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1.
J Stud Alcohol Drugs ; 82(2): 257-268, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33823973

RESUMO

OBJECTIVE: The aims of the study were to (a) determine rates of early, late, and overall 30-day all-cause readmission for women and men with the diagnosis of alcoholic cardiomyopathy (ACM), (b) examine hospital- and patient-level characteristics associated with the risk of readmission and how these factors differed by sex, and (c) examine the association between sex and in-patient mortality during readmission. METHOD: We conducted a multi-year cross-sectional analysis of adult (≥18 years) inpatient hospitalizations in the United States. Descriptive statistics including frequencies and percentages were used to describe the study population, stratified by sex. We then used Poisson regression with robust error variance estimation to estimate risk ratios (RRs) and 95% confidence intervals (CIs) that represented the associations between sex and likelihood of 30-day all-cause readmission and inpatient mortality. RESULTS: Among more than 116 million hospitalizations, there were 53,207 ACM-related hospitalizations (45,573 men and 7,634 women). Thirty-day all-cause readmission rates following an ACM-related index hospitalization were similar between men (20.3%) and women (20.5%). For men and women, cancer, hepatitis, chronic renal failure, cirrhosis, asthma, and anemia were associated with a higher risk of readmission. Although crude in-hospital mortality rates were higher among women (6.6%) than men (4.3%), there were no sex differences in mortality after adjusting for confounders (RR = 1.26, 95% CI [0.88, 1.81]). CONCLUSIONS: Although men are more likely to be hospitalized for ACM, readmission risk is high (approximately 20%) and is similar in men and women following hospitalization for ACM. Hospital care transition programs that include a multidisciplinary approach are needed to help prevent these readmissions and associated morbidity and mortality.


Assuntos
Cardiomiopatia Alcoólica/epidemiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos , Adulto Jovem
2.
J Card Fail ; 27(2): 143-152, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33388469

RESUMO

BACKGROUND: Cardiovascular conditions are leading contributors to increasing maternal morbidity and mortality. Heart failure with preserved ejection fraction (HFpEF) results in the majority of HF admissions in women, yet its impact in pregnancy is unknown. We examined the prevalence rates, risk factors and adverse pregnancy outcomes in women with HFpEF during pregnancy-related hospitalizations in the United States. METHODS AND RESULTS: We conducted a cross-sectional analysis of pregnancy-related hospitalizations from 2002 through 2014 using the National Inpatient Sample. HFpEF cases were identified using the 428.3 International Classification of Diseases, 9th edition, Clinical Modification code. Weighting variables were used to provide national estimates, unconditional survey logistic regression to generate odds ratios and 95% confidence intervals (CI) representing adjusted associations with adverse pregnancy outcomes and Joinpoint regression to estimate temporal trends. Among 58,732,977 hospitalizations, there were 3840 HFpEF cases, an overall rate of 7 cases per 100,000 pregnancy-related hospitalizations; 56% occurred postpartum, 27% during delivery, and 17% antepartum. The temporal trend for hospitalization increased throughout the timeframe by 19.4% (95% CI 13.9-25.1). HFpEF hospitalizations were more common for Black, older, or poor women. Risk factors included hypertension (chronic hypertension and hypertensive disorders of pregnancy), anemia, obesity, diabetes, renal disease and coronary atherosclerosis; all known risk factors for HFpEF. Women with HFpEF were 2.61-6.47 times more likely to experience adverse pregnancy outcomes. CONCLUSIONS: The pregnancy-related HFpEF hospitalization prevalence has increased and is associated with adverse pregnancy outcomes. Risk factors resemble those outside pregnancy, emphasizing the need for screening and monitoring women with risk factors during pregnancy for HFpEF.


Assuntos
Insuficiência Cardíaca , Estudos Transversais , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Hospitalização , Humanos , Gravidez , Fatores de Risco , Volume Sistólico , Estados Unidos/epidemiologia
3.
J Am Heart Assoc ; 9(12): e016292, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32486880

RESUMO

Background Evidence suggests familial aggregation and intergenerational associations for individual cardiovascular health (CVH) metrics. Over a 53-year life course, we examined trends and association of CVH between parents and their offspring at similar mean ages. Methods and Results We conducted a series of cross-sectional analyses of the FHS (Framingham Heart Study). Parent-offspring pairs were assessed at exams where their mean age distributions were similar. Ideal CVH was defined using 5 CVH metrics: blood pressure (<120/<80 mm Hg), fasting blood glucose (<100 mg/dL), blood cholesterol (<200 mg/dL), body mass index (<25 kg/m2), and non-smoking. Joinpoint regression and Chi-squared test were used to assess linear trend; proportional-odds regression was used to examine the association between parents and offspring CVH. A total of 2637 parents were paired with 3119 biological offspring throughout 6 exam cycles. Similar patterns of declining ideal CVH with advancing age were observed in parents and offspring. Small proportions of parents (4%) and offspring (17%) achieved 5 CVH metrics at ideal levels (P-trend <0.001). Offspring of parents with poor CVH had more than twice the odds of having poor CVH (pooled odds ratio, 2.59; 95% CI, 1.98-3.40). Over time, elevated glucose levels and obesity doubled among the offspring and were the main drivers for declining ideal CVH trends. Conclusions Parental CVH was positively associated with offspring CVH. However, intergenerational CVH gains from declining smoking rates, cholesterol, and blood pressure were offset by rising offspring obesity and elevated glucose levels. This suggests an intergenerational phenotypic shift of risk factors and the need for a family-centered approach to cardiovascular care.


Assuntos
Crianças Adultas , Doenças Cardiovasculares/epidemiologia , Nível de Saúde , Pais , Adulto , Biomarcadores/sangue , Glicemia/análise , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Colesterol/sangue , Análise por Conglomerados , Estudos Transversais , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , não Fumantes , Fatores de Proteção , Medição de Risco , Fatores de Tempo
4.
Nurs Res ; 69(1): 42-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31609900

RESUMO

BACKGROUND: Although prior studies of inpatient maternal mortality in the United States provide data on the overall rate and trend in inpatient maternal mortality, there are no published reports of maternal mortality data stratified by timing of its occurrence across the pregnancy continuum (antepartum, intrapartum, and postpartum). OBJECTIVE: The study objective was to determine whether the maternal mortality rate, trends over time, self-reported race/ethnicity, and associated factors vary based on the timing of the occurrence of death during pregnancy. METHODS: We conducted a cross-sectional analysis of the Nationwide Inpatient Sample database to identify pregnancy-related inpatient stays stratified by timing. Among women in the sample, we determined in-hospital mortality and used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify comorbidities and behavioral characteristics associated with mortality, including alcohol, drug, and tobacco use. Joinpoint regression was used to calculate rates and trends of in-hospital maternal mortality. RESULTS: During the study period, there were 7,411 inpatient maternal mortalities among an estimated 58,742,179 hospitalizations of women 15-49 years of age. In-hospital maternal mortality rate stratified by race showed that African Americans died at significantly higher rates during antepartum, intrapartum, and postpartum periods compared to hospitalizations for Whites or Hispanics during the same time period. Although the postpartum hospitalization represents only 2% of pregnancy-related hospitalizations among women aged 15-49 years, hospitalization during this time period accounted for 27.2% of all maternal deaths during pregnancy-related hospitalization. DISCUSSION: Most in-hospital maternal mortalities occur after hospital discharge from child birth (postpartum period). Yet, the postpartum period continues to be the time period with the least maternal healthcare surveillance in the pregnancy continuum. African American women experience three times more in-hospital mortality when compared to their White counterparts.


Assuntos
Mortalidade Hospitalar/tendências , Mortalidade Materna/tendências , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Previsões , Humanos , Pessoa de Meia-Idade , Gravidez , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
5.
Eur J Prev Cardiol ; 2020 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-33624039

RESUMO

BACKGROUND: Cardiovascular disease (CVD) risk factors are transmitted from parents to children. We prospectively examined the association between parental cardiovascular health (CVH) and time to onset of CVD in the offspring. METHODS AND RESULTS: The study consisted of a total of 5967 offspring-mother-father trios derived from the Framingham Heart Study. Cardiovascular health score was defined using the seven American Heart Association's CVH metrics attained at ideal levels: poor (0-2), intermediate (3-4), and ideal CVH (5-7). Multivariable-adjusted Cox proportional hazards regression models, Kaplan-Meier plots, and Irwin's restricted mean were used to examine the association and sex-specific differences between parental CVH and offspring's CVD-free survival. In a total of 71 974 person-years of follow-up among the offspring, 718 incident CVD events occurred. The overall CVD incidence rate was 10 per 1000 person-years [95% confidence interval (CI) 9.3-10.7]. Offspring of mothers with ideal CVH lived 9 more years free of CVD than offspring of mothers with poor CVH (P < 0.001). Maternal poor CVH was associated with twice as high hazard of early onset of CVD compared with maternal ideal CVH (adjusted Hazard Ratio 2.09, 95% CI 1.50-2.92). No statistically significant association was observed in the hazards of CVD-free survival by paternal CVH categories. CONCLUSIONS: We found that offspring of parents with ideal CVH had a greater CVD-free survival. Maternal CVH was a more robust predictor of offspring's CVD-free survival than paternal CVH, underscoring the need for clinical and policy interventions that involve mothers to break the intergenerational cycle of CVD-related morbidity and mortality.

6.
J Womens Health (Larchmt) ; 28(11): 1460-1467, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31373869

RESUMO

Background: Depression and hypertensive disorders of pregnancy (HDP) are common morbidities during pregnancy. However, our knowledge about the national prevalence, correlates, and outcomes of co-occurring depression and HDP remains unknown. Materials and Methods: Using a multiyear (2002-2014) nationwide inpatient sample, we conducted a population-based, cross-sectional study. Cases, behavioral and clinical covariates, and outcomes were identified using International Classification of Disease, 9th Revision, Clinical Modification Codes. Rates of depression and HDP were calculated across demographics, hospital characteristics, and morbidities. We estimated adjusted odds ratios that represent the unique and joint association of depression and HDP with birth outcomes. Joinpoint regression was used to describe temporal trends in depression and HDP. Results: Among the over 58-million hospitalizations, there were 2,346,619 (3.99%), 1,117,857 (1.90%), and 63,081 (0.11%) cases of HDP, depression, and co-occurring depression and HDP, respectively. Compared to pregnant women without depression and HDP, women with depression and HDP were 3.41 times (confidence interval [95% CI]: 3.15-3.68), 1.94 times (95% CI: 1.65-2.27), and 4.10 times (95% CI: 3.89-4.32) more likely to experience intrauterine growth restriction, stillbirth, and preterm labor, respectively, even after adjusting for potential demographic, socioeconomic, and clinical confounders. Depression- and HDP-related hospitalizations resulted in an additional cost of over $5 billion during the study period. Conclusion: Depression and HDP are associated with increased risk of adverse birth outcomes and significant health care cost, with HDP being the main driving factor. Screening for both HDP and depression followed by multidisciplinary care could alleviate the health and economic burden of HDP and depression.


Assuntos
Depressão/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Comorbidade , Estudos Transversais , Feminino , Humanos , Pacientes Internados , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Adulto Jovem
7.
Early Hum Dev ; 136: 21-26, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31295648

RESUMO

BACKGROUND: Meconium aspiration syndrome (MAS) is a leading cause of morbidity and mortality among term, otherwise healthy newborns, yet population studies are rare. Definitions, outcomes and International Classification of Diseases (ICD) codes are heterogenous, complicating estimates of incidence, outcomes and risks. AIMS: To measure population incidence, risks and outcomes of MAS by ICD codes. STUDY DESIGN: Retrospective population study. SUBJECTS: Kids Inpatient Database (KID) 2012, a nationally representative weighted sample of newborn discharges in the United States. OUTCOME MEASURES: Incidence, demographic distribution, and comorbidity associated with MAS. RESULTS: In 2012 there were 9295 weighted discharges diagnosed MAS with symptoms (2.49/1000) and 4304 cases without symptoms (1.15/1000). Newborns with symptoms had nearly twice the length of stay (LOS) (6.68 vs 3.65 days, p 0.001) and nearly 3 times the total charges ($44,473 versus $15,461, p < 0.001) as those without symptoms. Incidence of death was over four times higher (7.7/1000 vs 1.7/1000, p < 0.001), persistent pulmonary hypertension 3 times higher (57.6/1000 vs 15.8/1000, p < 0.001), and hypoxic ischemic encephalopathy 5 times higher (6.2/1000 vs 1.2/1000, p < 0.001) among MAS cases with respiratory symptoms than MAS cases without respiratory symptoms. Odds ratio of MAS with symptoms was 1.54 (95% CI 1.39-1.73) for black newborns compared to whites. CONCLUSIONS: Discharge data are useful for providing population estimates of MAS incidence. Prior studies have used consolidated ICD codes for MAS (with and without respiratory symptoms), yet these represent very different disease severities. Combining MAS diagnoses with and without respiratory symptoms misrepresents incidence and disease severity, complicating comparisons of outcomes and prevention strategies.


Assuntos
Síndrome de Aspiração de Mecônio/epidemiologia , Alta do Paciente/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Comorbidade , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Fatores Socioeconômicos , Estados Unidos
8.
Alcohol Alcohol ; 54(4): 386-395, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31206165

RESUMO

AIMS: The aims of this study were to: examine differences in alcoholic cardiomyopathy (ACM) prevalence, temporal trends and the distribution of socio-demographic factors and comorbidities by sex; and investigate differences in selected inpatient outcomes between women and men with ACM. METHODS: We used the 2002-2014 Nationwide Inpatient Sample databases. Overall and sex-specific rates of ACM were estimated across sociodemographic, clinical, and hospital characteristics. Joinpoint regression was used to estimate temporal trends (annual percent change [APC]) of ACM-related hospitalization by sex and race/ethnicity. Adjusted odds ratios (AOR) representing associations between sex and selected ACM outcomes were calculated using survey logistic regression. RESULTS: The rate of ACM among all inpatient men and women was 128 per 100,000 and 17 per 100,000 hospitalizations, respectively. Among women, the rate of ACM remained unchanged during the study period, while for men, there was 1.2% annual reduction from 2002-2010 (APC -1.3, 95% CI: -1.7, -0.8). Women with ACM were more likely than men with ACM to experience depression (AOR=2.24, 95% CI: 2.06-2.43) and anxiety (AOR=1.94, 95% CI: 1.75-2.15), while men with ACM were 21% and 24% more likely than women with ACM to experience 'any heart failure (HF)' and HF with reduced ejection fraction respectively. One in 1,471 hospitalizations were related to ACM with a male-to-female ratio of 8:1. CONCLUSION: Individuals with ACM are at increased likelihood of adverse outcomes. Women with ACM are at increased risk of depression and anxiety, while men are at increased risk of HF.


Assuntos
Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Cardiomiopatia Alcoólica/diagnóstico , Cardiomiopatia Alcoólica/epidemiologia , Caracteres Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/terapia , Cardiomiopatia Alcoólica/terapia , Estudos Transversais , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
J Racial Ethn Health Disparities ; 6(4): 790-798, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30877505

RESUMO

Severe maternal morbidity (SMM) is 50 to 100 times more common than maternal death, and has increased disproportionately among ethnic/racial minority women in the United States. However, specific knowledge about how the types and timing of severe maternal morbidities deferentially affect ethnic/racial minority women is poorly understood. This study examines racial/ethnic disparities in severe maternal morbidity during antepartum (AP), intrapartum (IP), and postpartum (PP) hospital admissions in the United States (US) for 2002-2014. We identified AP, IP, and PP hospitalizations in the National Inpatient Sample. Distribution of sociodemographic, behavioral and hospital characteristics, insurance, comorbidities, and SMM occurrence was summarized using descriptive statistics. Through Joinpoint regression, temporal SMM trends of hospitalizations were examined and stratified by race. Multivariate logistic regression assessed the association between race and SMM. We found black women have the highest proportion of SMM across all pregnancy intervals with a 70% greater risk of SMM during AP after adjusting for all cofactors. In the PP period, Hispanic women's risk of SMM is 19% less when compared to white women. Racial/ethnic disparities in SMM vary in timing and SMM type. Systematic investigation is needed to understand risks to black women and the protective factors associated with Hispanic women in the PP. Addressing racial disparities in maternal morbidity and mortality requires national policies and initiatives tailored to black women that address the specific types and timings of life-threatening obstetric complications.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Complicações na Gravidez/etnologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Comorbidade , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Gravidez , Características de Residência , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
10.
J Hypertens ; 36(4): 957-958, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29489618
11.
Circ Heart Fail ; 11(1): e004005, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29330153

RESUMO

BACKGROUND: Heart failure (HF) is a leading cause of maternal morbidity and mortality in the United States, but prevalence, correlates, and outcomes of HF-related hospitalization during antepartum, delivery, and postpartum periods remain unknown. The objective was to examine HF prevalence, correlates, and outcomes among pregnancy-related hospitalizations among women 13 to 49 years of age. METHODS AND RESULTS: We used the 2001 to 2011 Nationwide Inpatient Sample. Rates of HF were calculated by patient and hospital characteristics. Survey logistic regression was used to estimate adjusted odds ratios representing the association between HF and each outcome, stratified by antepartum, delivery, and postpartum periods. Joinpoint regression was used to describe temporal trends in HF and in-hospital mortality. Over 50 million pregnancy-related hospitalizations were analyzed. The overall rate of HF was 112 cases per 100 000 pregnancy-related hospitalizations. Although postpartum encounters represented only 1.5% of pregnancy-related hospitalizations, ≈60% of HF cases occurred postpartum, followed by delivery (27.3%) and antepartum (13.2%). Among postpartum hospitalizations, there was a significant 7.1% (95% confidence interval, 4.4-9.8) annual increase in HF from 2001 to 2006, followed by a steady rate through 2011. HF rates among antepartum hospitalizations increased on average 4.9% (95% confidence interval, 3.0-6.8) annually from 2001 to 2011. Women with a diagnosis of HF were more likely to experience adverse maternal outcomes, as reflected by outcome-specific adjusted odds ratios during antepartum (2.7-25), delivery (6-195), and postpartum (1.5-6.6) periods. CONCLUSIONS: HF is associated with increased risk of maternal mortality and morbidities. During hospitalization, high-risk mothers need to be identified and surveillance programs developed before discharge.


Assuntos
Insuficiência Cardíaca/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Mortalidade Materna , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
12.
J Hypertens ; 36(3): 608-618, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29045342

RESUMO

OBJECTIVES: Hypertensive disorders of pregnancy (HDP) represent the most common cause of maternal-fetal morbidity and mortality. Yet, the prevalence and cost of postpartum (42-day) readmission (PPR) among HDP-complicated pregnancies in the United States remains unknown. This study provides national prevalence and cost estimates of HDP, and examine factors associated with potentially preventable PPR following HDP-complicated pregnancies. METHOD: The 2013 and 2014 Nationwide Readmissions Databases were used to investigate HDP and PPR among delivery hospitalizations to women aged 15-49 years. PPR rates, length of stay, and costs were stratified by four HDP subtypes based on timing and severity of their condition. Survey logistic regression was employed to generate adjusted odds ratios for the association between HDP and PPR. RESULT: In 2013 and 2014, there were 6.3 million delivery hospitalizations; 666 506 (10.6%) were complicated by HDP. Annually, HDP was responsible for higher rates of potentially preventable PPR. Among HDP-complicated pregnancies, the 42-day all-cause PPR rate ranged from 2.5% (gestational hypertension) to 4.6% (superimposed preeclampsia/eclampsia). Compared with normotensive pregnancies, HDP resulted in an excess 404 800 hospital days and inpatient care costs of $731 million. Even after controlling for patient-level and hospital-level confounders, all hypertensive subgroups continued to have at least two-fold, statistically significant, increased odds of potentially preventable PPR. CONCLUSION: HDP is associated with increased risk of PPR and substantial medical costs. Preventive efforts should be made to identify women at increased risk of PPR during hospitalization so that transition care intervention can be initiated.


Assuntos
Eclampsia/epidemiologia , Custos Hospitalares/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Vigilância da População , Pré-Eclâmpsia/epidemiologia , Adolescente , Adulto , Eclampsia/economia , Feminino , Humanos , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Período Pós-Parto , Pré-Eclâmpsia/economia , Gravidez , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
13.
Am J Med ; 131(1): 64-71.e1, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28807713

RESUMO

BACKGROUND: Cardiovascular disease remains a leading cause of pregnancy-associated deaths in the United States. The extent to which increasing opioid use among pregnant women contributes to fatal cardiovascular events is unknown. We examined trends in opioid use among pregnant women over the previous decade and the association between changes in temporal trends in opioid drug use and the incidence of acute cardiac events among mothers. METHODS: In this retrospective analysis of the Healthcare and Cost Utilization Project, we used a 2-stage stratified cluster sampling of all inpatient hospital discharges from nonfederal hospitals from January 1, 2002 through December 31, 2014. The study population comprised pregnant women aged 13-49 years and related hospitalizations, including delivery. The primary exposure of interest was opioid use during pregnancy. The primary outcome was the occurrence of acute myocardial infarction or cardiac arrest during pregnancy or childbirth. RESULTS: Among the estimated 57.4 million pregnancy-related inpatient hospitalizations, 511,469 (approximately 1%) had documented use of opioids, cocaine, and/or amphetamines. There was a 300% increase in the use of opioids during pregnancy over the study period, whereas cocaine consumption significantly decreased and that of amphetamine remained stable. Over the 13-year period, the rise in opioid use paralleled a 50% increase in the incidence of acute cardiac events among mothers. CONCLUSION: Over the previous decade opioid use during pregnancy increased significantly, in parallel with the rise in the incidence of acute cardiac events in pregnancy and childbirth. An effective national policy is needed to address this emerging public health challenge.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Cardiopatias/induzido quimicamente , Complicações na Gravidez/induzido quimicamente , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Gravidez , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias , Estados Unidos
14.
J Immigr Minor Health ; 19(6): 1488-1497, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-27017598

RESUMO

Immigrants are often considered a vulnerable population. Paradoxically, some researchers have reported lower risk of pregnancy-related hypertension (PRH) among immigrants when compared to their non-immigrant counterparts. The lack of consistency and the absence of a synthesis of studies investigating the associations between immigration status and PRH represent a gap in our understanding of socioecological roots of PRH. Of studies published in during the study period, 16 met the inclusion criteria. For each study, we computed relative risks that compared PRH risk by migrant status. The pooled estimate of the relative risk of PRH represented a statistically significantly lower risk among immigrants (RR = 0.74; 95 % CI 0.67, 0.82). The body of evidence indicates that immigrant status is generally associated with reduced risk of PRH. However the strength of this association could vary by country of origin of immigrants.


Assuntos
Eclampsia/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Hipertensão/etnologia , Doença Crônica , Feminino , Humanos , Gravidez , Fatores de Risco
15.
Obstet Gynecol ; 128(4): 880-888, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27607874

RESUMO

OBJECTIVE: To examine the association between pregnancy status and in-hospital mortality after cardiopulmonary resuscitation (CPR) in an inpatient setting. METHODS: We conducted a population-based cross-sectional study using the Nationwide Inpatient Sample databases (2002-2011). International Classification of Diseases, 9th Revision, Clinical Modification codes were used to define cases, comorbidities, and clinical outcomes. Rates of CPR among study groups were calculated by patient and hospital characteristics. Survey logistic regression was used to estimate adjusted odds ratios (ORs) that represent the association between pregnancy status and mortality after CPR. Joinpoint regression was used to describe temporal trends in CPR and mortality rates. RESULTS: During the study period, 5,923 women (13-49 years) received inpatient CPR annually. Cardiopulmonary resuscitation rates increased significantly from 2002 to 2011, by 6.4% and 3.8% annually, for pregnant and nonpregnant women, respectively. In-hospital mortality rates after CPR were lower among pregnant women 49.4% (45.4-53.4) than nonpregnant women 71.1% (70.1-72.2), even after adjusting for confounders (adjusted OR 0.46, 95% confidence interval 0.39-0.56). CONCLUSION: Cardiopulmonary resuscitation in an inpatient pregnant woman is associated with improved survival compared with this procedure in nonpregnant women. Elucidating reasons behind this association could help to improve CPR outcomes in both pregnant and nonpregnant women.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Pacientes Internados , Avaliação de Resultados em Cuidados de Saúde , Assistência Perinatal , Complicações Cardiovasculares na Gravidez/terapia , Adolescente , Adulto , Estudos de Casos e Controles , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/mortalidade , Taxa de Sobrevida , Estados Unidos/epidemiologia , Adulto Jovem
16.
J Matern Fetal Neonatal Med ; 29(7): 1077-82, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25897639

RESUMO

OBJECTIVE: To describe the prevalence, trends, adverse maternal-fetal morbidities and healthcare costs associated with placenta accreta (PA) in the United States (US) between 1998 and 2011. METHODS: A retrospective, cross-sectional analysis of inpatient hospital discharges was conducted using the National Inpatient Sample (NIS). We used International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes to identify both cases of PA and of selected comorbidities. Survey logistic regression was used to assess the association between PA and various maternal-fetal outcomes. Joinpoint regression modeling was used to estimate annual percent changes (APCs) in PA prevalence during the study period. RESULTS: The prevalence of PA from 1998 to 2011 was 3.7 per 1000 delivery-related discharges. After adjusting for known or suspected confounders, PA conferred between a 20% to over a 19-fold increased odds of experiencing an adverse outcome. This resulted in a higher mean, per-hospitalization, cost of inpatient care after adjustment for inflation ($5561 versus $4989), translating into over $115 million dollars in additional inpatient expenditures relative to non-PA affected deliveries from 2001 to 2011. CONCLUSIONS: This study updates recent trends in the prevalence of PA, which is valuable to clinicians and policymakers as they formulate targeted strategies to address factors related to PA.


Assuntos
Doenças Fetais , Custos de Cuidados de Saúde/tendências , Complicações do Trabalho de Parto , Placenta Acreta/economia , Placenta Acreta/epidemiologia , Adulto , Comorbidade/tendências , Estudos Transversais , Feminino , Doenças Fetais/economia , Doenças Fetais/epidemiologia , Doenças Fetais/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/tendências , Humanos , Recém-Nascido , Doenças do Recém-Nascido/economia , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/terapia , Complicações do Trabalho de Parto/economia , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/terapia , Placenta Acreta/terapia , Gravidez , Resultado da Gravidez/economia , Resultado da Gravidez/epidemiologia , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia
17.
J Interpers Violence ; 31(3): 444-64, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25392375

RESUMO

Our purpose was to estimate the national prevalence of intimate partner violence (IPV) among delivery-related discharges and to investigate its association with adverse feto-maternal birth outcomes and delivery-related cost. A retrospective cross-sectional analysis of delivery-related hospital discharges from 2002 to 2009 was conducted using the Nationwide Inpatient Sample (NIS). We used ICD-9-CM codes to identify IPV, covariates, and outcomes. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between IPV and each outcome. Joinpoint regression was used for trend analysis. During the study period, 3,649 delivery-related discharges were diagnosed with IPV (11.2 per 100,000; 95% CI = [10.0, 12.4]). IPV diagnosis during delivery is associated with stillbirth (AOR = 4.12, 95% CI = [2.75, 6.17]), preterm birth (AOR = 1.97, 95% CI = [1.59, 2.44]), fetal death (AOR = 3.34, 95% CI = [1.99, 5.61]), infant with poor intrauterine growth (AOR = 1.55, 95% CI = [1.01, 2.40]), and increased inpatient hospital care cost (US$5,438.2 vs. US$4,080.1) per each discharge, incurring an additional cost of US$4,955,707 during the study period. IPV occurring during pregnancy has a significant health burden to both the mother and infant. Education about IPV; screening at periodic intervals, including during obstetric visits; and ongoing clinical care could help to reduce or eliminate adverse effects of pregnancy-related IPV. Preventing the lifelong consequences associated with IPV can have a positive effect on the overall health of all women and delivery-related health care cost.


Assuntos
Violência por Parceiro Íntimo/economia , Alta do Paciente/economia , Cuidado Pós-Natal/economia , Complicações na Gravidez/economia , Adulto , Estudos Transversais , Feminino , Custos de Cuidados de Saúde , Humanos , Recém-Nascido , Violência por Parceiro Íntimo/estatística & dados numéricos , Modelos Logísticos , Alta do Paciente/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/economia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Saúde da Mulher/economia , Adulto Jovem
18.
J Community Health Nurs ; 32(4): 199-211, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26529105

RESUMO

This study examined the association of self-efficacy and self-regulation with nutrition and exercise behaviors. The study used a cross-sectional design and included 108 participants (54 men, 54 women). Nutrition behaviors (fruit/vegetable consumption, dinner cooking, and restaurant eating) and exercise were measured using total days in last week a behavior was reported. Instruments measuring self-efficacy and self-regulation demonstrated excellent Cronbach's alphas (.93-.95). Path analysis indicated only fruit/vegetable consumption and exercise were associated with self-efficacy and self-regulation. Self-regulation showed direct association with fruit/vegetable consumption and exercise, but self-efficacy had direct association only with exercise. Self-efficacy and self-regulation should be strategically used to promote health behaviors.


Assuntos
Exercício Físico/psicologia , Estado Nutricional , Autoeficácia , Autocontrole/psicologia , Adolescente , Adulto , Estudos Transversais , Dieta/psicologia , Feminino , Frutas , Humanos , Masculino , Pessoa de Meia-Idade , Testes Psicológicos , Inquéritos e Questionários , Verduras , Adulto Jovem
19.
Nurs Econ ; 33(4): 210-8, 232, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26477119

RESUMO

Many breast cancer survivors continue to experience residual symptoms including anxiety, cognitive impairment, depression, fatigue, and pain. In this study, the cost-effectiveness of a Mindfulness-Based Stress Reduction intervention for breast cancer survivors was examined. The cost of the program was assessed from the societal perspective, accounting for both direct medical and patient opportunity costs. The cost per quality-adjusted life year was relatively low compared to the cost-utility findings of other published breast cancer interventions. The program appears to provide for significantly improved health-related quality of life at a comparativelv low cost.


Assuntos
Neoplasias da Mama/psicologia , Análise Custo-Benefício , Atenção Plena , Estresse Psicológico/prevenção & controle , Adulto , Idoso , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
20.
Obesity (Silver Spring) ; 23(11): 2299-308, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26390841

RESUMO

OBJECTIVE: Pre-pregnancy obesity and gestational diabetes mellitus (GDM) are increasingly prevalent independent risk factors for maternal and infant morbidities. However, there is a paucity of information on their joint effects on health outcomes and healthcare costs. METHODS: A population-based retrospective cohort study was conducted in Florida using a validated statewide database covering 1,057,647 infants born between 2004 and 2009. Using generalized linear modeling, joint associations between levels of pre-pregnancy body mass index (BMI) and GDM and maternal complications of pregnancy, adverse birth outcomes, and healthcare costs were examined. The relative excess risk due to interaction was used to describe the direction and magnitude of the BMI-GDM interaction on the additive scale. RESULTS: Increasing pre-pregnancy BMI conferred increasing odds of adverse consequences, as did GDM, and the BMI-GDM interaction was greater than additive for 9 of 14 outcomes. The cost for infants born to women with GDM/obesity-III was 34% higher during the first year compared with those born to women with normal BMI and without GDM. The costs of maternal and infant inpatient care associated with overweight/obesity and GDM totaled over $351 million. CONCLUSIONS: These findings provide further evidence of the importance of lifestyle modifications to decrease rates of obesity and risk factors from GDM.


Assuntos
Índice de Massa Corporal , Diabetes Gestacional/economia , Diabetes Gestacional/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Adulto , Diabetes Gestacional/metabolismo , Feminino , Florida/epidemiologia , Humanos , Lactente , Estilo de Vida , Obesidade/complicações , Obesidade/economia , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/economia , Sobrepeso/epidemiologia , Gravidez , Resultado da Gravidez/economia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
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