Age-standardized Admission Rates Research Articles

Hospital admission and mortality rates for ischemic heart disease in Thailand: 2012-2021.

To provide an update on the epidemiology of ischemic heart disease (IHD), including the age-standardized rates of hospital admission and mortality for IHD in Thailand from 2012 to 2021, using the Ministry of Public Health National database. The overall age-standardized hospital admission rate for IHD decreased from 427.5 per 100,000 people in 2012 to 390.5 per 100,000 in 2021. In men, the age-standardized hospital admission rate was 462.7 per 100,000 people in 2012, reaching 485.8 per 100,000 in 2021,pfor trend = 0.141. In women, the age-standardization hospital admission rate for IHD dropped by 24.1% over the decade (pfor trend = 0.008). The overall age-standardized IHD mortality rate in 2012 was 23.4 per 100,000 people, peaked at 28.6 per 100,000 in 2016, and reached 26.9 per 100,000 in 2021, p for trend = 0.181. In men, the age-standardized IHD mortality rate rose by 26.6% over a decade,pfor trend = 0.004. The age-standardized IHD mortality rate among women was consistent from 2012 to 2021,pfor trend = 0.130. However, for people aged < 60, rising trends in IHD mortality rates over a decade were observed; it rose by 59.6% in men and 36.1% in women.

Trends in hospital admissions for chronic obstructive pulmonary disease over 16 years in Canada.

Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition, and the rate of hospital admissions for COPD is an indicator of the quality of outpatient care. We sought to determine long-term trends in hospital admissions for COPD in Canada. Using a comprehensive national database of hospital admissions in Canada, we identified those with a main discharge diagnosis of COPD for patients aged 40 years and older between 2002 and 2017. We calculated sex-specific, age-standardized trends in annual rates of hospital admissions for COPD separately for younger (40-64 yr) and older adults (≥ 65 yr). We used spline regression to examine changes in the admissions trends for each sex and age group. Over 16 years, 1 134 359 hospital admissions were for COPD. Between 2002 and 2017, the total number of admissions increased by 68.8%, from 52 937 to 89 384. The overall crude admission rate increased by 30.0%, from 368 to 479 per 100 000 population, and the sex-and age-standardized admission rate increased by 9.6%, from 437 to 479 per 100 000 population. Age-standardized rates increased by 12.2% among younger females, by 24.4% among younger males and by 29.8% among older females, but decreased by 9.0% among older males. Over the same period, the all-cause sex-and age-standardized admission rate declined by 23.0%. Hospital admissions for COPD have increased since 2010, even after adjusting for population growth and aging, and despite declining rates of all-cause hospital admissions. The secular increase in COPD admissions indicates that the burden of COPD on Canadian health care systems is increasing.

The Changing Epidemiology of Adrenal Insufficiency: Iatrogenic Factors Predominate

Adrenal insufficiency (AI)-related morbidity persists despite efforts to minimize its effect. Reasons for this are unknown and warrant examination. This work aimed to investigate trends in AI hospitalizations and glucocorticoid (GC) replacement therapy use. Data on hospitalizations for a principal diagnosis of AI and prescriptions for short-acting GCs between 2000 and 2019 were extracted from national repositories. Age-standardized admission and prescription rates were calculated using census data. Rates were compared over time overall and according to age, sex, and disease subtype. AI admissions increased by 62.0%, from 36.78/million to 59.59/million (trend P < .0001). Adrenal crisis (AC) admissions also increased, by 90.1% (from 10.73/million to 20.40/million; trend, P < .00001). These increases were more pronounced in the second decade. Prescriptions for short-acting GCs also increased (by 67.2%, from 2198.36/million in 2000/2001 to 3676.00/million in 2017/2018). Females had higher average admission rates and a greater increase in admission rates than males. Increased AI admissions were found in all age groups among females but only in men aged 70+ yrs. Secondary AI (SAI) admission rates increased by 91.7%, whereas admission rates for primary AI (PAI) remained unchanged. The prevalence of AI and hospitalizations for this disorder (including ACs) have increased since 2000, with a greater increase occurring after 2010. Admission rates for SAI increased but PAI admissions remained stable. Possible causes include immunotherapies for malignancy, increased cranial imaging detecting pituitary tumors and their subsequent treatment, and increased use of low-dose, short-acting GC-replacement therapy.

Health Resource Utilisation and Disparities: an Ecological Study of Admission Patterns Across Ethnicity in England Between 2017 and 2020

Background and AimThe COVID-19 pandemic highlighted adverse outcomes in Asian, Black, and ethnic minority groups. More research is required to explore underlying ethnic health inequalities. In this study, we aim to examine pre-COVID ethnic inequalities more generally through healthcare utilisation to contextualise underlying inequalities that were present before the pandemic.DesignThis was an ecological study exploring all admissions to NHS hospitals in England from 2017 to 2020.MethodsThe primary outcomes were admission rates within ethnic groups. Secondary outcomes included age-specific and age-standardised admission rates. Sub-analysis of admission rates across an index of multiple deprivation (IMD) deciles was also performed to contextualise the impact of socioeconomic differences amongst ethnic categories. Results were presented as a relative ratio (RR) with 95% confidence intervals.ResultsAge-standardised admission rates were higher in Asian (RR 1.40 [1.38–1.41] in 2019) and Black (RR 1.37 [1.37–1.38]) and lower in Mixed groups (RR 0.91 [0.90–0.91]) relative to White. There was significant missingness or misassignment of ethnicity in NHS admissions: with 11.7% of admissions having an unknown/not-stated ethnicity assignment and ‘other’ ethnicity being significantly over-represented. Admission rates did not mirror the degree of deprivation across all ethnic categories.ConclusionsThis study shows Black and Asian ethnic groups have higher admission rates compared to White across all age groups and when standardised for age. There is evidence of incomplete and misidentification of ethnicity assignment in NHS admission records, which may introduce bias to work on these datasets. Differences in admission rates across individual ethnic categories cannot solely be explained by socioeconomic status. Further work is needed to identify ethnicity-specific factors of these inequalities to allow targeted interventions at the local level.

Trends in hospitalizations due to endometriosis in Spain, 1999-2019

ABSTRACT Objective Although there have been variations in the management of the patients with endometriosis, an important population of these women still require hospitalization . This study aimed to analyze the trends in hospital admissions associated with endometriosis from 1999 to 2019 in Spain. Methods An observational study of temporal trends was performed including women aged 15 to 54 years who were admitted to hospital for endometriosis in Spain from 1999 to 2019. Data on hospitalizations were drawn from the minimum basic data set. The data source used for the population was the continuous civil registry. The study variables were: age, year of admission, type of admission (elective/emergency), if there was surgical intervention during admission and length of hospital stay. Direct age-standardized admission rates were calculated using the 2013 European Standard Population differentiating between hospital admissions for elective surgery and any emergency admissions. Joinpoint regression models were fitted to estimate the annual percent change (APC). Results Admissions for elective surgery increased significantly, by 5.7% annually, until 2003, when they began to decrease slightly at different speeds until 2019. The mean APC for the entire study period was −0.88% (95%CI: −2.74; 1.02). There was a significant mean decrease of 4% in annual emergency admissions until 2012. Then, there was a significant average increase of 2% per year until 2019. Regarding the length of stay, there was a gradual decrease until 2012, after which slight, oscillating increases were apparent. Conclusion There was a reduction of hospital admissions for elective surgery to treat endometriosis from 2003 to 2019 in Spain but emergency hospitalizations due to endometriosis have been growing since 2012. The mean length of hospital decreased for the study period.

Patterns of emergency admission for IBD patients over the last 10 years in Lothian, Scotland: a retrospective prevalent cohort analysis.

SummaryObjectiveIt is unclear how the compounding prevalence of inflammatory bowel disease (IBD) has translated into the causes and rates of hospitalisation, particularly in an era of increased biologic prescribing. We aimed to analyse these trends in a population‐based IBD cohort over the last 10 years.DesignThe Lothian IBD registry is a complete, validated, prevalent database of IBD patients in NHS Lothian, Scotland. ICD‐10 coding of hospital discharge letters from all IBD patient admissions to secondary care between 1 January 2010 and 31 December 2019 was interrogated for admission cause, with linkage to local/national data sets on death and prescribed drugs.ResultsFifty‐seven per cent (4673/8211) of all IBD patients were admitted to secondary care for >24 h between 1 January 2010 and 31 December 2019. In patients <40 years, IBD was the commonest reason for admission (38% of admissions), whereas infection was the most common cause in those >60 years (19% of admissions). Three per cent (243/8211) of IBD patients accounted for 50% of the total IBD bed‐days over the study period.Age‐standardised IBD admission rates fell from 39.4 to 25.5 admissions per 100,000 population between 2010 and 2019, an average annual percentage reduction of 3% (95% CI −4.5% to −2.1%, p < 0.0001). Non‐IBD admission rates were unchanged overall (145–137 per 100,000 population) and specifically for serious (hospitalisation) and severe (ITU admission or death) infection over the same period.ConclusionDespite compounding prevalence and increased biologic use, IBD admission rates are falling. The cause of admission varies with age, with infection the predominant cause in older patients.

Hospitalization Trends for Acute Appendicitis in Spain, 1998 to 2017.

The incidence of acute appendicitis decreased in Western countries from 1930 to at least the early 1990s, when epidemiological data started becoming scarcer. This study aimed to assess the trend in annual hospitalizations for acute appendicitis in all people Spain for a 20-year period between 1998 and 2017. This observational study analyzing direct age-standardized hospital admission rates by gender and age group (0–14 years, 15–34 years, 35–44 years, 45–64 years, and ≥65 years). Joinpoint regression models were fitted to evaluate changes in trends. There were 789,533 emergency hospital admissions for acute appendicitis between 1998 and 2017: 58.9% in boys and men and 41.1% in girls and women. Overall, there was a significant increase in admissions for this cause from 1998 to 2009, with an annual percent change (APC) of 0.6%. Following the peak in 2009, admission rates decreased by around 1.0% annually until 2017. The length of hospital stay gradually decreased from 4.5 days in 1998 to 3.4 days in 2017. The trends in hospital admissions for acute appendicitis in Spain changed over the study period, decreasing from 2009, especially in people younger than 35 years.

Health disparities of critically ill children according to poverty: the Korean population-based retrospective cohort study

BackgroundThere is a lack of nationwide studies on critically ill patients’ health disparity under the National Health Insurance (NHI) system. We evaluated health disparities in intensive care unit (ICU) admission, outcomes, and readmission in impoverished children.MethodsWe conducted a retrospective cohort study using a national database from the Korean NHI and Medical Aid Program (MAP). MAP supports the population whose household income is lower than 40% of the median Korean household income. We defined poverty as being a MAP beneficiary and compared the poverty and non-poverty groups. Patients between 28 days and 18 years old who were admitted to the ICU were included. Hospital mortality and readmission were analyzed with adjustment for patient characteristics, hospital type, and management procedures.ResultsOut of 17,893 patients, 1153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There was more age-standardized mortality in the poverty group (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group did not have a statistically different risk of adjusted in-hospital mortality to those in the non-poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84–1.55) but had a higher readmission rate (hazard ratio 1.25, CI 1.09–1.42).ConclusionUnder the NHI system, the disparity in pediatric critical care outcomes according to poverty is not definite, but the healthcare disparity in pre- and post-hospital care is a concern. Further studies are required to improve pre- and post-hospital healthcare quality of impoverished children.

Association Between Poverty and Intensive Care Unit Admission and Clinical Outcomes Among Critically Ill Patients: A Nationwide Cohort Study

Background: There have been inconsistent results regarding the impact of poverty on clinical outcomes in critically ill patients. This study was conducted to evaluate the association between poverty and clinical outcomes among critically ill patients. Methods: We used the claims data between 2008, and 2015, which covers all ICU admissions in Korea (N = 1,657,218). The patients who were Medical Aid beneficiaries at the time of ICU admission were considered as the poverty group. Study outcomes were ICU admission, in-hospital mortality, readmission to hospital/ICU, and visit to emergency room (ER) within 3 and 12 months of discharge. Results: The age-standardized ICU admission rate were higher in the poverty group than in the non-poverty group (1,716.1 vs. 465.4 per 100,000 persons). The risk of in-hospital mortality was higher in the poverty group than in the non-poverty group (Odds Ratio: 1.10; 95% CI, 1.09-1.12) adjusting for age, sex, comorbidity, severity, region, admission type, type of hospital, and ICU quality. The risks of readmission to the hospital (HR: 1.26; 95% CI, 1.25-1.26), ICU (HR: 1.17; 95% CI, 1.15-1.19) and ER visit (1.17; 95% CI, 1.16-1.19) after 12 months of discharge were higher in the poverty group than in the non-poverty group. Interpretation: Patients in the poverty group were more likely to be admitted to the ICU and visit low-quality hospitals than non-poverty group patients. Poverty group patients were more likely to die than non-poverty group patients and experience worse outcome after discharge. Funding Statement: Ministry of Health & Welfare, Republic of Korea Declaration of Interests: None declared. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of Samsung Medical Center (2015-11-017).

Trends in Hospital Admissions for Chronic Obstructive Pulmonary Disease in Men and Women in Spain, 1998 to 2018.

The prevalence of chronic obstructive pulmonary disease (COPD) is rising faster in women in some countries. An observational time trends study was performed to assess the evolution of hospital admissions for COPD in men and women in Spain from 1998 to 2018. ICD-9 diagnostic codes (490–492, 496) from the minimum basic data set of hospital discharges were used. Age-standardised admission rates were calculated using the European Standard Population. Joinpoint regression models were fitted to estimate the annual percent change (APC). In 2018, the age-standardised admission rate per 100,000 population/year for COPD was five times higher in men (384.8, 95% CI: 381.7, 387.9) than in women (78.6, 95% CI: 77.4, 79.9). The average annual percent change (AAPC) was negative over the whole study period in men (−1.7%/year, 95% CI: −3.1, −0.2) but positive from 2010 to 2018 (1.1%/year, 95% CI: −0.8, 2.9). In women, the APC was −6.0% (95%CI: −7.1, −4.9) from 1998 to 2010, but the trend reversed direction in the 2010–2018 period (7.8%/year, 95% CI: 5.5, 10.2). Thus, admission rates for COPD decreased from 1998 to 2010 in both men and women but started rising again until 2018, modestly in men and sharply in women.

Socio-demographic characteristics associated with hospitalization for sepsis among adults in Canada: a Census-linked cohort study.

Sepsis is a considerable health system burden. Population-based epidemiological surveillance of sepsis is limited to basic data available in administrative databases. We sought to determine if routinely collected Census data, linked to hospitalization data, can provide a broad socio-demographic profile of patients admitted to Canadian hospitals with sepsis. Linking the 2006 long-form Canadian Census (most recent available for linkage) to the Discharge Abstract Data from 2006/2007 to 2008/2009, we created a population-based cohort of approximately 3,433,900 Canadians. Patients admitted to hospital with sepsis were identified using the Canadian Institute for Health Information administrative data definition. Age-standardized hospital admission rates for sepsis were calculated. Multivariable modelling was used to examine the relationship between Census characteristics and hospitalization with sepsis. Of those individuals successfully linked to the 2006 long-form Canadian Census, 10,400 patients of 18 yr and older were admitted to hospital with sepsis between the fiscal years 2006/2007 and 2008/2009. These individuals represented a weighted count of approximately 49,000 Canadians from all provinces and territories, excluding Quebec. The age-standardized rate of sepsis hospitalization was 96 cases/100,000 population. Of these, 37/100,000 cases were classified as severe sepsis. The association of Census characteristics with sepsis hospitalization varied with age. In all age-specific models, male sex, never being married, visible minority status, having functional limitations, and not being in the labour force were associated with an increased odds of hospital admission. Census data identified broad socio-demographic risk factors for admission to hospital with sepsis. Consideration should be given to incorporating Census data linked to administrative hospital data in population-based epidemiologic surveillance.

Age-Specific Distribution of Diagnosis and Outcomes of Children Admitted to ICUs: A Population-Based Cohort Study.

Although several studies have reported outcome data on critically ill children, detailed reports by age are not available. We aimed to evaluate the age-specific estimates of trends in causes of diagnosis, procedures, and outcomes of pediatric admissions to ICUs in a national representative sample. A population-based retrospective cohort study. Three hundred forty-four hospitals in South Korea. All pediatric admissions to ICUs in Korea from August 1, 2009, to September 30, 2014, were covered by the Korean National Health Insurance Corporation, with virtually complete coverage of the pediatric population in Korea. Patients less than 18 years with at least one ICUs admission between August 1, 2009, and September 30, 2014. We excluded neonatal admissions (< 28 days), neonatal ICUs, and admissions for health status other than a disease or injury. The final sample size was 38,684 admissions from 32,443 pediatric patients. None. The overall age-standardized admission rate for pediatric patients was 75.9 admissions per 100,000 person-years. The most common primary diagnosis of admissions was congenital malformation (10,897 admissions, 28.2%), with marked differences by age at admission (5,712 admissions [54.8%] in infants, 3,994 admissions [24.6%] in children, and 1,191 admissions [9.9%] in adolescents). Injury was the most common primary diagnosis in adolescents (3,248 admissions, 27.1%). The overall in-hospital mortality was 2,234 (5.8%) with relatively minor variations across age. Neoplasms and circulatory and neurologic diseases had both high frequency of admissions and high in-hospital mortality. Admission patterns, diagnosis, management, and outcomes of pediatric patients admitted to ICUs varied by age groups. Strategies to improve critical care qualities of pediatric patients need to be based on the differences of age and may need to be targeted at specific age groups.

THU-431-The burgeoning growth in cirrhosis-related hospitalization in Australia, 2008-2016

Background and aims:While chronic liver disease is a major global public health problem, it has not been recognized as a National Health Priority Area in Australia. A population-based study using hospital admission data for cirrhosis in the large state of Queensland, Australia during 2008-2016 was performed. Method:Hospital data on all patient admissions (public and private)and deaths during 2008-2016 in the state of Queensland were obtained. Queensland is a large state in the north-east of Australia with a population of 4.9 million. We identified all hospital admissions for cirrhosis for patients aged 20 years or older. We reported age-standardized hospitalization rates/10, 000 person-years by gender and per calendar year, in-hospital case fatality rate among these admissions (n = 30, 327) and examined the factors associated with hospital deaths. Results:Age-adjusted hospitalization rates increased by 32%between 2008 and 2016, from 8.50/10, 000 (95%CI 8.18-8.82) to11.21/10, 000 (95%CI 10.87-11.54). Admission rates peaked in men at34.03/10, 000 in 55-59 year-olds. The age-standardized admission rate for Indigenous Australians was 32.79/10, 000 (95%CI 31.28-34.31). Alcohol misuse was a contributing factor in over half (55.1%) of all admissions, and in 26.8% of admissions patients resided in most socio-economically disadvantaged areas. The overall in-hospital case fatality rate was 9.7% for males and 9.3% for females, and decreased significantly in males from 10.25% in 2008 to 8.32% in 2016 (p Conclusion:Our data highlights the increasing healthcare use by Australians with cirrhosis and this has major resource and economic implications. Greater awareness and emphasis on preventive care is needed to reduce the increasing prevalence of cirrhosis and the personal, social and economic burden of its complications.

The epidemiology of non-viral gastroenteritis in New Zealand children from 1997 to 2015: an observational study

BackgroundAcute gastroenteritis is a substantial cause of hospitalization in children. Shigella, Salmonella, Campylobacter, Yersinia, enterotoxigenic Escherichia coli (ETEC), Giardia and Cryptosporidium are gastrointestinal pathogens that are notifiable in New Zealand (NZ). The impact of these infections in the pediatric population has not yet been analyzed. The aim of this study was to describe the epidemiological trends in disease notifications and hospital admissions due to non-viral gastroenteritis in NZ children.MethodsIn this population-based descriptive study, age-specific and age-standardized notification and hospital admission rates were analyzed from 1997-to-2015 for Shigella, Salmonella, Campylobacter, Yersinia, ETEC, Giardia and Cryptosporidium infections in children < 15 years of age. Variations in disease by gender, age, ethnicity and geography were described.ResultsFrom 1997-to-2015 there were 74,454 notifications (57.6% male) and 3192 hospitalizations (56.4% male) due to non-viral gastroenteritis in NZ children aged < 15 years. There was an overall trend towards a reduction in disease notifications and hospitalizations, however each disease showed a unique pattern of change over time. Campylobacter was the pathogen most frequently notified, accounting for 51.7% of notifications and 43.4% of hospitalizations. The hospitalization-to-notification ratios were, from highest to lowest, Salmonella typhi (1:1.09), Shigella (1:4.0), ETEC (1:7.81), nontyphoidal Salmonella (1:13.1), Campylobacter (1:27.8), Yersinia (1:29.2), Cryptosporidium (1,33.4), and Giardia (1,72.5). Compared to females, male notification rates were approximately 40% higher for Campylobacter, 25% higher for Giardia and Yersinia, and 15% higher for Cryptosporidium and nontyphoidal Salmonella (p < 0.001). Notification rates were highest in children 1–4 years, with the exceptions of nontyphoidal Salmonella, Salmonella typhi and Yersinia. Notification rates for nontyphoidal Salmonella and Yersinia were highest in children < 1 year, and for Salmonella typhi those aged 5–9 years. Children < 1 year were most likely to be hospitalized.ConclusionsThe incidence of non-viral gastroenteritis in NZ children reduced during the 19-year period considered. The burden of disease was highest in the community, with only a small percentage of cases requiring hospitalization. This study provides important insight into the non-viral causes of gastroenteritis in NZ children and how environmental influences and changes in food safety practices may have helped to reduce the burden of these diseases in children.

The impact of the Danish smoking ban from 2007 on smoking-related morbidity. A register-based natural experiment

Introduction The number of countries introducing national tobacco control policies has increased. In terms of both countries and population covered, smoking bans in public settings that protect nonsmokers from second hand tobacco smoke, create supportive environments that encourage smoking cessation, and prevent smoking initiation, represents the one tobacco control policy with the greatest progress since 2007. Extensive research has documented the impact of smoke-free policies on preventing adverse health outcomes, especially cardiovascular diseases, reducing exposure to second hand tobacco smoke and decreasing smoking-related mortality. In 2007, Denmark introduced a national smoking ban, prohibiting all indoor smoking in workplaces and public places. However, little is known about the impact of this smoking ban over time on smoking-related morbidity in the Danish population. This study investigates the effect of the Danish smoking ban on hospital admissions for acute myocardial infarction (AMI), chronic obstructive pulmonary disorder (COPD) and cancer in oral cavity and pharynx. We hypothesized that admission rates decreased after the introduction of the Danish smoking ban in 2007 compared to pre-legislation. Methods This study was designed as a natural experiment in which the whole Danish population form the study population (> 30 years). Interrupted time series analysis was performed to quantify changes in-hospital admission rates for AMI, COPD and cancer in oral cavity and pharynx, pre- and post the introduction of the national smoking ban. Monthly age-standardised admission rates per 100,000 inhabitants were estimated for each diagnosis and two subperiods defined: pre-legislation (January 2000 to August 2007) and post-legislation (September 2007 to December 2015). As an immediate change in admission rates after the introduction of the smoking ban was not expected, increases or decreases in the slope of the trend after the introduction of the ban were compared with pre-legislative trends. Diagnostic information was obtained from the Danish National Patient Register and information on demographics was obtained from the Danish Civil Registration System. The exposure was defined as the introduction of the smoking ban in August 2007 and the outcome as hospital admissions during the study period 2000–2015 due to a primary diagnosis of AMI (I21), COPD (J44) and cancer in oral cavity and pharynx (C06-C06.9, C14). Results We found no significant changes in trends for hospital admissions for any of the included smoking-related diseases after the introduction of the smoking ban compared to post-legislation trends. To exemplify, a steady decrease in-hospital admissions for AMI was observed during the study period suggesting that the decrease in AMI admissions at the time the smoking ban was introduced represented a continuation of a pre-existing trend. Conclusion The findings may be explained by the fact that the smoking ban included several exceptions resulting in a less comprehensive ban compared to other countries.

A retrospective cohort study to compare post-injury admissions for infectious diseases in burn patients, non-burn\xa0trauma patients and uninjured people

BackgroundInjury triggers a range of systemic effects including inflammation and immune responses. This study aimed to compare infectious disease admissions after burn and other types of injury using linked hospital admissions data.MethodsA retrospective longitudinal study using linked health data of all patients admitted with burns in Western Australia (n = 30,997), 1980–2012, and age and gender frequency matched cohorts of people with non-burn trauma (n = 28,647) and no injury admissions (n = 123,399). Analyses included direct standardisation, negative binomial regression and Cox proportional hazards regression.ResultsAnnual age-standardised infectious disease admission rates were highest for the burn cohort, followed by the non-burn trauma and uninjured cohorts. Age-standardised admission rates by decade showed different patterns across major categories of infectious diseases, with the lower respiratory and skin and soft tissue infections the most common for those with burns and other open trauma. Compared with the uninjured, those with burns had twice the admission rate for infectious disease after discharge (incident rate ratio (IRR), 95% confidence interval (CI): 2.04, 1.98–2.11) while non-burn trauma experienced 1.74 times higher rates (95%CI: 1.68–1.81). The burn cohort experienced 10% higher rates of first-time admissions after discharge when compared with the non-burn trauma (hazard ratio (HR), 95%CI: 1.10, 1.05–1.15). Compared with the uninjured cohort, incident admissions were highest during the first 30 days after discharge for burns (HR, 95%CI: 5.18, 4.15–6.48) and non-burn trauma (HR, 95%CI: 5.06, 4.03–6.34). While incident rates remained high over the study period, the magnitude decreased with increasing time from discharge: burn vs uninjured: HR, 95%CI: 30 days to 1 year: 1.69, 1.53–1.87; 1 to 10 years: 1.40, 1.33–1.47; 10 years to end of study period: 1.16, 1.08–1.24; non-burn trauma vs uninjured: HR, 95%CI: 30 days to 1 year: 1.71, 1.55–1.90; 1 to 10 years: 1.30, 1.24–1.37; 10 years to end of study period: 1.09, 1.03–1.17).ConclusionsBurns and non-burn trauma patients had higher admission rates for infectious diseases compared with age and gender matched uninjured people. The pattern of annual admission rates for major categories of infectious diseases varied across injury groups. Overall, the burn cohort experienced the highest rates for digestive, lower respiratory and skin and soft tissue infections. These results suggest long-term vulnerability to infectious disease after injury, possibly related to long-term immune dysfunction.

Socioeconomic changes in Brazil impacted breast cancer indexes at the beginning of the 21st century?

ObjectivesTo analyze the relationship between Socioeconomic development, income inequality and breast cancer mortality in Brazil. SettingEcological study. ParticipantsBrazilian Women Primary and secondary outcome measures: Age-standardized Hospital admission rates and mortality due to breast cancer in Brazilian Women's were analyzed. Deaths due to breast cancer were obtained from Department of Informatics of the Unified Health System. Human Development Index (HDI) and Gini Index were obtained from the United Nations Development Program. The gross domestic product was obtained from the World Bank. The period was between 2010 and 2014. The annual percentage change (APC) and average annual percentage change (AAPC) were estimated. Linear regression adjusted for income per capita was performed. ResultsThere was a significant increase of 14.5% in breast cancer mortality (AAPC, 3%; 95% CI, 2–3%), an increase of 21.4% in the hospital admission rate (AAPC, 5%; 95% CI, 1–10%), a 4.6% decrease in the Gini index (AAPC, −0.09; 95% CI, 0.10 to −1.0%), and a 5.4% increase in the HDI (AAPC, 6%; 95% CI, 6–7%). Besides, the increase of 0.01 in the HDI is related to an increase of 1.4 deaths per 100,000 women. ConclusionsHuman Development Index was related to increases in breast cancer mortality in Brazil. Besides, the changes in income inequality indexes occurred in Brazil were not sufficient to impact the age-standardized mortality and hospital admission rate due to breast cancer.

Ambient soil cation exchange capacity inversely associates with infectious and parasitic disease risk in regional Australia

Human contact with soil may be important for building and maintaining normal healthy immune defence mechanisms, however this idea remains untested at the population-level. In this continent-wide, cross-sectional study we examine the possible public health benefit of ambient exposures to soil of high cation exchange capacity (CEC), a surrogate for potential immunomodulatory soil microbial diversity. We compare distributions of normalized mean 2011/12–2012/13 age-standardized public hospital admission rates (cumulative incidence) for infectious and parasitic diseases across regional Australia (representing an average of 29,516 patients/year in 228 local government areas), within tertiles of socioeconomic status and soil exposure. To test the significance of soil CEC, we use probabilistic individual-level environmental exposure data (with or without soil), and group-level variables, in robust non-parametric multilevel modelling to predict disease rates in unseen groups. Our results show that in socioeconomically-deprived areas with high CEC soils, rates of infectious and parasitic disease are significantly lower than areas with low CEC soils. Also, health inequality (relative risk) due to socioeconomic status is significantly lower in areas with high CEC soils compared to low CEC soils (Δ relative risk = 0.47; 95% CI: 0.13, 0.82). Including soil exposure when modelling rates of infectious and parasitic disease significantly improves prediction performance, explaining an additional 7.5% (Δ r2 = 0.075; 95% CI: 0.05, 0.10) of variation in disease risk, in local government areas that were not used for model building. Our findings suggest that exposure to high CEC soils (typically high soil biodiversity) associates with reduced risk of infectious and parasitic diseases, particularly in lower socioeconomic areas.

A nationwide analysis of intensive care unit admissions, 2009–2014 – The Korean ICU National Data (KIND) study

PurposeTo evaluate unbiased information on the characteristics, procedures, and outcomes of intensive care unit (ICU) admissions in a long-term nationwide study. Materials and methodsCohort study of all ICU admissions in patients >18years of age in Korea between August 1, 2009 and September 30, 2014 (1,553,673 ICU admissions in 1,265,509 patients). ResultsFrom August 2009 to September 2014, the age-standardized ICU admission rate was 744.6 per 100,000 person-years (869.5 per 100,000 person-years in men and 622.0 per 100,000 person-years in women). The overall in-hospital mortality was 13.8% (14.1% in men and 13.5% in women). Among all Koreans, the ICU mortality rate was 102.9 per 100,000 person-years (122.5 per 100,000 person years in men and 83.8 per 100,000 person years in women). The median ICU and hospital length of stay were 4 and 13days, respectively. The median cost per ICU admission was $5051, which increased steadily over the study period. There were marked differences by gender in ICU admission rates, aggressive support, and outcomes. ConclusionsOur study identified increasing trends in ICU admissions and utilization of advance life support systems that add to the burden of care in a developed society.

30-year trends in admission rates for encephalitis in children in England and effect of improved diagnostics and measles-mumps-rubella vaccination: a population-based observational study

Encephalitis is a serious neurological disorder, yet data on admission rates for all-cause childhood encephalitis in England are scarce. We aimed to estimate admission rates for childhood encephalitis in England over 33 years (1979-2011), to describe trends in admission rates, and to observe how these rates have varied with the introduction of vaccines and improved diagnostics. We did a retrospective analysis of hospital admission statistics for encephalitis for individuals aged 0-19 years using national data from the Hospital Inpatient Enquiry (HIPE, 1979-85) and Hospital Episode Statistics (HES, 1990-2011). We analysed annual age-specific and age-standardised admission rates in single calendar years and admission rate trends for specified aetiologies in relation to introduction of PCR testing and measles-mumps-rubella (MMR) vaccination. We compared admission rates between the two International Classification of Diseases (ICD) periods, ICD9 (1979-94) and ICD10 (1995-2011). We found 16 571 encephalitis hospital admissions in the period 1979-2011, with a mean hospital admission rate of 5·97 per 100 000 per year (95% CI 5·52-6·41). Hospital admission rates declined from 1979 to 1994 (ICD9; annual percentage change [APC] -3·30%; 95% CI -2·88 to -3·66; p<0·0001) and increased between 1995 and 2011 (ICD10; APC 3·30%; 2·75-3·85; p<0·0001). Admissions for measles decreased by 97% (from 0·32 to 0·009) and admissions for mumps encephalitis decreased by 98% (from 0·60 to 0·01) after the introduction of the two-dose MMR vaccine. Hospital admission rates for encephalitis of unknown aetiology have increased by 37% since the introduction of PCR testing. Hospital admission rates for all-cause childhood encephalitis in England are increasing. Admissions for measles and mumps encephalitis have decreased substantially. The numbers of encephalitis admissions without a specific diagnosis are increasing despite availability of PCR testing, indicating the need for strategies to improve aetiological diagnosis in children with encephalitis. None.