Characterization of Brazilian hospital admissions due to cardiovascular diseases: a longitudinal study.

BACKGROUND: Cardiovascular diseases (CVD) are the main cause of death and comorbidities worldwide. It is estimated that three quarters of all deaths related to CVD occur in low and middle income countries such as Brazil. Furthermore, it is estimated that emerging countries will present the highest worldwide prevalence of such diseases by 2050. In view of the above, this study aims to characterize Brazilian hospital admission distribution classified by the ICD-10 in adults between 2008 and 2017 in Brazil. METHODS: This is a longitudinal descriptive study in which all data regarding hospital admissions registered in the Brazilian Hospital Information System of "Sistema Único de Saúde" (SIH/SUS) due to cardiovascular diseases (ICD-10) were included. All admissions from private or public services linked to the SUS from 2008 and 2017 were evaluated. The following variables were collected: number of hospital admissions, place of hospitalization classified by the ICD-10 and mortality rate at the federal level and according to regions. Absolute values and frequency of hospital admissions were grouped according to sex, age and living region as well as the number of deaths. The extracted data was stored in a Microsoft Excel 2013 program spreadsheet. Statistical analysis was performed by GraphPad Prism version 5.0 software. RESULTS: There was a total of 11,345,821 hospital admissions due to CVD registered between 2008 and 2017. Individuals from 50 to 79 years old were the most affected. Heart failure (21.3%), other ischemic heart diseases (13.3%) and stroke (11.4%) were responsible for almost half of the hospital admissions associated to CVD. The number of registered deaths caused by any CVD was 867,838 and the national mortality rate was 7.82. CONCLUSION: CVD were responsible for around 10% of all hospital admissions in Brazil between 2008 and 2017. Moreover, it was possible to observe a decrease in hospital admissions as well as mortality rate over time after implementing governmental strategies to prevent cardiovascular diseases.

The effect of lockdown on the outcomes of COVID-19 in Spain: An ecological study.

It is paramount to expand the knowledge base and minimize the consequences of the pandemic caused by the new Coronavirus (SARS-Cov2). Spain is among the most affected countries that declared a countrywide lockdown. An ecological study is presented herein, assessing the trends for incidence, mortality, hospitalizations, Intensive Care Unit admissions, and recoveries per autonomous community in Spain. Trends were evaluated by the Joinpoint software. The timeframe employed was when the lockdown was declared on March 14, 2020. Daily percentage changes were also calculated, with CI = 95% and p<0.05. An increase was detected, followed by reduction, for the evaluated indicators in most of the communities. Approximately 18.33 days were required for the mortality rates to decrease. The highest mortality rate was verified in Madrid (118.89 per 100,000 inhabitants) and the lowest in Melilla (2.31). The highest daily percentage increase in mortality occurred in Catalonia. Decreasing trends were identified after approximately two weeks of the institution of the lockdown by the government. Immediately the lockdown was declared, an increase of up to 33.96% deaths per day was verified in Catalonia. In contrast, Ceuta and Melilla presented significantly lower rates because they were still at the early stages of the pandemic at the moment of lockdown. The findings presented herein emphasize the importance of early and assertive decision-making to contain the pandemic.

Weekend admissions with ascites are associated with delayed paracentesis: A nationwide analysis of the 'weekend effect'.

INTRODUCTION AND OBJECTIVES: Weekend admissions has previously been associated with worse outcomes in conditions requiring specialists. Our study aimed to determine in-hospital outcomes in patients with ascites admitted over the weekends versus weekdays. Time to paracentesis from admission was studied as current guidelines recommend paracentesis within 24h for all patients admitted with worsening ascites or signs and symptoms of sepsis/hepatic encephalopathy (HE). PATIENTS: We analyzed 70 million discharges from the 2005-2014 National Inpatient Sample to include all adult patients admitted non-electively for ascites, spontaneous bacterial peritonitis (SBP), and HE with ascites with cirrhosis as a secondary diagnosis. The outcomes were in-hospital mortality, complication rates, and resource utilization. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS: Out of the total 195,083 ascites/SBP/HE-related hospitalizations, 47,383 (24.2%) occurred on weekends. Weekend group had a higher number of patients on Medicare and had higher comorbidity burden. There was no difference in mortality rate, total complication rates, length of stay or total hospitalization charges between the patients admitted on the weekend or weekdays. However, patients admitted over the weekends were less likely to undergo paracentesis (OR 0.89) and paracentesis within 24h of admission (OR 0.71). The mean time to paracentesis was 2.96 days for weekend admissions vs. 2.73 days for weekday admissions. CONCLUSIONS: We observed a statistically significant "weekend effect" in the duration to undergo paracentesis in patients with ascites/SBP/HE-related hospitalizations. However, it did not affect the patient's length of stay, hospitalization charges, and in-hospital mortality.

Burden of hospitalisation among older people in the Brazilian public health system: a big data analysis from 2009 to 2015.

BACKGROUND: The world's population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older (>60 years) compared with non-older population, as well as the epidemiology of these hospital admissions. METHODS: Using the Brazilian Unified Health System (known as 'Sistema Único de Saúde' (SUS)), an analysis of all hospital admissions of adult patients in the SUS from 2009 to 2015 was undertaken. The following indicators were used: hospital admission rate, intensive care unit (ICU) admission rate, average length of hospital and ICU stay, hospital mortality and average reimbursement per hospitalisation. RESULTS: A total of 61 958 959 admissions during the 7-year period, were analysed, encompassing 17 893 392 (28.9%) older patients. Elderly represent 15% (n=21 294 950) of the Brazilian adult population, but are responsible for 29% (n=17 893 392) of hospitalisations, 52% (n=1 731 299) of ICU admissions and 66% (n=1 885 291) of hospital mortality. Among the adults, elderly represents 39% of the total reimbursement made related to admission/hospitalisation. For 2009 to 2015, while the older population increased 27%, ICU admission rate increased 20%; the average length of ICU stay was 12% higher in 2015 (6.5 days) compared with 2009 (5.8 days); and the hospital mortality increased from 9.8% to 11.2%. CONCLUSION: These findings illustrate the current panorama of the burden due to hospitalisation of older people in the Brazilian public health system, and evidence the consolidation of the epidemiological transition toward the predominance of non-communicable diseases as the main cause of hospitalisation among the elderly in Brazil.

Troponin I at admission in the intensive care unit predicts the need of dialysis in septic patients.

BACKGROUND: In a previous study we showed that troponin I (TnI) > 0.42 ng/mL predicted the need of dialysis in a group of 29 septic patients admitted to the intensive care unit (ICU). We aimed to confirm such finding in a larger independent sample. METHODS: All septic patients admitted to an ICU from March 2016 to February 2017 were included if age between 18 and 90 years, onset of sepsis < 24 h, normal left ventricular ejection fraction, and no previous coronary or kidney diseases. TnI was measured on day 1. Patients were followed by 30 days or until death. RESULTS: A total of 120 patients were included (51% male, 74 ± 13 years old). At ICU admission, 70 patients had TnI > 0.42 ng/mL. These patients had serum creatinine slightly higher (1.66 ± 0.34 vs. 1.32 ± 0.39 mg/dL; P <  0.0001) than those with lower TnI and similar urine output (1490 ± 682 vs. 1406 ± 631 mL; P = 0.44). At the end of the follow-up period, 70.0% of the patients with lower TnI were alive in comparison with 38.6% of those with higher TnI (p = 0.0014). After 30 days, 69.3 and 2.9% of the patients with lower and higher TnI levels remained free of dialysis, respectively (p <  0.0001). In a Cox regression model, after adjustment for gender, age, Charlson comorbidity index, serum creatinine, potassium, pH, brain natriuretic peptide and urine output, TnI > 0.42 ng/mL persisted as a strong predictor of dialysis need (hazard ratio 3.48 [95%CI 1.69-7.18]). CONCLUSIONS: TnI levels at ICU admission are a strong independent predictor of dialysis need in sepsis.

Secular trends of candidemia at a Brazilian tertiary care teaching hospital.

BACKGROUND: Candidemia is the most frequent invasive fungal disease in hospitalized patients, and is associated with high mortality rates. The main objective of this study was to evaluate changes in the epidemiology of candidemia at a tertiary care hospital in a 21-year period. METHODS: We evaluated all episodes of candidemia diagnosed between 1996 and 2016 at a University-affiliated tertiary care hospital in Brazil. We arbitrarily divided the study period in 3: 1996-2002 (period 1), 2003-2009 (period 2) and 2010-2016 (period 3). Incidence rates were calculated using hospital admissions as denominator. RESULTS: We observed 331 episodes of candidemia. The incidence was 1.30 episodes per 1000 admissions, with no significant change over time. Candida albicans (37.5%), C. tropicalis (28.1%), C. parapsilosis (18.4%) and C. glabrata (6.9%) were the most frequent species. The proportion of patients receiving treatment increased (65.5%, 79.4% and 74.7% in periods 1, 2 and 3, respectively, p = 0.04), and the median time from candidemia to treatment initiation decreased from 4 days in period 1 (range 0-32 days) to 2 days in period 2 (range 0-33 days) and 2 days in period 3 (range 0-14 days, p < 0.001). We observed a significant decrease in the use of deoxycholate amphotericin B (47.4%, 14.8% and 11.9%), and an increase in the use of echinocandins (0%, 2.8% and 49.1%; p < 0.001). The APACHE II score increased over time (median 16, 17.5, and 22, p < 0.001). The overall 30-day mortality was 58.9%, and did not change significantly over the study period. CONCLUSIONS: There was an improvement in patient care, with an increase in the proportion of patients receiving treatment and a decrease in the time to treatment initiation, but no improvement in the outcome, possibly because the proportion of sicker patients increased over time.

Secular trends of candidemia at a Brazilian tertiary care teaching hospital

ABSTRACT Background Candidemia is the most frequent invasive fungal disease in hospitalized patients, and is associated with high mortality rates. The main objective of this study was to evaluate changes in the epidemiology of candidemia at a tertiary care hospital in a 21-year period. Methods We evaluated all episodes of candidemia diagnosed between 1996 and 2016 at a University-affiliated tertiary care hospital in Brazil. We arbitrarily divided the study period in 3: 1996-2002 (period 1), 2003-2009 (period 2) and 2010-2016 (period 3). Incidence rates were calculated using hospital admissions as denominator. Results We observed 331 episodes of candidemia. The incidence was 1.30 episodes per 1000 admissions, with no significant change over time. Candida albicans (37.5%), C. tropicalis (28.1%), C. parapsilosis (18.4%) and C. glabrata (6.9%) were the most frequent species. The proportion of patients receiving treatment increased (65.5%, 79.4% and 74.7% in periods 1, 2 and 3, respectively, p= 0.04), and the median time from candidemia to treatment initiation decreased from 4 days in period 1 (range 0-32 days) to 2 days in period 2 (range 0-33 days) and 2 days in period 3 (range 0-14 days, p< 0.001). We observed a significant decrease in the use of deoxycholate amphotericin B (47.4%, 14.8% and 11.9%), and an increase in the use of echinocandins (0%, 2.8% and 49.1%; p< 0.001). The APACHE II score increased over time (median 16, 17.5, and 22, p< 0.001). The overall 30-day mortality was 58.9%, and did not change significantly over the study period. Conclusions There was an improvement in patient care, with an increase in the proportion of patients receiving treatment and a decrease in the time to treatment initiation, but no improvement in the outcome, possibly because the proportion of sicker patients increased over time.

Hospitalizations for diabetes mellitus and the Family Health Strategy, Paraná, Brazil, 2000-2012. / Internações por diabetes mellitus e a Estratégia Saúde da Família, Paraná, Brasil, 2000 a 2012.

The aim of this study was to identify trends in hospitalization for diabetes mellitus and their correlation with the Family Health Strategy (FHS) coverage in the state of Paraná, by Health District (HD), between 2000 and 2012. It is an ecological study based on secondary data from the Hospital Information System of the Brazilian Unified Health System and the Primary Care Department. There was downward trend for general admission rates (from 10.2 to 9.0/10,000 inhabitants), but upward trend for some HDs. No correlation was observed between admission rates and the FHS coverage for the state. However, there was strong inverse correlation for Paranaguá, Metropolitan, Foz do Iguaçu and Umuarama HDs, and strong and direct correlation for Pato Branco, Campo Mourão, Cianorte, Telêmaco Borba and Ivaiporã HDs. Overall, hospitalizations for diabetes mellitus proved to be decreasing and without correlation with FHS coverage; however, there were differences according to HDs.

Objetivou-se identificar a tendência das internações por Diabetes Mellitus e a correlação com a cobertura da Estratégia Saúde da Família (ESF) no Estado do Paraná, segundo Regionais de Saúde (RS), entre 2000 e 2012. Estudo ecológico de dados secundários do Sistema de Informações Hospitalares do Sistema Único de Saúde e do Departamento da Atenção Básica. Verificou-se tendência decrescente para as taxas de internação geral (de 10,2 para 9,0/10.000 habitantes), porém, tendência crescente para algumas RS. Observou-se correlação entre as taxas de internação e a cobertura da ESF para o estado; correlação forte e inversa para as RS de Paranaguá, Metropolitana, Foz do Iguaçu e Umuarama; e correlação forte e direta para as RS de Pato Branco, Campo Mourão, Cianorte, Telêmaco Borba e Ivaiporã. No geral, as internações por Diabetes Mellitus mostraram-se decrescentes e sem correlação com a cobertura da ESF, porém, observaram-se diferenças conforme as RS.

Internações por diabetes mellitus e a Estratégia Saúde da Família, Paraná, Brasil, 2000 a 2012 / Hospitalizations for diabetes mellitus and the Family Health Strategy, Paraná, Brazil, 2000-2012

Resumo Objetivou-se identificar a tendência das internações por Diabetes Mellitus e a correlação com a cobertura da Estratégia Saúde da Família (ESF) no Estado do Paraná, segundo Regionais de Saúde (RS), entre 2000 e 2012. Estudo ecológico de dados secundários do Sistema de Informações Hospitalares do Sistema Único de Saúde e do Departamento da Atenção Básica. Verificou-se tendência decrescente para as taxas de internação geral (de 10,2 para 9,0/10.000 habitantes), porém, tendência crescente para algumas RS. Observou-se correlação entre as taxas de internação e a cobertura da ESF para o estado; correlação forte e inversa para as RS de Paranaguá, Metropolitana, Foz do Iguaçu e Umuarama; e correlação forte e direta para as RS de Pato Branco, Campo Mourão, Cianorte, Telêmaco Borba e Ivaiporã. No geral, as internações por Diabetes Mellitus mostraram-se decrescentes e sem correlação com a cobertura da ESF, porém, observaram-se diferenças conforme as RS.

Abstract The aim of this study was to identify trends in hospitalization for diabetes mellitus and their correlation with the Family Health Strategy (FHS) coverage in the state of Paraná, by Health District (HD), between 2000 and 2012. It is an ecological study based on secondary data from the Hospital Information System of the Brazilian Unified Health System and the Primary Care Department. There was downward trend for general admission rates (from 10.2 to 9.0/10,000 inhabitants), but upward trend for some HDs. No correlation was observed between admission rates and the FHS coverage for the state. However, there was strong inverse correlation for Paranaguá, Metropolitan, Foz do Iguaçu and Umuarama HDs, and strong and direct correlation for Pato Branco, Campo Mourão, Cianorte, Telêmaco Borba and Ivaiporã HDs. Overall, hospitalizations for diabetes mellitus proved to be decreasing and without correlation with FHS coverage; however, there were differences according to HDs.

Trends in elderly psychiatric admissions to the Brazilian public health care system

Objective: To evaluate trends in psychiatric bed occupancy by elderly inpatients in the Brazilian public health care system between 2000 and 2010 and to determine the leading psychiatric diagnosis for hospital admissions. Methods: Data from all 895,476 elderly psychiatric admissions recorded in the Brazilian Public Health Care Database (DATASUS) between January 2000 and February 2010 were analyzed. Polynomial regression models with estimated curve models were used to determine the trends. The number of inpatient days was calculated for the overall psychiatric admissions and according to specific diagnoses. Results: A moderate decreasing trend (p < 0.001) in the number of inpatient days was observed in all geriatric psychiatric admissions (R2 = 0.768) and in admissions for organic mental disorders (R2 = 0.823), disorders due to psychoactive substance use (R2 = 0.767), schizophrenia (R2 = 0.680), and other diagnoses (R2 = 0.770), but not for mood disorders (R2 = 0.472). Most admissions (60 to 65%) were due to schizophrenia. Conclusion: There was a decreasing trend in inpatient days for elderly psychiatric patients between 2000 and 2010. The highest bed occupancy was due to schizophrenia, schizotypal, and delusional disorders.

A time-series analysis of the relation between unemployment rate and hospital admission for acute myocardial infarction and stroke in Brazil over more than a decade.

BACKGROUND: The effect of socioeconomic stressors on the incidence of cardiovascular disease (CVD) is currently open to debate. Using time-series analysis, our study aimed to evaluate the relationship between unemployment rate and hospital admission for acute myocardial infarction (AMI) and stroke in Brazil over a recent 11-year span. METHODS AND RESULTS: Data on monthly hospital admissions for AMI and stroke from March 2002 to December 2013 were extracted from the Brazilian Public Health System Database. The monthly unemployment rate was obtained from the Brazilian Institute for Applied Economic Research, during the same period. The autoregressive integrated moving average (ARIMA) model was used to test the association of temporal series. Statistical significance was set at p<0.05. From March 2002 to December 2013, 778,263 admissions for AMI and 1,581,675 for stroke were recorded. During this time period, the unemployment rate decreased from 12.9% in 2002 to 4.3% in 2013, while admissions due to AMI and stroke increased. However, the adjusted ARIMA model showed a positive association between the unemployment rate and admissions for AMI but not for stroke (estimate coefficient=2.81±0.93; p=0.003 and estimate coefficient=2.40±4.34; p=0.58, respectively). CONCLUSIONS: From 2002 to 2013, hospital admissions for AMI and stroke increased, whereas the unemployment rate decreased. However, the adjusted ARIMA model showed a positive association between unemployment rate and admissions due to AMI but not for stroke. Further studies are warranted to validate our findings and to better explore the mechanisms by which socioeconomic stressors, such as unemployment, might impact on the incidence of CVD.

Trends in elderly psychiatric admissions to the Brazilian public health care system.

OBJECTIVE:: To evaluate trends in psychiatric bed occupancy by elderly inpatients in the Brazilian public health care system between 2000 and 2010 and to determine the leading psychiatric diagnosis for hospital admissions. METHODS:: Data from all 895,476 elderly psychiatric admissions recorded in the Brazilian Public Health Care Database (DATASUS) between January 2000 and February 2010 were analyzed. Polynomial regression models with estimated curve models were used to determine the trends. The number of inpatient days was calculated for the overall psychiatric admissions and according to specific diagnoses. RESULTS:: A moderate decreasing trend (p < 0.001) in the number of inpatient days was observed in all geriatric psychiatric admissions (R2 = 0.768) and in admissions for organic mental disorders (R2 = 0.823), disorders due to psychoactive substance use (R2 = 0.767), schizophrenia (R2 = 0.680), and other diagnoses (R2 = 0.770), but not for mood disorders (R2 = 0.472). Most admissions (60 to 65%) were due to schizophrenia. CONCLUSION:: There was a decreasing trend in inpatient days for elderly psychiatric patients between 2000 and 2010. The highest bed occupancy was due to schizophrenia, schizotypal, and delusional disorders.

Differences upon admission and in hospital course of children hospitalized with community-acquired pneumonia with or without radiologically-confirmed pneumonia: a retrospective cohort study.

BACKGROUND: The use of chest radiograph (CXR) for the diagnosis of childhood community-acquired pneumonia (CAP) is controversial. We assessed if children with CAP diagnosed on clinical grounds, with or without radiologically-confirmed pneumonia on admission, evolved differently. METHODS: Children aged ≥ 2 months, hospitalized with CAP diagnosed on clinical grounds, treated with 200,000 IU/Kg/day of aqueous penicillin G for ≥ 48 h and with CXR taken upon admission, without pleural effusion, were included in this retrospective cohort. One researcher, blinded to the radiological diagnosis, collected data on demographics, clinical history and physical examination on admission, daily hospital course during the first 2 days of treatment, and outcome, all from medical charts. Radiological confirmation of pneumonia was based on presence of pulmonary infiltrate detected by a paediatric radiologist who was also blinded to clinical data. Variables were initially compared by bivariate analysis. Multi-variable logistic regression analysis assessed independent association between radiologically-confirmed pneumonia and factors which significantly differed during hospital course in the bivariate analysis. The multi-variable analysis was performed in a model adjusted for age and for the same factor present upon admission. RESULTS: 109 (38.5%) children had radiologically-confirmed pneumonia, 143 (50.5%) had normal CXR and 31 (11.0%) had atelectasis or peribronchial thickening. Children without radiologically-confirmed pneumonia were younger than those with radiologically-confirmed pneumonia (median [IQR]: 14 [7-28 months versus 21 [12-44] months; P = 0.001). None died. The subgroup with radiologically-confirmed pneumonia presented fever on D1 (33.7 vs. 19.1; P = 0.015) and on D2 (31.6% vs. 16.2%; P = 0.004) more frequently. The subgroup without radiologically-confirmed pneumonia had chest indrawing on D1 (22.4% vs. 11.9%; P = 0.027) more often detected. By multi-variable analysis, Fever on D2 (OR [95% CI]: 2.16 [1.15-4.06]) was directly and independently associated with radiologically-confirmed pneumonia upon admission. CONCLUSION: The compared subgroups evolved differently.

Burden of liver disease in Brazil.

BACKGROUND & AIMS: The burden of liver diseases in the Brazilian population is still unknown. To assess the impact of liver diseases on hospital admissions and mortality within the framework of the Brazilian Unified Health System. METHODS: An analytical ecological observational study was carried out. Secondary data on hospital admissions and deaths because of liver disease were collected from the Unified Health System Information Technology Department (DATASUS) database, between 2001 and 2010. All liver diseases included in the International Classification of Diseases (ICD-10) were reviewed. RESULTS: Liver diseases were the eighth leading cause of death in Brazil. The prevalence of hospital admission because of liver disease during the period of analysis was 0.72% (853 571 hospitalizations), and the mortality rate was 3.34% (308 290 deaths). The mean age at hospital admission and death because of liver disease was 48.05 and 58.10 years respectively. Both hospitalization and death because of liver disease were more common among men, and followed an upward trend over the years. Cirrhosis was the main cause of hospital admissions and death by liver disease in Brazil. The South region of the country had the highest hospital admission rates because of liver disease in Brazil, whereas the Southeast region had the highest mortality rate. CONCLUSION: This study provides evidence of the relevance of liver diseases within the framework of the Brazilian Unified Health System, and shows that the burden of these diseases is not only significant but progressive, at least in terms of hospital admissions and mortality rate.

Trends in primary health care-sensitive conditions in Brazil: the role of the Family Health Program (Project ICSAP-Brazil).

BACKGROUND: This study describes trends in hospital admission rates for primary healthcare-sensitive conditions (PHCSC) in Brazil. OBJECTIVES: To evaluate the impact of increased primary healthcare availability through the implementation of the Family Health Program (FHP) on PHCSC admissions rates at the national, regional, and state-levels between 1999 and 2007. RESEARCH DESIGN: An ecologic panel data study was used and a fixed effects multivariate negative binomial model was used to estimate the association of PHCSC admission rate and FHP controlling for other relevant covariates. RESULTS: It was shown that, at the national level, PHCSC hospital admissions declined by 24%-over 2.5 times more rapidly than the decline in hospitalizations for all other (non-PHCSC) conditions. Greater reductions in the PHCSC admission rates when compared with the non-PHCSC admission rates were also observed when the data were divided by regions and states. Regression models showed that at the state level the greater the FHP coverage, the less was the PHCSC hospital admissions even when controlling for confounding variables. CONCLUSIONS: The results of this study have important implications for the healthcare model in countries that base their national health systems on primary healthcare. This is the first study to evaluate the association between FHP coverage and PHCSC admissions rates in all the Brazilian states over a long and relevant period for the consolidation of FHP in the country.

Venous thromboembolism and adolescent and young adult oncology inpatients in US children's hospitals, 2001 to 2008.

OBJECTIVES: To determine the frequency of venous thromboembolism (VTE) in the adolescent and young adult oncology population and the effects of age and cancer type on VTE, and to characterize adolescent and young adult oncology admissions at US children's hospitals. STUDY DESIGN: We extracted data on oncology patients 15 to 24 years of age who were discharged from 35 hospitals in the Pediatric Hospital Information System (PHIS) between 2001 and 2008. RESULTS: Of 9721 unique patients, VTE occurred in 511 (5.3%). An elevated OR of VTE occurred in patients 18 to 20 and 21 to 24 years of age (OR, 1.65; 95% CI, 1.36-2.00 and OR, 1.67; 95% CI, 1.21-2.32, respectively) compared with that in patients 15 to 17 years old. Patients with leukemia (OR, 5.53; 95% CI, 3.63-8.42) and bone/soft tissue sarcomas (OR, 4.32; 95% CI, 2.80-6.69) had a higher risk of VTE compared with patients with brain tumors. The number of adolescent and young adult oncology admissions to pediatric hospitals increased 31.9%, from 5409 admissions in 2001 to 7134 admissions in 2008. CONCLUSIONS: Adolescent and young adult oncology patients, a growing population at pediatric hospitals, experience VTE as a common complication. Pediatricians should implement adolescent and young adult-specific studies to develop a standardized approach to preventing this adverse event.

Increasing hospital admission rates and economic burden for colorectal cancer in Brazil, 1996-2008.

OBJECTIVE: to determine the trends in hospital admission rates for colorectal cancer (CRC) in the Brazilian Public Health System from 1996 to 2008 and to assess the economic costs. METHODS: data from the Hospital Information Systems database of the Brazilian Unified Health System were used for analysis of all admissions with a primary diagnosis of CRC between 1996 and 2008. RESULTS: there were 297 108 CRC admissions over the study period, with an annual increase from 12 821 in 1996 to 35 040 in 2008. Age-standardized admission rates increased from 8.7 to 23.56 per 100 000 for a percentage increase of 171%. The average length of stay decreased from 11.6 days in 1996 to 7.5 days in 2008. The average hospital mortality declined from 10.4% to 8.5%. Overall costs in United States dollars (US$) of CRC hospitalizations rose from US$ 16.5 million in 1996 to US$ 33.5 million in 2008; the average cost of each admission, however, decreased from US$ 1 283 to US$ 954. CONCLUSIONS: hospitalization rates for CRC in Brazil significantly increased during a 13-year period, incurring a considerable rise in the inflation-adjusted economic burden; national in-hospital mortality rates have remained relatively high.

Increasing hospital admission rates and economic burden for colorectal cancer in Brazil, 1996-2008 / Aumento de las tasas de ingresos hospitalarios por cáncer colorrectal y su carga económica en Brasil, 1996-2008

OBJECTIVE: To determine the trends in hospital admission rates for colorectal cancer (CRC) in the Brazilian Public Health System from 1996 to 2008 and to assess the economic costs. METHODS: Data from the Hospital Information Systems database of the Brazilian Unified Health System were used for analysis of all admissions with a primary diagnosis of CRC between 1996 and 2008. RESULTS: There were 297 108 CRC admissions over the study period, with an annual increase from 12 821 in 1996 to 35 040 in 2008. Age-standardized admission rates increased from 8.7 to 23.56 per 100 000 for a percentage increase of 171 percent. The average length of stay decreased from 11.6 days in 1996 to 7.5 days in 2008. The average hospital mortality declined from 10.4 percent to 8.5 percent. Overall costs in United States dollars (US$) of CRC hospitalizations rose from US$ 16.5 million in 1996 to US$ 33.5 million in 2008; the average cost of each admission, however, decreased from US$ 1 283 to US$ 954. CONCLUSIONS: Hospitalization rates for CRC in Brazil significantly increased during a 13-year period, incurring a considerable rise in the inflation-adjusted economic burden; national in-hospital mortality rates have remained relatively high.

OBJETIVO: Determinar las tendencias de las tasas de ingresos hospitalarios por cáncer colorrectal (CCR) en el sistema de salud pública brasileño de 1996 al 2008 y evaluar sus costos económicos. MÉTODOS: Se utilizó la información de la base de datos de los sistemas de información de los hospitales del Sistema Único de Salud brasileño con objeto de analizar todos los ingresos con diagnóstico primario de CCR entre 1996 y el 2008. RESULTADOS: Durante el período de estudio, se produjeron 297 108 ingresos por CCR, con un aumento anual de 12 821 en 1996 a 35 040 en el 2008. Las tasas de ingresos estandarizadas según la edad aumentaron de 8,7 a 23,56 por 100 000, con un aumento porcentual de 171 por ciento. La estancia hospitalaria media disminuyó de 11,6 días en 1996 a 7,5 días en el 2008. La mortalidad hospitalaria promedio descendió de 10,4 por ciento a 8,5 por ciento. Los costos de las hospitalizaciones por CCR aumentaron de US$16,5 millones en 1996 a US$33,5 millones en el 2008; el costo promedio de cada ingreso, sin embargo, disminuyó de US$1 283 a US$954. CONCLUSIONES: Las tasas de hospitalización por CCR en Brasil han aumentado significativamente a lo largo de un período de 13 años y han acarreado un considerable incremento de la carga económica ajustada según la inflación; las tasas nacionales de mortalidad hospitalaria se han mantenido relativamente elevadas.