All-payer Administrative Database Research Articles

Metabolic Syndrome Components and Its Impact on Acute Kidney Injury After Total Joint Arthroplasty

BackgroundMetabolic syndrome (MetS) is an independent risk factor for postoperative complications. This study aimed to evaluate the associated risk of MetS for perioperative complications, especially urinary complications, in patients who underwent primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). MethodsWe used a publicly available all-payer administrative database to identify patients undergoing TKA and THA from 2016 to 2020. The primary exposure of interest was MetS. Multivariable adjusted models based on propensity score matching were used to evaluate the association of MetS components with acute kidney injury (AKI), urinary tract infection (UTI), and acute posthemorrhagic anemia (APHA) in patients who underwent TKA and THA. A counterfactual-based mediation analysis was conducted to investigate the mediating effect of APHA on the relationship between MetS and AKI. ResultsThe analysis included 2,097,940 (16.4% with MetS) THA and 3,073,310 (24.0% with MetS) TKA adult hospitalizations. Multivariable adjustment analysis indicated MetS was associated with an increased risk of AKI (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.69 to 1.89 for THA; OR 1.88, 95% CI 1.79 to 1.96 for TKA), UTI (OR 1.13, 95% CI 1.03 to 1.23 for THA; OR 1.26, 95% CI 1.17 to 1.35 for TKA), and APHA (OR 1.17, 95% CI 1.14 to 1.20 for THA; OR 1.7, 95% CI 1.15 to 1.19 for TKA). The risk of AKI increased with the number of MetS components, with ORs ranging from 2.58 to 9.46 in TKA patients and from 2.22 to 5.75 in THA patients. This increase was particularly associated with diabetes and hypertension, which were the most significant associated risk factors. Furthermore, APHA mediated the association between MetS and AKI. ConclusionsThe prevalence of MetS is increasing in TKA and THA patients. Metabolic syndrome was associated with increased risk of AKI, UTI, and APHA. The risk of AKI increased with each additional MetS component, with diabetes and hypertension contributing most. In addition, APHA may play a partial mediating role in MetS-induced AKI.

Early Prosthetic Hip Dislocation: Does the Timing of the Dislocation Matter?

BackgroundEarly dislocation following total hip arthroplasty (THA) is a common reason for revision. The purpose of this study was to determine if the acuity of the dislocation episode affects the risk of revision surgery. MethodsA retrospective review of a national, all-payer administrative database comprised of claims from 2010 to 2020 was used to identify patients who had a prosthetic hip dislocation at various postoperative time intervals (0 to 7, 7 to 30, 30 to 60, and 60 to 90 days). Of the 45,352 primary unilateral THA patients who had sufficient follow-up, there were 2,878 dislocations within 90 days. Dislocators were matched 1:1 based on age, sex, and a comorbidity index with a control group (no dislocation). Demographics, surgical indications, comorbidities, ten-year revision rates, and complications were compared among cohorts. Multivariable logistic regression analysis was performed to identify risk factors for revision THA following early dislocation. ResultsAmong matched cohorts, dislocation at any time interval was associated with significantly increased odds of subsequent 10-years revision (OR [odds ratio] = 25.60 to 33.4, P < .001). Acute dislocators within 7 days did not have an increased risk of all cause revisions at 10 years relative to other early dislocators. Revision for indication of instability decreased with time to first dislocation (<7 days: 85.7% versus 60 to 90 days: 53.9%). Primary diagnoses of posttraumatic arthritis (OR = 2.53 [1.84 to 3.49], P < .001), hip fracture (OR = 3.8 [2.53 to 5.72], P < .001), and osteonecrosis (OR = 1.75 [1.12 to 2.73], P = .010) were most commonly associated with revision surgery after an early dislocation. ConclusionsDislocation within 90 days of THA is associated with increased odds of subsequent revision. Early dislocation within 7 days of surgery has similar all cause revision-free survivorship, but an increased risk of a subsequent revision for instability when compared to patients who dislocated within 7 to 90 days

MT27 Comparison of High-Flow Nasal Canula and Non-Invasive Mechanical Ventilation in Treating COVID-19 Patients

The World Health Organization has declared COVID-19 a global pandemic in March 2020. Multiple COVID-19 waves are putting tremendous stress on healthcare systems. Evidence showed that high-flow nasal canula (HFNC) reduced the need for mechanical ventilation and shortened the time to clinical recovery among patients with severe COVID-19. This study aimed to assess the effect of using HFNC compared to non-invasive mechanical ventilation (NIV), on adult patients with COVID-19. This retrospective study included patients hospitalized due to COVID-19 between October 2020 to December 2021 with appropriate ICD-10 diagnosis recorded in a commercially available, all-payer administrative database across 300+ hospitals. The identified patients were divided in two cohorts, one being the patients treated with HFNC as the first line respiratory support and another with NIV. Outcomes included all-cause mortality rate and length of stay. Multivariable analyses were performed to adjust for baseline characteristics. Out of 16,534 eligible patients, 4,334 patients received HFNC as the first line respiratory support, whereas 12,200 received NIV. The all-cause mortality rate was 20.24% and 37.14% in the HFNC and NIV group, respectively. After adjusting for baseline characteristics, the all-cause mortality rate in the HFNC group was lower compared to NIV (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.47-0.55; p<0.001). The total length of stay was around 15 days for all patients. No different was observed between groups ( mean difference 0.3 days; 95% CI, -0.27 – 0.92 days; p>0.05). Patients treated with HFNC showed lower mortality rates compared to NIV for hospitalized COVID-19 patients. However, further studies are still needed to better elucidate the clinical and economic benefit of HFNC in COVID-19 patients.

The Impact of Social Determinants of Health in Pediatric Shunted Hydrocephalus.

Social risk factors have been shown to negatively affect health outcomes in children. However, this has not been characterized regarding pediatric shunted hydrocephalus. To explore the impact of social risk factors on outcomes in pediatric shunted hydrocephalus with the goal of identifying specific areas of intervention that might improve the outcomes of children undergoing cerebrospinal fluid (CSF) diversion. In an all-payer administrative database, records between January 2010 and October 2020 were analyzed to identify children undergoing CSF shunting procedures. Children with social risk factors were compared with those without regarding rates of infection, shunt-related interventions, and mortality within 5 years of their shunting procedure. Among the 5420 children who underwent first-time shunting procedures, 263 (4.9%) were identified to have social risk factors. Children with identified social risk factors had increased odds of central nervous system infection (odds ratio [OR] 2.06, 95% CI 1.45-2.91), revision (OR 2.43, 95% I 1.89-3.12), and mortality (OR 2.86, 95% CI 1.23-5.72). The mean numbers of computed tomography studies (14.60 ± 17.78 vs 6.34 ± 6.10), MRI studies (18.76 ± 24.37 vs 7.88 ± 24.37), and shunt series X-rays (17.22 ± 19.04 vs 7.66 ± 8.54) were increased among children with social risk factors. Children with social risk factors had increased rates of central nervous system infection, shunt-related interventions, and mortality within 5 years of CSF shunting. We underscore the importance of characterizing the impact of social risk factors in specific conditions, such as pediatric shunted hydrocephalus, and look to future directions aimed to mitigate these risk factors with coordination and direction of individualized resources, encouragement of advocacy, and community partnership.

Pre- and Postoperative Risk of Psychiatric Disorders: Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass

Introduction: Previous research has reported that patients undergoing bariatric surgery commonly experience debilitating psychopathology, both in the pre- and postoperative phases. However, it is unknown whether the surgical procedure type (sleeve gastrectomy (SG) vs Roux-en-Y gastric bypass (RYGB)) is associated with a differential risk of psychiatric disorders, providing the objective of our study. Methods: We conducted a retrospective cohort study employing PearlDiver Mariner, a national all-payer administrative database, to identify patients eligible for bariatric surgery who underwent SG or RYGB from January 2010 to October 2020. The differential risk of psychiatric disorders between SG and RYGB patients from one year before to one year after surgery was evaluated using difference-in-differences (DiD) regression. Results: The matched cohort included 34,517 patients in each group. The risk of preoperative psychiatric disorders among RYGB and SG patients was comparable (16% vs 15%). The risk of psychiatric disorders in the postoperative period increased among both groups, but to a larger extent among those who underwent RYGB (75% vs 69%). DiD analysis suggests that RYGB was associated with a 5% absolute increase (p < 0.0001) in the probability of psychiatric disorders, for a relative increase of 33%. Conclusion: This is the first study to compare the risk of psychiatric disorders between RYGB and SG patients in a large cohort. Since psychopathology was not on par between the two groups, patients undergoing bariatric surgery may decide to undergo SG in order to prevent excess risk of psychiatric disorders.

MP58-14 IMMUNOCOMPROMISED PATIENTS ARE NOT AT ELEVATED RISK OF INFLATABLE PENILE PROSTHESIS EXPLANT

INTRODUCTION AND OBJECTIVE: Infection of inflatable penile prostheses (IPP) occurs in 1-3% of cases and is associated with significant morbidity. Immunocompromised men may be at higher risk of infection. We explored reoperation rates [removal, revision or replacement] in immune deficient men to determine if immunocompromised patients are at higher risk of device complications. METHODS: We analyzed men who underwent initial IPP insertion from 2000 to 2016 in the New York Statewide Planning and Research Cooperative System (SPARCS) database, a de-identified, comprehensive, all-payer administrative database that collects patient, physician, and hospital data in New York state. Immune deficient patients were identified using billing codes and sub-stratified into categories of chronic steroid use, organ transplant, use of immune modulating drugs, and other congenital or acquired immune deficiencies (NOS). Immunocompromised men were propensity score matched in a 1:3 fashion with immune competent men based on age, race, insurance, comorbid conditions, procedure year, hospital volume, and disease status using multivariable logistic regression. RESULTS: 234 immune deficient patients were identified who received an IPP between 2000 and 2016. 177 (76.7%) were post-transplant, 29 (12.6%) on chronic steroids, and 29 (12.6%) NOS). Patients on immune modulators were not reportable and subgroup analysis for men on chronic steroids or with immunocompromise NOS was not possible due to sample size. After propensity score matching, we analyzed 230 immunocompromised men and 690 controls. Overall, there were no differences between age, comorbidities, race, type of insurance, year of implant or hospital center volume between cases and controls. Reoperation rate was similar at 90 days (5.0% versus 6.4%, p=0.35), 1 year (8.8% versus 10.0%, p=0.35), and 3 years (11.0% versus 14%, p=0.26) between immunocompromised men and controls. Reoperation rates remained similar in our subgroup analysis of transplant patients (Table 1). CONCLUSIONS: Reoperation rates are similar between immunocompromised men and immune competent controls overall and in men with transplants. Using reoperation rate as a proxy for infection, we conclude that immune status does not place men at higher risk for post IPP infection.Source of Funding: None

Readmissions after Acute Kidney Injury during Left Ventricular Assist Device Implantation Hospitalization

Background: Acute kidney injury (AKI) frequently complicates hospitalizations for left ventricular assist device (LVAD) implantation. Little is known about the relationship of AKI with subsequent readmissions, and we investigated the relationship of AKI during LVAD implantation hospitalization with all-cause and cause-specific 30-day readmissions. Methods: We used a United States (US) nationwide all-payer administrative database, identifying patients who underwent implantable LVAD placement 2010–2015. Patients were classified into 3 mutually exclusive groups based on presence and severity of AKI during the LVAD placement hospitalization: no AKI, AKI, and AKI requiring dialysis (AKI-D). Outcomes were all-cause and cause-specific 30-day readmissions. Results: Within 30 days after discharge 25.4% of patients were readmitted. Of those without AKI, 23.9% were readmitted, compared to 25.5% of those with AKI and 42.2% of those with AKI-D. Compared to no AKI (adjusted for demographics, index hospitalization and chronic comorbidity factors, and year), odds of 30-day readmission were 2.18 (95% CI 1.37–3.49) times higher for those with AKI-D, whereas those with AKI not requiring dialysis had similar 30-day readmission risk (OR 1.03 [95% CI 0.89–1.20]). Those with AKI-D had higher risk of 30-day readmission for infection (OR 2.02 [95% CI 1.13–3.61]), gastrointestinal (GI) bleed (2.32 [95% CI 1.24–4.34]), and kidney disease (13.9 [95% CI 4.0–48]). There was no increased risk for stroke readmission with AKI or AKI-D. Conclusion: AKI-D was associated with highest ­30-day readmission risk, possibly related to negatively synergistic effects of LVAD, kidney dysfunction, and dialysis related factors on infection and GI bleeding risks. AKI alone was not associated with increased readmission risk.

Left Ventricular Assist Device Implantation Site Volume and 30 Day Readmissions

Introduction Readmissions within 30 days of left ventricular assist device (LVAD) implantation are common, contributing to increased morbidity and cost. The relationship between hospital volume and outcomes after LVAD implantation has not been well established. The purpose of this study was to examine 30-day readmission rates after LVAD implantation, stratified by hospital volume, using the Nationwide Readmissions Database (NRD), an all-payer administrative database. Methods Using the 2014 NRD, we examined 1,311 adults discharged following LVAD implantation in January-November 2014. We identified LVAD implantations based on ICD-9-CM procedure code 37.66 and excluded patients with concurrent ICD-9-CM codes of heart transplantation (37.51 and 33.60). LVAD site volume was determined by counting the number of LVAD implantations from January through December 2014 at each hospital. We then classified patients into site volume quartiles (≤ 23, 24-40, 41-49, and ≥ 50). To determine whether LVAD site volume was independently associated with all-cause 30-day readmission, we conducted multivariable logistic regression accounting for the sample design and adjusting for age, sex, payer status, income quartile, Elixhauser weighted comorbidity index, discharge disposition, pre-LVAD mechanical circulatory support, and length of stay. Results Among 1,311 patients discharged following LVAD implantation, 363 (27%) were readmitted within 30 days. Patients who experienced an LVAD implantation at a hospital in the lowest quartile of LVAD volume were more likely to have higher comorbidity burden, longer index hospitalization length of stay, and have had their implantation at a smaller hospital (bed size Conclusion LVAD site volume was not associated with 30-day readmission. This suggests that regulatory processes in place to ensure high quality LVAD care across sites in the United States have been effective independent of volume.

National Estimates of 30-Day Unplanned Readmissions of Patients on Maintenance Hemodialysis.

Patients on hemodialysis have high 30-day unplanned readmission rates. Using a national all-payer administrative database, we describe the epidemiology of 30-day unplanned readmissions in patients on hemodialysis, determine concordance of reasons for initial admission and readmission, and identify predictors for readmission. This is a retrospective cohort study using the Nationwide Readmission Database from the year 2013 to identify index admissions and readmission in patients with ESRD on hemodialysis. The Clinical Classification Software was used to categorize admission diagnosis into mutually exclusive clinically meaningful categories and determine concordance of reasons for admission on index hospitalizations and readmissions. Survey logistic regression was used to identify predictors of at least one readmission. During 2013, there were 87,302 (22%) index admissions with at least one 30-day unplanned readmission. Although patient and hospital characteristics were statistically different between those with and without readmissions, there were small absolute differences. The highest readmission rate was for acute myocardial infarction (25%), whereas the lowest readmission rate was for hypertension (20%). The primary reasons for initial hospitalization and subsequent 30-day readmission were discordant in 80% of admissions. Comorbidities that were associated with readmissions included depression (odds ratio, 1.10; 95% confidence interval [95% CI], 1.05 to 1.15; P<0.001), drug abuse (odds ratio, 1.41; 95% CI, 1.31 to 1.51; P<0.001), and discharge against medical advice (odds ratio, 1.57; 95% CI, 1.45 to 1.70; P<0.001). A group of high utilizers, which constituted 2% of the population, was responsible for 20% of all readmissions. In patients with ESRD on hemodialysis, nearly one quarter of admissions were followed by a 30-day unplanned readmission. Most readmissions were for primary diagnoses that were different from initial hospitalization. A small proportion of patients accounted for a disproportionate number of readmissions.

Gastrostomy in the era of minimally invasive head and neck cancer surgery.

Minimally invasive transoral robotic surgery (TORS) is less likely to necessitate gastrostomy tube (GT) following resection of head and neck lesions versus conventional open procedures. However, the incidence of and indications for GT after TORS have not been reported in detail. This study defines the incidence of intra- and postoperative gastrostomy following robotic resection of advanced head and neck disease. It seeks to clarify the relevance of GT after TORS. Adult patients undergoing TORS and neck dissection from 2008 to 2014 were identified in the New York Statewide Planning and Research Cooperative System all-payer administrative database. Demographic data and timing of GT in relation to surgery were recorded. Emergency department (ED) visits and inpatient readmissions were compared with multivariable logistic analysis. Of the 441 included patients, immediate, delayed, and total GT incidence within the first postoperative year was 9.5%, 11.6%, and 21.1%, respectively. Gastrostomy tube complications resulted in 4.5% of 30-day ED visits, 3.3% of 30-day readmissions, and 3.5% of 90-day readmissions. Thirty-nine percent of 90-day readmissions were linked to poor postoperative oral intake. Delayed GT status was associated with an increase in 30-day ED visits, and 30- or 90-day readmissions attributable to poor oral intake (P = 0.10, P < 0.0001, 0.002, respectively). Even in the era of minimally invasive TORS, impaired oral intake is a significant postoperative burden to head and neck cancer patients with advanced disease. Attention to patient risk factors combined with a complicated hospital course may identify patients benefiting from early GT. 2c. Laryngoscope, 128:847-851, 2018.

Trends and the utilization of transoral robotic surgery with neck dissection in New York State.

The timing of neck dissection (ND) in relation to transoral robotic surgery (TORS) is controversial. This study identifies local practice patterns and economic and social access disparities during adoption of TORS. We analyzed utilization patterns of TORS and ND using the New York Statewide Planning and Research Cooperative System all-payer administrative database. Statewide head and neck cancer incidence from the Centers for Disease Control and Prevention (Bethesda, MD) was used to control for overall cancer incidence. Patient demographic, insurer, and institutional information of patients aged ≥ 18 (n = 225) years from 2008 to 2012 were evaluated. Temporal trends were analyzed with Poisson regression models for counts. Transoral robotic surgery was used in 386 procedures, and 58.3% involved ND (n = 225). Concurrent ND was most frequent (n = 173), followed by staged TORS then ND (n = 44) and staged ND preceding TORS (n = 8). Caucasians were more likely than Blacks/Hispanics to undergo TORS (P = 0.03). Medicare (26.2%) and Medicaid (2.7%) payers comprised a minority of patients compared to those commercially insured (70.2%). Only 20% of patients received care outside a major urban center, and these patients were more likely to undergo staged procedures, P = 0.02. Staged procedures resulted in higher mean hospital charges (P = 0.02). Concurrent TORS + ND, the most common practice in New York, is more cost-effective. Patients without commercial insurance, patients in racial minorities, or patients residing outside major urban centers may be targeted to improve care access disparities with respect to minimally invasive TORS technology. 2c. Laryngoscope, 127:1571-1576, 2017.

Validation of the Inhospital Mortality for Pulmonary Embolism Using Claims Data (IMPACT) Prediction Rule within an All-Payer Inpatient Administrative Claims Database

Background: Current guidelines suggest that low risk pulmonary embolism (PE) patients may be managed as outpatients or with an abbreviated hospital stay. There is need for a claims-based prediction rule that payers and hospitals can use to efficiently risk stratify PE patients. The authors recently derived a rule found to have high sensitivity and moderate specificity for predicting in-hospital mortality. Objective: To validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule originally developed in a commercial claims database in an all-payer administrative database restricted to inpatient claims. Methods: This study utilized data from the 2012 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Adult PE admissions were identified by the presence of an appropriate International Classification of Diseases, ninth edition, Clinical Modification (ICD-9-CM) code either in the primary position or secondary position when accompanied by a primary code for a PE complication. The IMPACT rule, consists of age + 11 weighted comorbidities calculated based upon the maximum of 25 ICD-9-CM diagnosis codes and 25 procedural codes reported for each discharge in the NIS (myocardial infarction, chronic lung disease, stroke, prior major bleeding, atrial fibrillation, cognitive impairment, heart failure, renal failure, liver disease, coagulopathy, cancer), and was used to estimate patients' risk of in-hospital mortality. Low risk was defined as in-hospital mortality ≤1.5%. We present the validity of the rule by calculating prognostic test characteristics and 95% confidence intervals (CIs). In order to estimate the potential cost savings from an early discharge, we calculated the difference in total hospital costs between low-risk patients having and not having an abbreviated hospital stay (defined as ≤1, ≤2 or ≤3 days). Results: A total of 34,108 admissions for PE were included (46.7% male, mean ± standard deviation age of 61.9±17.2); and we observed a 3.4% in-hospital PE case-fatality rate. The IMPACT prediction rule classified 11,025 (32.3%) patient admissions as low-risk; and had a sensitivity of 92.4% (95%CI=90.7-93.8), specificity of 33.2% (95%CI=32.7-33.7), negative and positive predictive values of 99.2% (95%CI=99.0-99.4) and 4.6% (95%CI=4.4-4.9) and a C-statistic of 0.74 (95%CI=0.73-0.76) for in-hospital mortality. Low-risk patients had significantly lower in-hospital mortality (0.8% vs. 4.6%, odds reduction of 83%; 95%CI=79-87), shorter LOSs (-1.2 days, p&lt;0.001) and lower total treatment costs (-$3,074, p&lt;0.001) than patients classified as higher-risk. Of low-risk patients, 13.1%, 31.1% and 47.7% were discharged within 1, 2 and 3 days of admission. Low-risk patients discharged within 1 day accrued $5,465 (95%CI=$5,018-$5,911) less in treatment costs than those staying longer. Discharge within 2 or 3 days in low-risk patients was also associated with a reduced cost of hospital treatment [$5,820 (95%CI=$5,506-$6,133) and $6,314 (95%CI=$6,031-$6,597), respectively] when compared to those staying longer. Conclusion: The prior claims-based in-hospital mortality prediction rule was valid when used in this all-payer, inpatient only administrative claims database. The rule classified patients' mortality risk with high sensitivity and had a high negative predictive value; and consequently, may be valuable to those wishing to benchmark rates of PE treated at home or following an abbreviated hospital admission. Disclosures Coleman: Janssen Scientific Affairs, LLC: Consultancy, Research Funding. Crivera:Janssen Scientific Affairs, LLC: Employment, Equity Ownership. Schein:Janssen Scientific Affairs, LLC: Employment. Peacock:Singulex: Consultancy; Prevencio: Consultancy; The Medicines Company: Consultancy, Research Funding; Roche: Consultancy, Research Funding; Portola: Consultancy, Research Funding; Janssen Pharmaceuticals: Consultancy, Research Funding; Cardiorentis: Research Funding; Banyan: Research Funding; Alere: Research Funding; Abbott: Research Funding; Comprehensive Research Associates, LLC: Equity Ownership; Emergencies in Medicine, LLC: Equity Ownership.

Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance.

We sought to improve public health surveillance by using a geographic analysis of emergency department (ED) visits to determine local chronic disease prevalence. Using an all-payer administrative database, we determined the proportion of unique ED patients with diabetes, hypertension, or asthma. We compared these rates to those determined by the New York City Community Health Survey. For diabetes prevalence, we also analyzed the fidelity of longitudinal estimates using logistic regression and determined disease burden within census tracts using geocoded addresses. We identified 4.4 million unique New York City adults visiting an ED between 2009 and 2012. When we compared our emergency sample to survey data, rates of neighborhood diabetes, hypertension, and asthma prevalence were similar (correlation coefficient = 0.86, 0.88, and 0.77, respectively). In addition, our method demonstrated less year-to-year scatter and identified significant variation of disease burden within neighborhoods among census tracts. Our method for determining chronic disease prevalence correlates with a validated health survey and may have higher reliability over time and greater granularity at a local level. Our findings can improve public health surveillance by identifying local variation of disease prevalence.

Recent Trends in Hospitalization for Acute Myocardial Infarction

Rates of acute myocardial infarction (AMI) hospitalizations for elderly Medicare patients decreased during the previous decade. However, trends in population rates of AMI hospitalizations for all adults by subgroups have not been described. Using data from a large all-payer administrative database of hospitalizations, we calculated annual AMI hospitalization rates from 2001 through 2007. Trend analysis was performed across age, gender, and ethnicity categories using survey regression. Overall rate decreased from 314 to 222 AMI hospitalizations per 100,000 patients from 2001 through 2007, representing a 29.2% decrease. Significant decreases were observed in AMI hospitalization rate for each group by age categories (p <0.001) and by gender (p <0.001). When stratified by ethnicity and gender, age-adjusted AMI hospitalization rates in white men and women decreased by 30.8% and 31.4%, whereas black men and women had significantly slower rates of decrease of 13.6% and 12.6%, respectively. In conclusion, although the overall rate of AMI hospitalizations decreased from 2001 through 2007, the observed decrease was smaller for black patients compared to white patients across all age groups studied.

RECENT TRENDS IN HOSPITALIZATION RATES FOR ACUTE MYOCARDIAL INFARCTION

Rates of acute myocardial infarction (AMI) hospitalizations for elderly Medicare patients decreased during the previous decade. However, trends in population rates of AMI hospitalizations for all adults by subgroups have not been described. Using data from a large all-payer administrative database of hospitalizations, we calculated annual AMI hospitalization rates from 2001 through 2007. Trend analysis was performed across age, gender, and ethnicity categories using survey regression. Overall rate decreased from 314 to 222 AMI hospitalizations per 100,000 patients from 2001 through 2007, representing a 29.2% decrease. Significant decreases were observed in AMI hospitalization rate for each group by age categories (p <0.001) and by gender (p <0.001). When stratified by ethnicity and gender, age-adjusted AMI hospitalization rates in white men and women decreased by 30.8% and 31.4%, whereas black men and women had significantly slower rates of decrease of 13.6% and 12.6%, respectively. In conclusion, although the overall rate of AMI hospitalizations decreased from 2001 through 2007, the observed decrease was smaller for black patients compared to white patients across all age groups studied. © 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:1589‐1593)