COVID-19 pandemic.

OBJECTIVE: To assess differences in the prevalence of anxiety/depression symptoms among cancer patients before (2019) and during the COVID-19 pandemic (2020); and the associations between anxiety/depression and sociodemographic and health behavior factors among cancer patients before and during the pandemic. METHODS: We analyzed data from the 2019 (n = 856) and 2020 (n = 626) Health Information National Trends Survey, a nationally representative survey of United States adults aged ≥18 years. Only adults with a cancer diagnosis were used in the analyses. Anxiety/depression was assessed using the Patient Health Questionnaire-4 (low/none [0-2], mild [3-5], moderate [6-8], and severe [9-12]) and dichotomized as low/none and current anxiety/depression (mild/moderate/severe). Multivariate analysis was performed. RESULTS: The prevalence of anxiety/depression symptoms among cancer patients was 32.7% before the COVID-19 pandemic and 31.1% during the pandemic. The odds of anxiety/depression among patients with fair/poor health status was higher during the pandemic relative to before (before: odds ratio [OR] = 1.85 vs. during: OR = 3.89). Participants aged 50-64 years (before: OR = 0.29, 95% confidence interval [95% CI] = 0.11-0.76; during: OR = 0.33, 95% CI = 0.11-0.97) and ≥65 years (before: OR = 0.13, 95% CI = 0.05-0.34; during: OR = 0.18, 95% CI = 0.07-0.47) had lower odds of anxiety/depression before and during the pandemic compared to those aged 35-49 years. Hispanics/Latinos had higher odds of anxiety/depression (OR = 2.70, 95% CI = 1.11-6.57) before the pandemic and lower odds of anxiety/depression during the pandemic (OR = 0.2, 95% CI = 0.05-1.01) compared to non-Hispanic Whites. Those who completed high school (before: OR = 0.08, 95% CI = 0.01-0.42), some college (before: OR = 0.10, 95% CI = 0.02-0.42), ≥college degree had lower odds of anxiety/depression symptoms (before: OR = 0.05, 95% CI = 0.01-0.26; during: OR = 0.06, 95% CI = 0.01-0.61) compared to those with less than a high school education. CONCLUSION: Our results suggest the need to increase the provision of mental health services to cancer patients at high risk of developing anxiety/depression symptoms, particularly during public health emergencies, to alleviate further health burdens.

Pediatric and adolescent mood disorders: An analysis of factors that influence inpatient presentation in the United States.

Background: Mental health is an essential aspect of health and wellbeing that the general population often overlooks. This study aims to utilize a nationwide sample [Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID)] to analyze the factors affecting inpatient mood disorder admissions in the United States. Methods: A total of 295,472 cases ages 1-20 were identified to meet the criteria (Appendix A) for the selected mood disorders from the HCUP KID 2016 dataset. We conducted descriptive statistics of the individual diagnosis. We evaluated the relationships with variables such as age (grouped), sex, region, disposition, household income, race, rural-urban demographics, and mean charges. We also conducted association tests for the variables of interest. Results: An average of six days LOS was observed for mood disorders compared to four days LOS for other pediatric inpatient admissions nationwide. The highest prevalence rate (per 100,000) of single (5050), recurrent (2284) episode MDD and bipolar disorder (2445) was observed among no charge (uninsured) populations. The native American population had the highest rate prevalence of single episode MDD (3274) and highest extreme and significant loss of function at presentation. The highest manic episode presentation rate was observed among Black (12) and Native American (9) populations. Manic episodes and bipolar disorder were higher among young adults (47 and 4554); teenagers (13-17) showed a higher presentation rate for all other mood disorders. Conclusion: No charge (uninsured), teenagers (13-17), females, native Americans, and south and midwest regions showed a higher rate of mood disorder presentations among the population. Understanding these variances could play a vital role in highlighting the need for new innovative care approaches. Comprehensive mental health programs in collaboration with educational and community organizations and other stakeholders could be vital to addressing mood and mental health among these populations. This approach tackles several social influencers such as stigma and support to ensure effectiveness and sustainability.conclusion.

Acute lymphocytic leukemia severity and mortality hospitalizations in the United States: A population-based study.

Objectives: The objective of the study was to understand the relationship between social and economic indicators of health and its association with hospitalization severity and mortality risk among ALL patients. Methods: In this retrospective study, hospitalizations with primary and secondary diagnosis were identified using International Classification of Diseases (ICD 10) codes (C91.00, C91.01, C91.02) of ALL in the National Inpatient Sample (NIS) between 2016 and 2018. Hospitalization outcomes such as LOS, mortality, severity and mortality risk, cost, diagnosis (NDX), number of procedures (NPR) were analyzed by race and ethnicity, household income, and patient location among patients with primary and secondary ALL diagnoses. Results: A total of 158090 hospitalizations were identified as meeting the inclusion criteria without missing cases with a primary or secondary diagnosis of ALL using ICD-10 codes. Severity risk at presentation varied from one area to the next, with the highest rate (per 10K) presentations in the New England region for both extreme likelihood (778) and extreme loss of function (2198) at presentation. Mortality and severity among uninsured patients were the second highest (614, 2193) compared to other payers. Extreme mortality risk at presentation was higher among African American (711), Caucasian (648), and Native American (612) populations compared to other racial and ethnic groups. Conclusion: The findings of this study suggest a relative decrease in presentation rate by year and higher mortality among specific groups-based demographics indicators. It also confirms the impact of advanced therapeutics and improved severity and mortality among younger populations with ALL compared to the older population.

Trend Analysis of Substance Use Disorder During Pregnancy.

OBJECTIVES: This study aims to analyze the trends in substance use among pregnant women in the United States. METHODOLOGY:  In this retrospective study, we utilized the National Inpatient Sample (NIS) dataset sponsored by the Agency for Healthcare Research and Quality (AHRQ) under the Healthcare Cost and Utilization Project (HCUP). Major Diagnostic Category (MDC) 14 (Pregnancy, Childbirth, and the Puerperium) and International Classification of Disease (ICD 10) codes were used to identify pregnancy-related diagnoses and presentations with any of the substance use disorder (SUD) indicators that met the inclusion criteria among the birthing population in the NIS dataset (2016-2018). We analyzed the demographic and regional characteristics between 2015 and 2018. RESULTS: Among the population, a total of 23,475 (2.7%) had a primary or secondary diagnosis of SUD, and 851,428 (97.3%) did not. In the study group of 332,275 (2.8%) that met the inclusion criteria, 12,750 (0.1%) use alcohol, 108,960 (0.9%) had opioid use disorder (OUD), 171,490 (1.4%) use cannabis, 6,375 (0.1%) use sedatives, 28,075 (0.2%) use cocaine, 48,765 (0.4%) use other stimulants, 1,155 (0%) use hallucinogens, 115 (0%) use inhalants, and 23,950 (0.2%) had other psychoactive diagnosis. Further analysis comparing the risk of severity and mortality at presentation, procedure type, delivery method, and cost of care shows statistically significant differences (p < 0.005) between the study and control groups. CONCLUSION:  The current trends necessitate a further assessment and implementation of comprehensive community-based treatment programs tailored to the most frequent regional SUD presentations, which could aid in mitigating drug use during pregnancy.

Social Determinants of Health: An Evaluation of Risk Factors Associated With Inpatient Presentations in the United States.

Social Determinants of Health (SDoH) are socioeconomic indicators that directly or indirectly impact individual and community health outcomes. The distribution of most of these indicators within communities can be traced to public policies. These public policies often lead to diverse inequities with varying impacts on communities across the country. The inequities that arise because of specific public policies can be associated with increased risk factors and poor health outcomes among communities at high risk for these indicators. This study examined inpatient hospitalization and SDoH indicators that put individuals at risk of poor health outcomes. We utilized the National Inpatient Sample (NIS) databases 2012-2014 and 2016-2017 through the Healthcare Cost and Utilization Project (HCUP). The NIS datasets are de-identified to ensure patients' privacy. The HCUP-NIS dataset is a well-established sizable all-payer inpatient dataset for national estimates. It includes primary, secondary inpatient diagnoses as well as demographic information. SDoH indicators were identified using the International Classification of Diseases (ICD), versions 9 and 10 diagnosis codes. The relationship between SDoH indicators such as housing, psychosocial, healthcare access, upbringing, unemployment, social factors, gender, race, income, region, payer, age group, mortality, and severity was evaluated in a regression analysis. A total of 3,002,557 (2012-2014) and 1,254,899 (2016-2017) cases were included in this study. Mental diseases (p < 0.001) were high between 2012-2014 (OR 18.8, 95% CI 18.20-19.42) and 2016-2017 (OR 4.11, 95% CI 3.99-4.23). Native Americans had odds of presentation (p < 0.001) with SDoH indicator between 2012-2014 (OR 1.15, 95% CI 1.12-1.18) and 2016-2017 (OR 1.75, 95% CI 1.70-1.79). The odds of presentation among long income group were high compared to other income categories (p < 0.001) between 2012-2014 (OR 1.15, 95% CI 1.15-1.16) and 2016-2017 (OR 1.26, 95% CI 1.28-1.32). In conclusion, disparities, severity, and mortality risk at presentation were high among minority communities, males, and low-income demographics across all regions of United States.

Inpatient Opioid Use Disorder and Social Determinants of Health: A Nationwide Analysis of the National Inpatient Sample (2012-2014 and 2016-2017).

Objective To evaluate the trends and relationship of inpatient presentations of Social Determinant of Health (SDOH) with superimposed Opioid Use Disorder (OUD), comparing 2012-2014 (ICD-9) and 2016-2017(ICD-10). Methods We used the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). We identified OUD among patients with any record of SDOH as the primary or secondary diagnosis using the International Classification of Diseases (ICD)-9/10 codes. A weighted SDOH sample size of 3,002,558 (2.8%) and 1,254,899(1.8%) was included for 2012-2014 and 2016-2017, respectively. The main predictors include census division, race, gender, and covariates, including age, income, disposition, payer, rural-urban classification, and combined SDOH indicator, which was used as a control variable in the regression analysis. The study provides a descriptive analysis of the social determinant of health in relation to OUD. We also evaluated the rate of the presentation by age group and race. Results A sample of 367,960 (12%) and 153,535 (12%) OUD presentations with SDOH indicators were identified for 2012-2014 and 2016-2017, respectively. An increase in housing difficulties between 2016-2017 (45%) as compared to 2012-2014 (20%) was observed. A statistically significant higher odds of presentation among black and other races were observed. There was significant variance in the presentation by region with Middle Atlantic with OR-2.04, 95 C. I (1.98, 2.10) and East North Central with OR-1.94, 95 C. I (1.89, 1.99). Higher admissions were observed for both 2012-2014 and 2016-2017 among patients without any payment method classified as no charge. Statistically significant relationships (p<0.05) were also observed among low income <$54,000 OR-1.01, 95 C. I (0.99, 1.04), Housing OR-1.49, 95 C. I (1.47, 1.52), Primary Support OR-0.93, 95 C. I (0.90, 0.95), Employment OR-1.37, 95 C. I (1.35, 1.39), Psychosocial OR-1.63, 95 C. I (1.59, 1.67), Age group 25-34 OR-15.64, 95 C. I (14.20, 17.22), 35-44 OR-29.07, 95 C. I (26.45, 31.95) in both 2012-2014 and 2016-2017. Conclusion SDOH has a direct impact on inpatient OUD presentations. Socio-economic disparities exist in all census regions, race, sex, and rural-urban demographics. Interventions aimed at reducing the incidence and risk of OUD should focus on specific local dynamics using a multidisciplinary, data-driven quality improvement (QI) approach to address the root cause of presentations effectively. A community-based approach to addressing SDOH through collaboration with care providers could play a substantial role in decreasing length of stay (LOS), cost, and potential readmission among these populations.

Pediatric pneumonia: An analysis of cost & outcome influencers in the United States.

BACKGROUND: Pediatric pneumonia is a significant cause of inpatient care in the United States. Significant resource utilization and the high cost of care necessitate careful evaluation, especially with continuously decreasing financial resources. Several studies have evaluated subsets and regional impact of these diagnoses, but only a few have evaluated these on a national level. METHODS: This retrospective analysis utilized the 2009-2012 HCUP KID Inpatient Dataset to evaluate the relationship between pneumonia diagnosis and factors affecting cost for patients between 0 and 21. One hundred forty-five thousand one hundred forty-six patients' charges with primary pneumonia diagnosis were evaluated based on LOS, chronic conditions, severity, mortality and region. RESULTS: Majority of cases of diagnosis were of unspecified organism: 11,4811 (78%) of the total population. RSV-related pneumonia diagnosis presented second with a total of 8,156 (5.5%). Charges for pneumonia in the Emergency Department (ER) were about $13,104 and non-ER presentation at $10,238. LOS affected total charge and mortality risk for all patient population regardless of age. CONCLUSION: This nationwide study provides a unique preview of the cost associated with care for pediatric pneumonia. Such information is essential in developing strategies to improve health outcomes and resources allocation.