Annual Age-adjusted Rates Research Articles

Infectious Disease Hospitalizations, New York City, 2001-2014.

Hospital discharge data are a means of monitoring infectious diseases in a population. We investigated rates of infectious disease hospitalizations in New York City. We analyzed data for residents discharged from New York State hospitals with a principal diagnosis of an infectious disease during 2001-2014 by using the Statewide Planning and Research Cooperative System. We calculated annual age-adjusted hospitalization rates and the percentage of hospitalizations in which in-hospital death occurred. We examined diagnoses by site of infection or sepsis and by pathogen type. During 2001-2014, the mean annual age-adjusted rate of infectious disease hospitalizations in New York City was 1661.6 (95% CI, 1659.2-1663.9) per 100 000 population; the mean annual age-adjusted hospitalization rate decreased from 2001-2003 to 2012-2014 (rate ratio = 0.9; 95% CI, 0.9-0.9). The percentage of in-hospital death during 2001-2014 was 5.9%. The diagnoses with the highest mean annual age-adjusted hospitalization rates among all sites of infection and sepsis diagnoses were the lower respiratory tract, followed by sepsis. From 2001-2003 to 2012-2014, the mean annual age-adjusted hospitalization rate per 100 000 population for HIV decreased from 123.1 (95% CI, 121.7-124.5) to 40.0 (95% CI, 39.2-40.7) and for tuberculosis decreased from 10.2 (95% CI, 9.8-10.6) to 4.6 (95% CI, 4.4-4.9). Although hospital discharge data are subject to limitations, particularly for tracking sepsis, lower respiratory tract infections and sepsis are important causes of infectious disease hospitalizations in New York City. Hospitalizations for HIV infection and tuberculosis appear to be declining.

Mortality Among Persons with Both Asthma and Chronic Obstructive Pulmonary Disease Aged ≥25 Years, by Industry and Occupation - United States, 1999-2016.

Patients with asthma typically have chronic airway inflammation, variable airflow limitation, and intermittent respiratory symptoms; patients with chronic obstructive pulmonary disease (COPD) often have fixed airflow limitation and persistent respiratory symptoms. Some patients exhibit features suggesting that they have both conditions, which is termed asthma-COPD overlap. These patients have been reported to have worse health outcomes than do those with asthma or COPD alone (1). To describe mortality among persons aged ≥25 years with asthma-COPD overlap, CDC analyzed 1999-2016 National Vital Statistics multiple-cause-of-death mortality data* extracted from the National Occupational Mortality System (NOMS), which included industry and occupation† information collected from 26 states§ for the years 1999, 2003, 2004, and 2007-2014. Age-adjusted death rates per one million persons¶ and proportionate mortality ratios (PMRs)** were calculated. During 1999-2016, 6,738 male decedents (age-adjusted rate per million=4.30) and 12,028 female decedents (5.59) had both asthma and COPD assigned on their death certificate as the underlying or contributing cause of death. The annual age-adjusted death rate per million among decedents with asthma-COPD overlap declined from 6.70 in 1999 to 3.01 in 2016 (p<0.05) for men and from 7.71 in 1999 to 4.01 in 2016 (p<0.05) for women. Among adults aged 25-64 years, asthma-COPD overlap PMRs, by industry, were significantly elevated among nonpaid workers, nonworkers, and persons working at home for both men (1.72) and women (1.40) and among male food, beverage, and tobacco products workers (2.64). By occupation, asthma-COPD overlap PMRs were significantly elevated among both men (1.98) and women (1.79) who were unemployed, had never worked, or were disabled workers and among women bartenders (3.28) and homemakers (1.34). The association between asthma-COPD overlap mortality and nonworking status among adults aged 25-64 years suggests that asthma-COPD overlap might be associated with substantial morbidity. Increased risk for asthma-COPD overlap mortality among adults in certain industries and occupations suggests targets for public health interventions (e.g., elimination of or removal from exposures, engineering controls, and workplace smoke-free policies) to prevent asthma and COPD in and out of the workplace.

P1497INCIDSENCE OF CANCER IN HEMODIALYSIS-TREATED PATIENTS

Abstract Background and Aims In recent decades, there has been an increase in the incidence and prevalence of patients with end stage renal disease (ESRD) worldwide. Previous studies have shown an increased incidence of malignancies among ESRD patients, compared to age-matched controls, although it was unclear whether different etiologies of ESRD ( diabetes, hypertension, cystic disease) confer different risk ratio. Our present study intends to re-examine relationships between ESRD, classified according to the etiology of renal disease, cancer incidence and types of malignancies in hemodialysis treated patients. Method We conducted a retrospective study, analyzing hemodialysis (HD) treated patients over the age of 18 at the Wolfson Medical Center in Holon, Israel, from 2008-2017. Patients diagnosed with cancer prior to dialysis or with history of transplantation were excluded. Data on etiology of chronic kidney disease and ESRD, comorbidities and cancer diagnosis was collected from patients' files and verified using the Israeli National Cancer Registry. A single, multivariate survival analysis was conducted to examine the relationship between the various predictors and the incidence of cancer. Results The study included 333 patients, 211 (63.4%) were males, mean age 67.2±13.1 years. The median follow was 4 years (95% CI: 2-6.5). Twenty eight (8.4%), developed primary malignancy during hemodialysis, annual rate: 2.1%, Vs 0.35% age-adjusted annual rate in Israeli general population. The average age of all patients diagnosed with cancer over the study period was higher than that of patients without cancer (72.3±7.7 Vs 66.7±13.4 years. P=0.001). The most common sites of malignancy were colon (33%), bladder (16.7%), kidney (10%) and prostate (10%). Older age was the only risk factor associated with the onset of malignancy. No statistically significant relationship was found between ESRD etiology, comorbidities and occurrence of malignancy. Conclusion Among our cohort of patients on chronic hemodialysis, annual cancer incidence rate is 6 times higher than age matched controls in the Israeli general population. Older age is a risk factor associated with onset of malignancy. We did not found associations between ESRD etiology, comorbidities and cancer incidence. This study constitutes a platform for a longer period multicenter study.

Racial/ethnic differences in opioid-involved overdose deaths across metropolitan and non-metropolitan areas in the United States, 1999−2017

BackgroundFrom 1999 to 2017, more than 400,000 Americans died from a drug overdose death involving an opioid. Early surveillance studies have observed large variations in opioid-involved overdose deaths among different geographic regions and racial/ethnic groups. The purpose of this study was to characterize trends in racial/ethnic opioid-involved overdose deaths across metropolitan and non-metropolitan areas in the United States from 1999 to 2017. MethodsThe analysis used National Vital Statistics System data from 1999 to 2017 that were accessed through the CDC WONDER online database. Drug overdose deaths involving any opioid were identified using the International Classification of Diseases, Tenth Revision, codes and were represented as age-adjusted rates per 100,000 population. Joinpoint regression was used to examine trends in opioid-involved overdose deaths among racial/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic other) by metropolitan and non-metropolitan status (large metropolitan areas, medium-small metropolitan areas, and non-metropolitan areas). ResultsThe annual age-adjusted death rates for drug overdose deaths that involved any opioid significantly increased for all racial/ethnic groups in metropolitan and non-metropolitan areas from 1999 to 2017. The largest average annual increases in rates occurred among non-Hispanic whites in non-metropolitan areas (13.6% increase per year) and medium-small metropolitan areas (12.3% increase per year), followed by non-Hispanic blacks in medium-small metropolitan areas (11.3% increase per year). ConclusionsThe variations in opioid-involved overdose deaths among different racial/ethnic groups across geographic regions support the existence of multiple sub-epidemics in the current opioid overdose crisis and provide directions for targeted intervention efforts.

Primary cerebral lymphoma' characteristics, incidence, survival, and causes of death in the United States

PurposeThis study aimed to provide an updated overview of primary central lymphoma (PCL) using a large cohort of 33 years. That being said, we attempted to examine the patient demographics, management plans and their outcome, causes of death and the time trends in overall incidence and mortality rates of these patients. MethodsWe conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database between 1983 and 2016. We calculated the frequencies and the average annual age-adjusted rate (AAR) of PCL patients. Uni- and multivariable accelerated failure time regression were used to identify possible prognostic factors affecting the patients' survival. Furthermore, detailed causes of death were extracted and joint point regression analysis was done to examine incidence and mortality trends. ResultsWe identified 2925 PCL cases. The AAR was 0.148 per 100,000. An increase in age was significantly associated with shorter survival (HR: 1.01, 95%CI = 1.01–1.01, P < .001), while a recent year of diagnosis after 1993–2002 and 2002 was associated with improved survival (HR: 0.76, CI = 0.65–0.89, P = .001), and (HR: 0.48, CI = 0.41–0.56, P < .001), respectively. Overall, the trend of mortality rates in PCL patients has declined over the past years (−1.38% per year). ConclusionOur results support the previous evidence by showing an increase in patients' survival over time. While most PCL-related deaths occur within the first year, subsequent slow progression was observed after the first few years of survival. More attention should be given to the other possible non-PCL causes of death, especially beyond ten years of survival.

Surgical management of benign prostatic obstruction: 20-year population-level trends.

Benign prostatic obstruction (BPO) due to histological benign prostatic hyperplasia is highly prevalent among older men. Despite widespread use of medical therapy, surgical treatment remains a mainstay in the management of BPO. We sought to characterize trends in the surgical management of BPO in Ontario, Canada. We performed an interrupted time-series analysis using segmented regression among men aged 18 years and older undergoing surgical treatment for BPO between January 1, 1994 and December 31, 2014 in Ontario, Canada. The passage of time was considered the primary exposure. The primary outcome was the proportion of all BPO surgeries performed using each of the following modalities: transurethral resection of the prostate (TURP), endoscopic laser prostatectomy, open/laparoscopic prostatectomy, and others. We identified 136 459 men who underwent BPO surgery between 1994 and 2014. The annual age-adjusted rate of BPO surgery declined significantly over time (24 to 10 per 10 000 population in 1994 and 2014, respectively). From 1994-2001, there were no significant changes in the distribution of BPO surgical modalities, with TURP the most common throughout (97.2% and 97% in 1994 and 2001, respectively). From 2002-2014, there was a significant decline in the use of TURP (92.1% to 76.9%; p=0.027) with a corresponding increase in the use of endoscopic laser prostatectomy (3.5% to 21.9%; p=0.0008). This study demonstrates a shift in the management of BPO, with increasing use of endoscopic laser prostatectomy, beginning in 2002. However, TURP remains the most common treatment modality.

414P - Characteristics, incidence, and survival of primary cerebral lymphoma: A population based study

BackgroundPrimary cerebral lymphoma (PCL) is a rare malignancy representing less than 1.5% of brain tumors. Given the lack of studies in the literature that describe PCL, we used data from the Surveillance, Epidemiology, and End Results (SEER) database to investigate PCL’s prognostic factors, incidence and survival rates. MethodsWe conducted a retrospective population-based cohort study using SEER database from 1983-2014. Patients with primary lymphoma as their only primary malignancy analyzed. Patients who were diagnosed by autopsy, had no active follow up in the registry and with unknown Ann Arbor Staging, or radiology status were excluded. We also calculated the frequencies and the average annual age-adjusted rate (AAR) of PCL patients between 2000 and 2015. Uni- and multivariable accelerated failure time regression were used to identify possible prognostic factors affecting the patient’s survival. ResultsWe identified 1,196 PCL cases, with an average age of diagnosis 56.71±17.28 years and 59.9% were males. Diffuse B-cell lymphoma was the most prevalent sub-type (61.3%). AAR was 0.14 per 100,000. These rates were higher in males, Asian or Pacific Islander and increasing with age. PCL-specific 1-year, 2-year, and 5-year survival rates were 89.6%, 84.4%, and 67%, respectively. Increased age (HR: 1.02, 95%CI=1.01–1.03, P<0.001) and recent diagnosis after 2002 (HR: 2.42, CI=1.46–3.42, P<0.001) were significantly associated with shorter survival, while having a PCL in the temporal lobe (HR: 0.62, 95%CI=0.40–0.98, P=0.040), or parietal lobe (HR: 0.63, 95%CI=0.42–0.94, P=0.024) as compared to the other sites, and receiving radiation (HR: 0.37, 95% CI=0.15–0.92, P=0.033) or chemotherapy (HR: 0.64, 95%CI=0.50–0.83, P=0.001) were associated with improved survival. ConclusionsThis is the first report to shed light on PCL’s incidence, survival rate, and prognostic factors. As a result, it will provide physicians and researchers with insights about this rare malignancy. Legal entity responsible for the studySherief Ghozy. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Health Impact of Local Interventions

TPS 641: Policies, interventions, communication, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background: Air quality in the United States has improved since the Clean Air Act of 1970, but these improvements have varied greatly both between and within metropolitan areas. Methods: We examined local variations in annual average air quality as determinants of local variation in annual age-adjusted cardiovascular hospital admission rates (CHR) among Medicare beneficiaries aged 65 years and older for 2002-2013 across 10,097 ZIP codes (postal codes) in 123 metropolitan core-based statistical areas (CBSA) with 2010 populations greater than 500,000 persons. For 11 air pollutants, we examined local variations (ZIP code-specific variation within CBSA) in CHR and air quality for centered means (2005) and for 12-year trends (2002-2013). Results: Interquartile increments in the centered means of fine particulate matter components were associated with increased CHR (admissions per 100,000 person-years at risk): total PM2.5 (35.0, 95% confidence interval (CI) 5.3, 64.8), elemental carbon (39.3, 95% CI 9.6, 69.1) and organic carbon (33.1, 95% CI 0.9, 65.3). After further adjustment for centered mean CHR to control for ZIP code-level variations in cardiovascular risk factors, interquartile increments in the 12-year trends of gaseous air pollutants were associated with 12-year trends in CHR (annual change in admissions per 100,000 person-years at risk): nitric oxide (4.4, 95% CI 1.8, 7.1), nitrogen dioxide (4.8, 95% CI 2.0, 7.5), and carbon monoxide (4.7, 95% CI 2.0, 7.4). Conclusion: Thus, after adjustment for metropolitan area characteristics and for local variations in cardiovascular risk factors, we have shown that local improvements in air quality lead to local improvements in cardiovascular health among Medicare beneficiaries. The views expressed in this presentation are those of the authors and do not necessarily represent the views or policies of the U.S. Environmental Protection Agency.

Visualizing Carbon Monoxide Poisoning Surveillance Data on the US CDC National Environmental Public Health Tracking Network

TPS 683: Short-term health effects of air pollutants 2, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background: CDC’s National Environmental Public Health Tracking Program (Tracking Program) aims to provide information from a nationwide network of integrated unintentional carbon monoxide (CO) poisoning data that could inform relevant public health action and prevention. Methods: The Tracking Program has developed dynamic environmental health surveillance system that includes standard visualization tools such as charts, interactive maps, and tables, and displays a variety of measures of morbidity and mortality (e.g., crude, and age-adjusted rates per 100,000) for unintentional CO poisoning. Users also can explore these measures by cause (i.e., fire, non-fire, unknown intent or mechanism). The hospitalization and emergency department (ED) data are obtained by the Tracking Program from funded state recipients (26 states); mortality data are from the National Vital Statistics System. We pooled the CO poisoning data from 2010-2014, and examined the proportion of unintentional non-fire CO poisonings, and compared state-specific age-adjusted rates during the same period. Results: During 2010-2014, there were more than 4,500 unintentional CO poisoning deaths with an average of 916 deaths annually. Deaths and hospitalizations categorized as non-fire comprised of 41.4%, and 55.4% of cases respectively. During the same period, states that had the two highest annual age-adjusted rate of ED visits for unintentional CO poisoning were Connecticut (AR: 21.4 in 2011) and Vermont (AR=15.7 in 2013), and the highest hospitalization rate were observed in New Mexico (AR: 2.1 in 2011) and Maryland (AR=1.8 in 2009). Conclusions: The Tracking Program demonstrates the opportunity to visualize environmental and health data on one data platform. This allows users to examine temporal and spatial trends and to identify communities at greater risk for CO poisoning. The Tracking Program’s CO poisoning data can be used to drive public health policy and actions that ultimately will reduce the burden of mortality and morbidity for CO poisoning.

Regional variation of avoidable hospitalisations in a universal health care system: a register-based cohort study from Finland 1996−2013

ObjectivesA persistent finding in research concerning healthcare and hospital use in Western countries has been regional variation in the medical practices. The aim of the current study was to examine...

Opioid-related US hospital discharges by type, 1993–2016

ObjectiveTo classify and compare US nationwide opioid-related hospital inpatient discharges over time by discharge type: 1) opioid use disorder (OUD) diagnosis without opioid overdose, detoxification, or rehabilitation services, 2) opioid overdose, 3) OUD diagnosis or opioid overdose with detoxification services, and 4) OUD diagnosis or opioid overdose with rehabilitation services. MethodsSurvey-weighted national analysis of hospital discharges in the Healthcare Cost and Utilization Project National Inpatient Sample yielded age-adjusted annual rates per 100,000 population. Annual percentage change (APC) in the rate of opioid-related discharges by type during 1993–2016 was assessed. ResultsThe annual rate of hospital discharges documenting OUD without opioid overdose, detoxification, or rehabilitation services quadrupled during 1993–2016, and at an increased rate (8% annually) during 2003–2016. The discharge rate for all types of opioid overdose increased an average 5–9% annually during 1993–2010; discharges for non-heroin overdoses declined 2010–2016 (3–12% annually) while heroin overdose discharges increased sharply (23% annually). The rate of discharges including detoxification services among OUD and overdose patients declined (−4% annually) during 2008–2016 and rehabilitation services (e.g., counselling, pharmacotherapy) among those discharges decreased (−2% annually) during 1993–2016. ConclusionsOver the past two decades, the rate of both OUD diagnoses and opioid overdoses increased substantially in US hospitals while rates of inpatient detoxification and rehabilitation services identified by diagnosis codes declined. It is critical that inpatients diagnosed with OUD or treated for opioid overdose are linked effectively to substance use disorder treatment at discharge.

Infectious Disease Hospitalizations: United States, 2001 to 2014

Infectious disease epidemiology has changed over time, reflecting improved clinical interventions and emergence of threats such as antimicrobial resistance. This study investigated infectious disease hospitalizations in the United States from 2001 to2014. Estimated rates of infectious disease hospitalizations were calculated by using the National (Nationwide) Inpatient Sample. Infectious disease hospitalizations were defined as hospitalizations with a principal discharge diagnosis of an infectious disease. Diagnoses according to site of infection and sepsis were examined, as was occurrence of in-hospital death. The leading nonsepsis infectious disease secondary diagnoses for hospitalizations with a principal diagnosis of sepsis were identified. The mean annual age-adjusted infectious disease hospitalization rate was 1,468.2 (95%CI, 1,459.9-1,476.4) per 100,000 population; in-hospital death occurred in 4.22%(95%CI, 4.18-4.25) of infectious disease hospitalizations. The mean annual age-adjusted infectious disease hospitalization rate increased from 2001-2003 to 2012-2014 (rate ratio, 1.05; 95%CI, 1.01-1.09), as did the percentage of in-hospital death (4.21%[95%CI, 4.13-4.29] to 4.30%[95%CI, 4.26-4.35]; P= .049). The diagnoses with the highest hospitalization rates among all sites of infection and sepsis diagnoses were the lower respiratory tract followed by sepsis. The most common nonsepsis infectious disease secondary diagnoses among sepsis hospitalizations were "urinary tract infection," "pneumonia, organism unspecified," and "intestinal infection due to Clostridium [Clostridioides] difficile." Although hospital discharge data are subject to limitations, particularly for tracking sepsis, lower respiratory tract infections and sepsis seem to be important contributors to infectious disease hospitalizations. Prevention of infections that lead to sepsis and improvements in sepsis management would decrease the burden of infectious disease hospitalizations and improve outcomes, respectively.

The Impact of State Firearm Laws on Homicide and Suicide Deaths in the USA, 1991-2016: a Panel Study.

Firearm injuries are a major cause of mortality in the USA. Few recent studies have simultaneously examined the impact of multiple state gun laws to determine their independent association with homicide and suicide rates. To examine the relationship between state firearm laws and overall homicide and suicide rates at the state level across all 50 states over a 26-year period. Using a panel design, we analyzed the relationship between 10 state firearm laws and total, age-adjusted homicide and suicide rates from 1991 to 2016 in a difference-in-differences, fixed effects, multivariable regression model. There were 1222 observations for homicide analyses and 1300 observations for suicide analyses. Populations of all US states. The outcome measures were the annual age-adjusted rates of homicide and suicide in each state during the period 1991-2016. We controlled for a wide range of state-level factors. Universal background checks were associated with a 14.9% (95% CI, 5.2-23.6%) reduction in overall homicide rates, violent misdemeanor laws were associated with a 18.1% (95% CI, 8.1-27.1%) reduction in homicide, and "shall issue" laws were associated with a 9.0% (95% CI, 1.1-17.4%) increase in homicide. These laws were significantly associated only with firearm-related homicide rates, not non-firearm-related homicide rates. None of the other laws examined were consistently related to overall homicide or suicide rates. We found a relationship between the enactment of two types of state firearm laws and reductions in homicide over time. However, further research is necessary to determine whether these associations are causal ones.

Trends in Breast MRI Use Among Women with BRCA Mutations: A National Claims Analysis 2006–2016

Abstract Women with BRCA mutations are recommended to receive breast MRI as an adjunct to annual mammography for breast cancer screening however adoption of these guidelines is unclear. We estimated breast MRI use from 2006–2016 among insured US women to understand use over time. Methods: Using medical care claims, we conducted a cohort study of breast MRI use in commercially-insured women aged 20–64 years continuously enrolled for ≥1 year in a large national insurer between 2006–2016. Women were identified as BCRA mutation carriers without a personal history of breast cancer using ICD9/10 diagnosis codes. We used CPT codes to identify breast MRIs and developed claims-based algorithms to categorized MRI indication as: screening, diagnostic or other. We calculated annual age-specific and age-adjusted rates of use overall and by indication among BCRA mutation carrier women. We used autoregressive time series models to estimate the yearly trend. Results: We identified 12,457 women with BRCA mutations during the study period. Breast MRI use overall among BRCA+ women aged 20–64 was 47/1000 women in 2006 and increased on average by 11 MRIs per year to a rate of 174/1000 in 2016 (P &amp;lt; 0.001). Across this time period, use for screening accounted for over 80% of breast MRIs and rates mirrored the overall trend with a 4.8-fold increase from 31/1000 in 2006 to 146/1000 women by 2016. Over the same time period, use of breast MRI for diagnostic workup or other indications remained stable. Use of screening breast MRI was highest among older women aged 50–64 compared with women &amp;lt;40 and 40–49 years (in 2016, 189, 95, and 177/1000, respectively) Discussion: Breast MRI screening increased dramatically over the past decade in women with BRCA mutations concordant with clinical guidelines. Additional research is needed to understand use of breast imaging relative to health outcomes for this high-risk population.

The economic burden of bronchiectasis \u2013 known and unknown: a systematic review

BackgroundThe increasing prevalence and recognition of bronchiectasis in clinical practice necessitates a better understanding of the economic disease burden to improve the management and achieve better clinical and economic outcomes. This study aimed to assess the economic burden of bronchiectasis based on a review of published literature.MethodsA systematic literature review was conducted using MEDLINE, Embase, EconLit and Cochrane databases to identify publications (1 January 2001 to 31 December 2016) on the economic burden of bronchiectasis in adults.ResultsA total of 26 publications were identified that reported resource use and costs associated with management of bronchiectasis. Two US studies reported annual incremental costs of bronchiectasis versus matched controls of US$5681 and US$2319 per patient. Twenty-four studies reported on hospitalization rates or duration of hospitalization for patients with bronchiectasis. Mean annual hospitalization rates per patient, reported in six studies, ranged from 0.3–1.3, while mean annual age-adjusted hospitalization rates, reported in four studies, ranged from 1.8–25.7 per 100,000 population. The average duration of hospitalization, reported in 12 studies, ranged from 2 to 17 days. Eight publications reported management costs of bronchiectasis. Total annual management costs of €3515 and €4672 per patient were reported in two Spanish studies. Two US studies reported total costs of approximately US$26,000 in patients without exacerbations, increasing to US$36,00–37,000 in patients with exacerbations. Similarly, a Spanish study reported higher total annual costs for patients with > 2 exacerbations per year (€7520) compared with those without exacerbations (€3892). P. aeruginosa infection increased management costs by US$31,551 to US$56,499, as reported in two US studies, with hospitalization being the main cost driver.ConclusionsThe current literature suggests that the economic burden of bronchiectasis in society is significant. Hospitalization costs are the major driver behind these costs, especially in patients with frequent exacerbations. However, the true economic burden of bronchiectasis is likely to be underestimated because most studies were retrospective, used ICD-9-CM coding to identify patients, and often ignored outpatient burden and cost. We present a conceptual framework to facilitate a more comprehensive assessment of the true burden of bronchiectasis for individuals, healthcare systems and society.

Changes in bone mineral density in women before critical illness: a matched control nested cohort study

The relative contribution of acute and chronic factors to accelerated loss of bone mineral density (BMD) following critical illness is unknown. This study compared the BMD trajectory of women before critical illness to the BMD trajectory of women who did not become critically ill. This prospective, nested, age- and medication-matched, case-control study compared trajectory of BMD in women in the Geelong Osteoporosis study (GOS) requiring admission to an Australian Intensive Care Unit (ICU) between June 1998 and March 2016, to women not admitted to ICU. The main outcome was age and medication use adjusted change in BMD. A total of 52 women, with a mean age of 77 ± 9years were admitted to ICU, predominantly post-surgery (75%), during the study period. A greater age-adjusted annual rate of decline was observed for pre-ICU women compared to no-ICU women for AP spine BMD (-0.010 ± 0.002g/cm2 vs -0.005 ± 0.002g/cm2, p = 0.01) over the 15-year study period. In participants with multiple BMDs 2years before critical illness, a significantly greater increase in femoral neck BMD compared to age- and medication-matched controls was observed (difference in BMD, ICU vs no-ICU = 0.037 ± 0.013g/cm2, p = 0.006). In a cohort of women with predominantly surgical ICU admission, bone health prior to critical illness was comparable to age- and medication-matched controls, with a relative increase in femoral neck bone mass immediately prior to critical illness. These findings suggest critical illness-related bone loss cannot be entirely explained as a continuation of pre-morbid bone trajectory.

Pneumonia-Associated Hospitalizations, New York City, 2001-2014.

Death certificate data indicate that the age-adjusted death rate for pneumonia and influenza is higher in New York City than in the United States. Most pneumonia and influenza deaths are attributed to pneumonia rather than influenza. Because most pneumonia deaths occur in hospitals, we analyzed hospital discharge data to provide insight into the burden of pneumonia in New York City. We analyzed data for New York City residents discharged from New York State hospitals with a principal diagnosis of pneumonia, or a secondary diagnosis of pneumonia if the principal diagnosis was respiratory failure or sepsis, during 2001-2014. We calculated mean annual age-adjusted pneumonia-associated hospitalization rates per 100 000 population and 95% confidence intervals (CIs). We examined data on pneumonia-associated hospitalizations by sociodemographic characteristics and colisted conditions. During 2001-2014, a total of 495 225 patients residing in New York City were hospitalized for pneumonia, corresponding to a mean annual age-adjusted pneumonia-associated hospitalization rate of 433.8 per 100 000 population (95% CI, 429.3-438.3). The proportion of pneumonia-associated hospitalizations with in-hospital death was 12.0%. The mean annual age-adjusted pneumonia-associated hospitalization rate per 100 000 population increased as area-based poverty level increased, whereas the percentage of pneumonia-associated hospitalizations with in-hospital deaths decreased with increasing area-based poverty level. The proportion of pneumonia-associated hospitalizations that colisted an immunocompromising condition increased from 18.7% in 2001 to 33.1% in 2014. Sociodemographic factors and immune status appear to play a role in the epidemiology of pneumonia-associated hospitalizations in New York City. Further study of pneumonia-associated hospitalizations in at-risk populations may lead to targeted interventions.

Epilepsy mortality trends in Cuba compared with England and Wales: 1987–2010

There are limited epilepsy mortality data from developing countries and Latin America in particular. We examined national epilepsy mortality data from Cuba and contrasted them with comparable data from England and Wales. National epilepsy mortality data for Cuba between the years 1987 and 2010 were obtained from the Medical Records and Health Statistics Bureau of the Cuban Public Health Ministry (www.sld.cu/sitios/dne/) with the corresponding mortality data from England and Wales obtained from the UK Office of National Statistics (ONS, www.ons.gov.uk). Indirect standardization with calculation of a standardized mortality ratio (SMR) was used to compare trends.The overall trend was of a slight decrease in mortality rates over the 23 years in Cuba, with higher mortality rates primarily occurring in young people. Annual age-adjusted rates were consistently lower in Cuba than those seen in England and Wales, with the SMR ranging from 0.35 (95% confidence interval (CI): 0.30 to 0.48) in 2007 to 1.00 (95% CI: 0.85 to 1.15) in 1994.Cuban epilepsy mortality rates are consistently lower than those of England and Wales. Reasons for this disparity in mortality rates are not immediately apparent but are likely to be multifactorial.

Alcohol Consumption and Chronic Liver Disease Mortality in New Mexico and the United States, 1999-2013.

Current chronic liver disease (CLD) mortality surveillance methods may not adequately capture data on all causes of CLD mortality. The objective of this study was to calculate and compare CLD death rates in New Mexico and the United States by using both an expanded definition of CLD and estimates of the fractional impact of alcohol on CLD deaths. We defined CLD mortality as deaths due to alcoholic liver disease, cirrhosis, viral hepatitis, and other liver conditions. We estimated alcohol-attributable CLD deaths by using national and state alcohol-attributable fractions from the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact application. We classified causes of CLD death as being alcohol-attributable, non-alcohol-attributable, or hepatitis C. We calculated average annual age-adjusted CLD death rates during five 3-year periods from 1999 through 2013, and we stratified those rates by sex, age, and race/ethnicity. By cause of death, CLD death rates were highest for alcohol-attributable CLD. By sex and race/ethnicity, CLD death rates per 100 000 population increased from 1999-2001 to 2011-2013 among American Indian men in New Mexico (67.4-90.6) and the United States (38.9-49.4), American Indian women in New Mexico (48.4-63.0) and the United States (27.5-39.5), Hispanic men in New Mexico (48.6-52.0), Hispanic women in New Mexico (16.9-24.0) and the United States (12.8-13.1), non-Hispanic white men in New Mexico (17.4-21.3) and the United States (15.9-18.4), and non-Hispanic white women in New Mexico (9.7-11.6) and the United States (7.6-9.7). CLD death rates decreased among Hispanic men in the United States (30.5-27.4). An expanded CLD definition and alcohol-attributable fractions can be used to create comprehensive data on CLD mortality. When stratified by CLD cause and demographic characteristics, these data may help states and jurisdictions improve CLD prevention programs.

Asthma in the USA: the good, the bad, and the disparity

Asthma in the USA: the good, the bad, and the disparity