Co-infections, comorbidities, and alcohol or other substances abuses in chronic hepatitis C-related hospitalisations in Spain / Coinfecciones, comorbilidades y abuso de alcohol u otras sustancias en las hospitalizaciones por hepatitis C crónica en España

Background: The Strategic Plan for Tackling Hepatitis C launched in 2015 in Spain has led to an important nationwide decrease in hepatitis C related hospitalisation rates. However, patients’ infection progression during decades could increase their health status complexity and challenge patient's prognosis after hepatitis C eradication. Methods: We carried out an observational retrospective study evaluating the prevalence of the main co-infections, comorbidities (risk factors and extrahepatic manifestations), and alcohol or other substances abuses in chronic hepatitis C related hospitalised patients in Spain. Data were obtained from the National Hospitalisation Registry discharges from January 1st of 2012 to December 31st of 2019. Results: Between 2012 and 2019 there were 356,197 chronic hepatitis C-related hospitalisations. In-hospital deaths occurred in 11,558 (4.6%) non-advanced liver disease and in 10,873 (10.4%) advanced liver disease-related hospitalisations. Compared to 2012–2015, in 2016–2019 the proportion of hospitalisations related to non-advanced liver disease increased from 69.4% to 72.4%, while the advanced disease-related hospitalisations decreased from 30.6% to 27.6% (P<.001). In spite of the decrease in severe cases among hospitalisations, all comorbidities evaluated, and alcohol abuse increased in 2016–2019 compared to 2012–2015, while co-infections and other substances abuses decreased in the same period.In the latest period (2016–2019): 28,679 (18.3%) of the hospitalised patients had a HIV, 6928 (4.4%) a hepatitis B, and 972 (.6%) a tuberculosis co-infection. Most frequent comorbidities were diabetes (N=33,622; 21.5%); moderate to severe renal disease (N=28,042; 17.9%), chronic obstructive pulmonary disease and asthma (N=25,559; 16.3%), and malignant neoplasms (excluding hepatocellular carcinoma) (N=19,873; 12.7%).(AU)

Antecedentes: El Plan Estratégico para el Abordaje de la Hepatitis C lanzado en España en 2015ha supuesto una importante disminución a nivel nacional de las tasas de hospitalización relacionadas con la hepatitis C. Sin embargo, la progresión de la infección en los pacientes durante décadas podría aumentar la complejidad de su estado de salud y desafiar el pronóstico del paciente después de la erradicación de la hepatitis C. Métodos: Se realizó un estudio observacional retrospectivo evaluando la prevalencia de las principales coinfecciones, comorbilidades (factores de riesgo y manifestaciones extrahepáticas) y abuso de alcohol u otras sustancias en pacientes hospitalizados relacionados con hepatitis C crónica en España. Los datos se obtuvieron del Registro de altas hospitalarias entre el 1 de enero de 2012 y el 31 de diciembre de 2019. Resultados: Entre 2012 y 2019 hubo 356.197 hospitalizaciones relacionadas con hepatitis C crónica y se registraron 11.558 (4,6%) muertes intrahospitalarias relacionadas con hospitalizaciones por enfermedad hepática no avanzada y 10.873 (10,4%) por enfermedad hepática avanzada. En comparación con 2012-2015, en 2016-2019 la proporción de hospitalizaciones relacionadas con enfermedad no avanzada aumentó del 69,4% al 72,4%, mientras que las relacionadas con enfermedad avanzada disminuyeron del 30,6% al 27,6% (P <0,001). A pesar de la disminución de casos graves entre las hospitalizaciones, todas las comorbilidades evaluadas y el abuso de alcohol aumentaron en 2016-2019 en comparación con 2012-2015, mientras que las coinfecciones y el abuso de otras sustancias disminuyeron en el mismo período. En el último período (2016-2019): 28.679 (18,3%) de los pacientes hospitalizados tenían VIH, 6928 (4,4%) hepatitis B y 972 (0,6%) coinfección tuberculosa. (AU)

Co-infections, comorbidities, and alcohol or other substances abuses in chronic hepatitis C-related hospitalisations in Spain.

BACKGROUND: The Strategic Plan for Tackling Hepatitis C launched in 2015 in Spain has led to an important nationwide decrease in hepatitis C related hospitalisation rates. However, patients' infection progression during decades could increase their health status complexity and challenge patient's prognosis after hepatitis C eradication. METHODS: We carried out an observational retrospective study evaluating the prevalence of the main co-infections, comorbidities (risk factors and extrahepatic manifestations), and alcohol or other substances abuses in chronic hepatitis C related hospitalised patients in Spain. Data were obtained from the National Hospitalisation Registry discharges from January 1st of 2012 to December 31st of 2019. RESULTS: Between 2012 and 2019 there were 356,197 chronic hepatitis C-related hospitalisations. In-hospital deaths occurred in 11,558 (4.6%) non-advanced liver disease and in 10,873 (10.4%) advanced liver disease-related hospitalisations. Compared to 2012-2015, in 2016-2019 the proportion of hospitalisations related to non-advanced liver disease increased from 69.4% to 72.4%, while the advanced disease-related hospitalisations decreased from 30.6% to 27.6% (P<.001). In spite of the decrease in severe cases among hospitalisations, all comorbidities evaluated, and alcohol abuse increased in 2016-2019 compared to 2012-2015, while co-infections and other substances abuses decreased in the same period. In the latest period (2016-2019): 28,679 (18.3%) of the hospitalised patients had a HIV, 6928 (4.4%) a hepatitis B, and 972 (.6%) a tuberculosis co-infection. Most frequent comorbidities were diabetes (N=33,622; 21.5%); moderate to severe renal disease (N=28,042; 17.9%), chronic obstructive pulmonary disease and asthma (N=25,559; 16.3%), and malignant neoplasms (excluding hepatocellular carcinoma) (N=19,873; 12.7%). Alcohol or substances abuse was reported in 48,506 (31.0%) hospitalisations: 30,782 (19.7%) with alcohol; 29,388 (18.8%) with other substances; and 11,664 (7.5%) with both, alcohol and other substances, abuses. CONCLUSIONS: Despite the reduction in advanced liver disease hepatitis C-related hospitalisations due to prioritisation of treatment to the more severe cases, high and increasing prevalence of comorbidities and risks factors among hepatitis C-related hospitalisations have been found.

Reduction in hepatitis C-related hospitalizations after the implementation of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System: regional level differences.

This work evaluates the potential impact at territorial level of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System on hepatitis C virus (HCV)-associated hospitalizations. Chronic HCV-related hospitalization discharges from 2014 to 2018 were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalizations was performed for all chronic, advanced liver disease and non-advanced liver disease. Hospitalization rates were calculated at national and regional level. Year 2015 and period 2016-2018 hospitalization rates were compared to 2014 hospitalization rates using a Poisson model. Municipal standardized hospitalization rates ratios adjusted by age-group were calculated for 2016-2018 period (2014 hospitalization rates as reference). From 2014 to 2018, there were 22,352 chronic HCV-related hospitalizations. In-hospital fatality rate was 4.3% for non-advanced liver disease and 11.7% for advanced liver disease patients. National hospitalization rate decreased 22% (95% CI: 21%-22%), 16% (95% CI: 15%-17%) and 34% (95% CI: 33%-35%) in 2016-2018 compared to 2014 for all chronic, non-advanced and advanced liver disease, respectively. During 2016-2018 period, 11/19 Spanish regions achieved >20% decrease in the hospitalization rates (p < .001) for non-advanced liver disease and 19/19 (except Melilla, the rest with p < .001) for advanced liver disease. At municipal level, 84.8% and 90.2% municipalities had <20% of chronic HCV-related hospitalization need compared to 2014 adjusted by age-group. Based on the data analysed, a high impact on reducing chronic HCV-associated hospitalizations have been achieved after the implementation of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System. However, small differences between regions and rural/urban areas were noticed.

Hepatitis C and hepatitis C-related advanced liver disease hospitalisation trends before and after the Strategic Plan for Tackling Hepatitis C in the National Health System.

INTRODUCTION: This work evaluates the burden and trends of hepatitis C virus (HCV)-associated hospitalisations in Spain before and after the implementation of the Strategic Plan for Tackling Hepatitis C in the National Health System in 2015. METHODS: HCV-related hospitalisation discharges from 2005 to 2017 were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalisations was performed. RESULTS: From 2005 to 2017, there were 674 067 HCV-related hospitalisations: 1.2%, 29.9%, 63.9% and 5% of them due to acute, carriers, chronic and unspecified hepatitis C. Average age of the patients was 57.7 years (SD: 16.4), average hospital stay was 9.1 days (SD: 12.2) and intra-hospital case-fatality rate was 6.5%. Hospitalisation rates decreased notably (P < 0.05) in 2016-2017 compared to 2005-2015 for all [hospitalisation rate ratio (HRR): 0.77], males (HRR: 0.80), females (HRR: 0.74), chronic hepatitis C (HRR: 0.84), non-advanced liver disease (N-AdLD) (HRR: 0.80) and AdLD (HRR: 0.73). Acute HCV (HRR: 0.54) and carriers (HRR: 0.49) show decreases in 2016-2017 vs. 2005-2015, although their rates started to decrease in 2008/2009. Unspecified HCV hospitalisation rates increased (P < 0.05) in 2016-2017 (HRR: 2.02) vs. 2005-2015. From 2015 to 2017, cost per patient increased from 5981 euros to 6349 euros, but overall cost decreased, as hospitalisations rates decreased from 302 to 264 million euros. DISCUSSION: HCV-related hospitalisation rates decreased notably in 2016 and 2017 after the strategic plan for tackling hepatitis C was launched. Although cost per AdLD patient increased in 2016 and 2017, globally costs were reduced around 35 million euros per year.

Trends in Sports- and Recreation-Related Traumatic Brain Injuries Treated in US Emergency Departments: The National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) 2001-2012.

IMPORTANCE: Sports- and recreation-related traumatic brain injuries (SRR-TBIs) are a growing public health problem affecting persons of all ages in the United States. OBJECTIVE: To describe the trends of SRR-TBIs treated in US emergency departments (EDs) from 2001 to 2012 and to identify which sports and recreational activities and demographic groups are at higher risk for these injuries. DESIGN: Data on initial ED visits for an SRR-TBI from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) for 2001-2012 were analyzed. SETTING: NEISS-AIP data are drawn from a nationally representative sample of hospital-based EDs. PARTICIPANTS: Cases of TBI were identified from approximately 500,000 annual initial visits for all causes and types of injuries treated in EDs captured by NEISS-AIP. MAIN OUTCOME MEASURE(S): Numbers and rates by age group, sex, and year were estimated. Aggregated numbers and percentages by discharge disposition were produced. RESULTS: Approximately 3.42 million ED visits for an SRR-TBI occurred during 2001-2012. During this period, the rates of SRR-TBIs treated in US EDs significantly increased in both males and females regardless of age (all Ps < .001). For males, significant increases ranged from a low of 45.8% (ages 5-9) to a high of 139.8% (ages 10-14), and for females, from 25.1% (ages 0-4) to 211.5% (ages 15-19) (all Ps < .001). Every year males had about twice the rates of SRR-TBIs than females. Approximately 70% of all SRR-TBIs were reported among persons aged 0 to 19 years. The largest number of SRR-TBIs among males occurred during bicycling, football, and basketball. Among females, the largest number of SRR-TBIs occurred during bicycling, playground activities, and horseback riding. Approximately 89% of males and 91% of females with an SRR-TBI were treated and released from EDs. CONCLUSION AND RELEVANCE: The rates of ED-treated SRR-TBIs increased during 2001-2012, affecting mainly persons aged 0 to 19 years and males in all age groups. Increases began to appear in 2004 for females and 2006 for males. Activities associated with the largest number of TBIs varied by sex and age. Reasons for the reported increases in ED visits are unknown but may be associated with increased awareness of TBI through increased media exposure and from campaigns, such as the Centers for Disease Control and Prevention's Heads Up. Prevention efforts should be targeted by sports and recreational activity, age, and sex.