Annual Hospital Admission Rates Research Articles

Musculoskeletal System and Connective Tissue Related Hospital Admission in England and Wales Between 1999 and 2019: An Ecologic Study.

Background There is a lack of data describing inpatient hospitalization trends for musculoskeletal and connective tissue diseases in the United Kingdom. Aim We aim to provide a comprehensive analysis of the trends of musculoskeletal and connective tissue disease related hospitalizations between 1999 and 2019 in England and Wales. Method We conducted an ecologic study. The data were obtained from the Hospital Episode Statistics database in England and the Patient Episode Database in Wales between 1999 and 2019. We used ICD-10 (International Classification of Diseases, 10th Revision) codes M00-M99 to identify hospital admissions. Results The total annual hospital admission rate increased from 1,303.63 (95% CI: 1,300.55-1,306.71) in 1999 to 2,479.09 (95% CI: 2,475.14-2,483.04) in 2019 per 100,000 persons (p<0.01). The ICD-10 categories other joint disorders, osteoarthritis, and other dorsopathies accounted for 19.6%, 19.6%, and 18.6% of hospitalizations, respectively. Advanced age groups experienced a larger increase in hospitalization rates (128.6% in the age group of 75 years and above vs. 45.9% in the age group below 15 years). Females contributed to 57.7% of hospitalizations and experienced a larger increase in hospitalization rate compared to males (103.8% vs. 73.8%). Conclusion Between 1999 and 2009, the hospitalization rate for musculoskeletal and connective tissue diseases has steadily increased in England and Wales. However, the rate has plateaued or declined in many of musculoskeletal and connective tissue diseases between 2010 and 2019. Due to the chronicity of these diseases, their significant morbidity, and significant long-term disability, national interventions are needed to mitigate the effects of the increased cost of treatment.

Healthcare Resource Utilization Among Veterans with Alzheimer’s Disease

AbstractBackgroundWe evaluated healthcare utilization patterns to understand the care pathways for Veterans with Alzheimer’s disease (AD) from the Department of Veterans Affairs (VA) healthcare system.MethodVA electronic health records (EHR) were used to extract data from clinical notes and identify patients with AD. The patient cohort was merged with the VA Informatics and Computing Infrastructure (VINCI) administrative database from October 2008–to October 2021 to obtain systematic healthcare utilization records including total inpatient admissions and outpatient visits. A control group was extracted for comparison and matched to the patient cohort using the propensity score on age, sex, and race. A linear mixed‐effects model was used to compare the total outpatient and inpatient utilization, adjusting for patient demographics and comorbidities.ResultWe extracted 21,442 AD patients from the EHR clinical notes. A cohort of 85,684 non‐AD and non‐dementia Veterans was constructed as a control group. In the AD vs control groups, the mean age was 82 vs 79 years, 83 vs 84% was White, and 97% were male in both groups. The number of annual outpatient visits 1 year before, and at 1 and 2 years after the first AD diagnosis code was 30, 34 and 27, respectively. The control group maintained 12 annual outpatient visits throughout the three‐year period. The average annual hospital admission rate was 1.8 vs 1.7 in the AD vs control group. The average length of inpatient stay in the year prior to the first AD diagnostic code was 23.1 days, increased to 27.4 days at year 1 after AD diagnosis, and declined back to 20.5 days at year 2, as compared to 13.1, 13.0, and 11.9 days, respectively, in the control group. The mixed‐effects analysis showed significantly higher healthcare utilization trends across VA outpatient and inpatient care settings (p&lt;0.001) in the AD vs control groups, after controlling for age, gender, race, ethnicity, and select comorbidities.ConclusionHealthcare resource utilization in patients with AD identified from the medical notes is more than doubled that in outpatient care and nearly doubled in inpatient length of stay relative to the matched controls in the VA healthcare system.

Spatiotemporal Distribution and Epidemiological Characteristics of Hospital Admissions for Carbon Monoxide Poisoning in Guangdong, China, 2013–2020

ObjectiveThis study aimed to determine the spatiotemporal distribution and epidemiological characteristics of hospital admissions for carbon monoxide poisoning (COP) in Guangdong, China, from 2013 to 2020. MethodsData on age- and sex- specific numbers of hospital admissions due to COP in Guangdong (2013–2020) were collected. Daily temperatures were downloaded through the China Meteorological Data Sharing Service System. We analyzed temporal trends through time series decomposition and used spatial autocorrelation analysis to detect spatial clustering. The distributed lag nonlinear model was used to quantify the effects of temperature. ResultsThere were 48,854 COP admissions over the study period. The sex ratio (male to female) was 1:1.74. The concentration ratios (M) ranged from 0.73–0.82. The highest risk occurred in January (season index = 3.59). Most cases were concentrated in the northern mountainous areas of Guangdong with high-high clustering. COP in the study region showed significant spatial autocorrelation, and the global Moran's I value of average annual hospital admission rates for COP was 0.447 (P < 0.05). Low temperatures were associated with high hospital admission rates for COP, with a lag lasting 7 days. With a lag of 0 days, the effects of low temperatures [5th (12 °C)] on COP were 2.24–3.81, as compared with the reference temperature [median (24 °C)]. ConclusionCOP in Guangdong province showed significant temporal and spatial heterogeneity. Low temperature was associated with a high risk of COP, and the influence had a lag lasting 7 days.

MO644: Comparative Analysis of Survival and Morbidity in Home and Hospital Haemodialysis

Abstract BACKGROUND AND AIMS Many studies have shown that home haemodialysis (HOHD) provides fewer complications and better outcomes as compared with hospital haemodialysis (HHD). The aim of this study was to compare morbidity and survival in patients on HOHD and HHD. METHOD We analysed 26 prevalent HOHD patients who were matched with 52 HHD patients according to sex, age and Davies Comorbidity Index (DCI). DCI is based on seven groups of comorbidities: ischaemic heart disease (IHD), left ventricular dysfunction (LVD), peripheral vascular disease (PVD), malignancy, diabetes mellitus (DM), systemic collagen vascular disease and other significant pathology. Grade 0 had patients without any of these comorbidities, grade 1 those with 1–2 and those with 3 or more comorbidities had grade 2. Patients were followed from January 2011 to January 2020. We analysed an overall number of hospitalizations during the study period, a number of hospitalizations per year (annual hospital admission rate) and longevity of in-hospital stay (days). We categorized each hospitalization into 1 of 4 causes: cardiovascular disease (CVD), infection, vascular access dysfunction, or other cause. RESULTS Median age for HOHD and HHD patients was 55.7 and 56 years respectively and 77% of patients in both groups were men. Majority of the patients in both groups had DCI 1 (65%), 31% had DCI 0 and only 4% had DCI 2. The most common comorbidity for both HOHD and HHD patients was IHD (35% and 29% respectively), followed by HCV infection (35% and 17% respectively) and PVD (11.5% and 15% respectively). There was no difference between HOHD and HHD patients in an overall number of hospitalization (3.7 ± 3.3 versus 3.9 ± 2.8; P = .47), nor in annual admission rate for all-cause morbidity (0.5 ± 0.4 versus 0.6 ± 0.4; P = .28), but HHD patients had longer in-hospital stay (7.4 ± 9.8 days versus 9.3 ± 8.7 days; P = .05). Cause-specific morbidity showed that HHD patients had a more frequent annual admission rate for CVD (0.2 ± 0.1 versus 0.4 ± 0.3; P = .05), while there were no differences for infections (0.3 ± 0.2 versus 0.3 ± 0.3; P = .9) nor vascular access complications (0.3 ± 0.3 versus 0.4 ± 0.3; P = .3). Also, annual in-hospital stays for CVD (3.0 ± 3.1 versus 4.0 ± 4.5 days; P = .5), infection (6.4 ± 7.5 versus 5.7 ± 7.6 days; P = .6) and vascular access complications (6.0 ± 7.0 versus 7.7 ± 7.8 days; P = .5) did not differ between HOHD and HHD group. Kaplan–Meier curve revealed that survival in HOHD and HHD patients were 92.3% versus 90.4% at 3 years, 84.6% versus 70.2% at 5 years and 55.7% versus 50% at 9 years (log-rank test P = .5). CONCLUSION Our study has shown that HOHD and HHD patients had similar hospitalization rates, but patients on HOHD had better rehabilitation and shorter hospitalizations for all-cause morbidity. Despite this, HHD and HOHD patients had similar survival rates.

Randomised controlled trial of nebulised gentamicin in children with bronchiectasis.

AimFollowing trials of inhaled antibiotics in adults, this study investigates the efficacy of nebulised gentamicin to improve respiratory function in children with bronchiectasis.MethodsThis is a randomised, double‐blind, placebo‐controlled, crossover trial of 12‐week nebulised placebo/gentamicin, 6‐week washout, 12‐week gentamicin/placebo. Participants were children (5–15 years) with bronchiectasis, chronic infection (any pathogen), and able to perform spirometry from a hospital bronchiectasis clinic. Primary outcomes were change in forced expiratory volume in 1 s (FEV1) and hospitalisation days. Secondary outcomes included sputum bacterial density, sputum inflammatory markers, additional antibiotics and symptom severity. Analyses were on an intention‐to‐treat basis.ResultsFifteen children (mean 11.7‐years‐old) completed the study. There was no significant change in mean FEV1 (56%/55%, P = 0.38) or annual rate of hospital admissions (1.1/0, P = 0.12) between gentamicin and placebo, respectively. However, Haemophilus influenzae sputum growth (27% vs. 80%, P = 0.002) and bacterial density (2.4 log10 cfu/mL lower P < 0.001) improved with gentamicin. Sputum inflammatory markers interleukin‐1β (P < 0.001), interleukin‐8 (P < 0.001) and tumour necrosis factor‐α (P = 0.003) were lower with gentamicin. Poor recruitment limited study power and treatment adherence was challenging for this cohort.ConclusionsIn this crossover study of nebulised gentamicin in children with bronchiectasis, there was a reduction in sputum bacterial density and inflammation. However, there were no major improvements in clinical outcomes and adherence was a challenge.

Machine learning directed interventions associate with decreased hospitalization rates in hemodialysis patients

BackgroundAn integrated kidney disease company uses machine learning (ML) models that predict the 12-month risk of an outpatient hemodialysis (HD) patient having multiple hospitalizations to assist with directing personalized interdisciplinary interventions in a Dialysis Hospitalization Reduction Program (DHRP). We investigated the impact of risk directed interventions in the DHRP on clinic-wide hospitalization rates. MethodsWe compared the hospital admission and day rates per-patient-year (ppy) from all hemodialysis patients in 54 DHRP and 54 control clinics identified by propensity score matching at baseline in 2015 and at the end of the pilot in 2018. We also used paired T test to compare the between group difference of annual hospitalization rate and hospitalization days rates at baseline and end of the pilot. ResultsThe between group difference in annual hospital admission and day rates was similar at baseline (2015) with a mean difference between DHRP versus control clinics of −0.008 ± 0.09 ppy and −0.05 ± 0.96 ppy respectively. The between group difference in hospital admission and day rates became more distinct at the end of follow up (2018) favoring DHRP clinics with the mean difference being −0.155 ± 0.38 ppy and −0.97 ± 2.78 ppy respectively. A paired t-test showed the change in the between group difference in hospital admission and day rates from baseline to the end of the follow up was statistically significant (t-value = 2.73, p-value < 0.01) and (t-value = 2.29, p-value = 0.02) respectively. ConclusionsThese findings suggest ML model-based risk-directed interdisciplinary team interventions associate with lower hospitalization rates and hospital day rate in HD patients, compared to controls.

Predicting The Mortality And Need Of Icu Admission By Using Various Scoring System In Patient Present With Hematemesis In Emergency Department.

BACKGROUNG: An overall annual incidence of acute upper gastrointestinal haemorrhage has been estimated to be 40-150 per 1,00,000 populations (1,2), leads to annual hospital admission rate of approximately 100 per 1,00,000 hospital admissions, and has significant associated morbidity and mortality, especially in the elderly. Gastrointestinal bleeding, which is most commonly arises from mucosal erosive disease accounts for up to 20,000 deaths annually. Various risk scoring systems have been recently developed to predict clinical Outcomes and need of ICU admission in patients with upper gastrointestinal bleeding (UGIB) or hematemesis. The two commonly used scoring systems include full Rockall score (RS) and the Glasgow Blatchford score (GBS). MATERIAL AND METHOD: An observational, study was conducted on 50 patients with obvious symptoms of UGIB in the emergency department of SVPIMSR, Ahmedabad. full Rockall score (RS) and the Glasgow-Blatchford score (GBS)were calculated. Data was collected from hospital iHiS system and analysed in epi info (version 7.3.2.1) CDC software. P <0.05 was considered statistically significant. RESULTS: A total of 50 patients with UGIB were included in the study of which 72% were male and 28% were female. The mean age of patients was 47.36±16.69 years. It was found that majority of patients (44%) were in the age group of 40-60 years. Mean frequency of hematemesis was significantly higher in non-survival patient in comparison with survival ones (3.1±1.1 versus 1.85±0.62, p=0.0004). In mortality prediction full Rockall score is better than GBS (p value 0.0769 versus 0.9612). Full RS system seems to be better than GBS in predicting mortality and need for ICU admission in patients presented with hematemesis.

Local Improvements in Greenspace Decrease Cardiovascular Hospital Admissions

Background: Comparisons of greenspace between metropolitan areas generally reflect regional differences in soil characteristics and climatic zone, while greenspace differences within a metropolitan area at the postal code level avoid these regional differences. We examined local differences and trends in greenspace as determinants of local differences and trends in cardiovascular health.Methods: We calculated annual age-adjusted cardiovascular hospital admission rates (admissions per 100,000 person-years at risk, CHR) among Medicare beneficiaries aged 65 years and older for 2002-2013 across 10,097 ZIP codes (postal codes) in 123 major metropolitan core-based statistical areas (CBSA). We obtained monthly normalized difference vegetative index (NDVI) from the Terra satellite (1km grid) mapped to metropolitan ZIP code, determined the month with maximum NDVI for each metropolitan area, and finally assigned maximum-month values of NDVI for each ZIP code and year. Finally, we modeled the associations scaled to the interquartile range (IQR) both for centered means and for 12-year trends in CHR and NDVI, adjusting for CBSA and for levels and trends in adjusted gross income, proportion White and population density.Results: Across 123 major US metropolitan areas for 2002-2013, CHR had a mean of 5,903 admissions per 100,000 person-years at risk and a trend of -122 per year. An IQR increment of 0.121 in the mean NDVI was associated with a 52.4 lower CHR (95% CI 20.4, 84.3), while an IQR increment of 0.018 in the annual trend in NDVI was associated with a 6.4 per year greater decrease in CHR (95% CI 4.5, 8.3).Conclusion: Thus, after adjustment for metropolitan area characteristics and for cardiovascular risk factors, we have shown that local improvements in greenspace (NDVI) lead to local improvements in cardiovascular health among Medicare beneficiaries.This abstract does not necessarily represent the views or policies of the U.S. Environmental Protection Agency.

Risk of Acute Respiratory Distress Syndrome Among Older Adults Living Near Construction and Manufacturing Sites.

Construction and manufacturing sites produce airborne toxins that may affect nearby residents' respiratory health. Living in heavy industrial sites has been linked to respiratory conditions such as asthma and pneumonia. However, limited information is available for risk of acute respiratory distress syndrome (ARDS), a form of acute respiratory failure with high incidence among older adults. We conducted a nationwide ecologic study to investigate associations between annual ZIP code-level changes in industrial activity and annual changes in ZIP code-level hospital admission rates for older community residents. Using adjusted generalized linear mixed models, we analyzed data from nearly 30 million yearly Medicare beneficiaries for the years 2006 through 2012. We found on average 92,363 hospital admissions for ARDS per year and 646,542 admissions over the course of 7 years. We found that an increase of 10 construction sites per year was associated with a 0.77% (95% confidence interval [CI] = 0.71, 0.84) increase in annual hospital admission rates for ARDS and an increase of 10 manufacturing industries per year was associated with a 1.21% (95% CI = 1.09, 1.33) increase in annual hospital admission rates for ARDS across all ZIP codes. The estimated effect of chemical product manufacturing industry on ARDS was higher than that of total manufacturing industries. Residing in ZIP codes with a high number of construction or manufacturing sites was associated with increased ARDS hospital admissions. This nationwide ecologic study of older adults suggests that residence in areas with more construction and manufacturing sites is associated with increased ARDS risk.

P1093BENEFITS OF HOME HEMODIALYSIS

Abstract Background and Aims Home hemodialysis (HOHD) has been available as a modality of renal replacement therapy since the 1960s, in our center since 1972. Despite better patients’ outcome provided by HOHD comparing to hospital hemodialysis (HHD), its adoption has been limited worldwide. The aim of this study was to compare anemia, nutrition, mineral metabolism and morbidity in patients on HOHD and HHD. Method we analyzed dialysis and uremia related complications and morbidity in 19 HOHD patients in comparison with patients on HHD (N= 57). Each HOHD patient was previously matched with three patients on HHD by sex, age and reason for end stage renal disease (ESRD). Patients on HHD were on dialysis 3x4 h per week while patients on HOHD had dialysis on consecutive days in duration of 5-6 hours. Also, patients on HOHD were more frequent on hemodiafiltration (HDF), 89.5% of them, as compared to HHD patients (only 21.4%). Results All patients on HOHD were using AVF as vascular access for HD, and most of the analyzed HHD patients (only 5.3% used AVG). As revealed by hemoglobin level (Hgb) patients on HOHD had significantly better anemia control than HHD patients (12±2.3 vs. 10.2±1g/dl, p=0.004), despite the lower ferritin level (94±117 vs. 256±175ng/ml, p=0,001) and less frequent use of erythropoietin-stimulating agents (ESA), (and only 31% on HOHD vs 80% patients on HHD, p=0,001). By analyzing patients that used ESA therapy, we revealed that HOHD patients had lower weekly dose of ESA (5333±3265 IU vs. 6068±4145 IU). The values of intact parathyroid hormone (iPTH), did not differ significantly between HOHD (311±419pg/ml ; min 5,25, max 1529) and HHD (233±212pg/ml; min 19,25, max 926), but higher percentage of patients in HOHD group underwent parathyroidectomy (63% vs. 3.5%). The average values of calcium, and phosphorus did not significantly differ between HOHD and HHD patients (2.4±0.3 vs. 2.3±0.2mmol/l; 1.5±0.5 vs. 1.6±0.5mmol/l, respectively). HOHD patients had significantly higher albumin level (43±4.5 vs. 40.6±4g/l, p=0,035). There was no difference in annual hospital admission rate (0.4±0.5 vs. 0.6±0.7, p=0.35) between groups, but HHD patients had longer in-hospital stay. (4.8±5.3 days for HOHD vs. 7.3±9.3 days for HHD; p=0.16). Vascular access complications were most frequent reason for hospitalization in both groups (37%), followed by cardiovascular complications 13.6%, in HOHD group and infectious complications in HHD group 24%. Conclusion Our study has shown that HOHD provides some advantages over HHD including better quality of life and better anemia and nutrition control, better control of parathyroid function and shorter in-hospital stay. More frequent and longer dialysis sessions may be possible reason including HDF.

BMI and Cause-Specific Hospital Admissions and Costs: The UK Biobank Cohort Study.

To estimate the effect of BMI on cause-specific hospital admissions and costs in men and women is not well understood, and this study's aim is to address this. For 451,320 men and women aged 40 years or older recruited into the UK Biobank, followed up for 6 years on average, this study estimated annual rates and costs (at 2016 UK prices) of hospital admissions, overall and by diagnostic category (using International Classification of Diseases, Tenth Revision chapters), in relation to BMI. Among those who were never smokers, a 2-kg/m2 higher BMI (above 20 kg/m2 ) was associated with a 6.2% (99% CI: 5.3% to 7.2%) higher admission rate and an 8.6% (99% CI: 7.3% to 10.0%) higher annual cost in men and with a 5.7% (99% CI: 4.9% to 6.6%) higher admission rate and an 8.4% (99% CI: 7.5% to 9.3%) higher annual cost in women. Higher BMI was associated with higher admission rates and costs for many types of health conditions, particularly for endocrine, skin, and musculoskeletal disorders in both men and women and for circulatory diseases in men. BMI beyond healthy weight is strongly associated with higher annual rates of hospital admission and higher costs in both men and women across a wide range of health conditions.

Socioeconomic differences in health-care use and outcomes for stroke and ischaemic heart disease in China during 2009–16: a prospective cohort study of 0·5 million adults

SummaryBackgroundChina initiated major health-care reforms in 2009 aiming to provide universal health care for all by 2020. However, little is known about trends in health-care use and health outcomes across different socioeconomic groups in the past decade.MethodsWe used data from the China Kadoorie Biobank (CKB), a nationwide prospective cohort study of adults aged 30–79 years in 2004–08, in ten regions (five urban, five rural) in China. Individuals who were alive in 2009 were included in the present study. Data for all admissions were obtained by linkage to electronic hospital records from the health insurance system, and to region-specific disease and death registers. Generalised linear models were used to estimate trends in annual hospital admission rates, 28-day case fatality rates, and mean length of stay for stroke, ischaemic heart disease, and any cause in all relevant individuals.Findings512 715 participants were recruited to the CKB between June 25, 2004, and July 15, 2008, 505 995 of whom were still alive on Jan 1, 2009, and contributed to the present study. Among them, we recorded 794 824 hospital admissions (74 313 for stroke, 69 446 for ischaemic heart disease) between 2009 and 2016. After adjustment for demographic, socioeconomic, lifestyle, and morbidity factors, hospitalisation rates increased annually by 3·6% for stroke, 5·4% for ischaemic heart disease, and 4·2% for any cause, between 2009 and 2016. Higher socioeconomic groups had higher hospitalisation rates, but the annual proportional increases were higher in those with lower education or income levels, those enrolled in the urban or rural resident health insurance scheme, and for those in rural areas. Lower socioeconomic groups had higher case fatality rates for stroke and ischaemic heart disease, but greater reductions in case fatality rates than higher socioeconomic groups. By contrast, mean length of stay decreased by around 2% annually for stroke, ischaemic heart disease, and any cause, but decreased to a greater extent in higher than lower socioeconomic groups for stroke and ischaemic heart disease.InterpretationBetween 2009 and 2016, lower socioeconomic groups in China had greater increases in hospital admission rates and greater reductions in case fatality rates for stroke and ischaemic heart disease. Additional strategies are needed to further reduce socioeconomic differences in health-care use and disease outcomes.FundingWellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China Ministry of Science and Technology, and Chinese National Natural Science Foundation.

Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia, Spain

ObjectiveTo assess the association between a comprehensive smoking ban and hospitalization rates for acute myocardial infarction (AMI). MethodsAn observational study was conducted to assess changes in hospital admission rates for AMI in the Autonomous Community of Valencia, Spain (population 5 million), during the period 1995-2013. Law 28/2005 prohibited smoking in all enclosed spaces (public and private), and Law 42/2010 extended the ban to bars and restaurants as well as children's playgrounds and access areas of schools and hospitals. Data on hospital admissions were obtained from the Hospital Discharge Database (CMBD) of the Autonomous Community. Annual hospital admission rates per 100000 population for AMI (ICD-9-CM code 410) for men and women were calculated. ResultsAdjusted hospital admission rates per 100000 population for AMI decreased markedly from 141.1 in 2005 to 119.2 in 2007, with a further reduction to 102.9 in 2013. Reductions in hospital admission were recorded in both men and women, but the downward trends were stronger in women. ConclusionThe Spanish comprehensive smoking ban was associated with a marked reduction in the adjusted rate of hospital admissions due to AMI in the Autonomous Community of Valencia. This decrease in the number of persons requiring in-patient care due to AMI is important from both a health care and a societal perspective.

Hospitalization rates among patients with cystic fibrosis using pancreatic enzyme replacement therapy

We investigated the relationship between self-reported adherence to pancreatic enzyme replacement therapy (PERT), nutritional status, and all-cause hospitalization in cystic fibrosis (CF) patients with a record of PERT use. Association of self-reported annual PERT use rate (adherence) with annual hospital admission rate (HAR) and annual total hospital nights (THNs) were analyzed for 5301 children (2000–2012) and 13,989 adults (2000–2013) from the CF Foundation Patient Registry. Multivariate linear regression was used to determine the association of HAR and THN with mean annual PERT use rate, cumulative PERT use rate, mean body mass index (BMI) (adult) or BMI percentile (pediatric), age, and sex. The median annual PERT use rate was 87% in children and 80% in adults. Statistically, higher annual PERT use, longer cumulative PERT, and higher BMI percentile (children) or BMI (adults) were significantly (p < 0.0001) associated with lower annual HAR and fewer annual THN in children and adults. Female sex was associated with higher annual HAR and more annual THN in children and adults (p < 0.05). Results indicate self-reported adherence to PERT, increased BMI, and male sex were associated with fewer hospital admissions and annual hospital nights in CF patients.

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.

Impact of Long-Term Exposures to Ambient PM2.5 and Ozone on ARDS Risk for Older Adults in the United States

Chronic exposures to particulate matter with an aerodynamic diameter< 2.5 μm (PM2.5) and ozone pollution can affect respiratory function. ARDS, an often lethal respiratory failure, is most common among older adults. However, few epidemiology studies have investigated an association between air pollution and the risk of ARDS. This observational study was conducted to estimate air pollution exposures at theZIP code level and hospital admissions with ARDS among US Medicare beneficiaries aged≥ 65 years from 2000 to 2012. A two-pollutant generalized linear mixed model, adjusting for sex, age, race, median household income, smoking, and weather, was applied. There were a total of 1,164,784 hospital admissions with ARDS in the cohort. Increases of 1 µg/m3 in annual average PM2.5 and of 1 parts per billion in annual average ozone were associated with increases in annual hospital admission rates for ARDS of 0.72%(95%CI, 0.62-0.82) and 0.15%(95%CI, 0.08-0.22), respectively. In low-pollution regions (annual average PM2.5 level< 12 µg/m3 and annual average ozone level< 45 parts per billion), the same annual increase in PM2.5 and ozone were associated with increases in annual hospital admission rates for ARDS of 1.50%(95%CI, 1.27-1.72) and 0.27%(95%CI, 0.16-0.38). Long-term exposures to PM2.5 and ozone were associated with increased risk of ARDS among older adults in the United States, including exposures below current annual US National Ambient Air Quality Standards.

Can a pulse oxygen saturation of 95% to 96% help predict further vital sign destabilization in school-aged children?: A retrospective observational study.

To determine whether a peripheral capillary oxygen saturation (SpO2) of 95% to 96% should be considered “nonurgent” in school-aged children, as suggested by the Canadian Emergency Department Triage and Acuity Scale.School-aged children (6–12 years old) with a normal body temperature (36.5–37.4°C) who visited our department between September, 2014 and August, 2015 (n = 4556) were divided into 4 groups based on SpO2: group A: 99% to 100%; group B: 97% to 98%; group C: 95% to 96%; and group D: ≤94%. The heart rate (HR), respiratory rate (RR), and hospitalization rate were compared among the groups, and also between children with SpO2 95% to 96% and matched controls with SpO2 ≥97% (n = 280 each).Among 4556 eligible patients, groups A, B, C, and D comprised 2700 patients (59.3%), 1534 patients (33.6%), 280 patients (6.2%), and 42 patients (0.9%), respectively. The median (interquartile range [IQR]) RR significantly increased with decreasing SpO2 (23 [20–25], 24 [20–26], 24 [23–30], and 30 [24–40] breaths/min in groups A–D, respectively; P < .001). Similarly, the median (IQR) HR significantly increased with decreasing SpO2 (93 [83–104], 98 [87–110], 107 [93–119], and 121 [109–137] bpm, groups A-D, respectively; P < .001). Group D had the highest annual hospital admission rate (18 cases/42 patients, 42.9%). Further, the HR and RR differed significantly between the cases (107 [93–119] bpm; 24 [23–30] breaths/min) and controls (96 [86–106] bpm; 24 [20–28] breaths/min, respectively) (P < .001 and P = .02, respectively).An SpO2 of 95% to 96% among school-aged children should not be considered “nonurgent,” but rather a significant clinical situation that requires early review of HR and RR. Prompt interventions among this group of children will help prevent further destabilization of vital signs, which will, in turn, contribute to decreased healthcare costs.

Hospital admissions for skin infections among Western Australian children and adolescents from 1996 to 2012.

The objective of this study was to describe the occurrence of skin infection associated hospitalizations in children born in Western Australia (WA). We conducted a retrospective cohort study of all children born in WA between 1996 and 2012 (n = 469,589). Of these, 31,348 (6.7%) were Aboriginal and 240,237 (51.2%) were boys. We report the annual age-specific hospital admission rates by geographical location and diagnostic category. We applied log-linear regression modelling to analyse changes in temporal trends of hospitalizations. Hospitalization rates for skin infections in Aboriginal children (31.7/1000 child-years; 95% confidence interval [CI] 31.0–32.4) were 15.0 times higher (95% CI 14.5–15.5; P<0.001) than those of non-Aboriginal children (2.1/1000 child-years; 95% CI 2.0–2.1). Most admissions in Aboriginal children were due to abscess, cellulitis and scabies (84.3%), while impetigo and pyoderma were the predominant causes in non-Aboriginal children (97.7%). Admissions declined with age, with the highest rates for all skin infections observed in infants. Admissions increased with remoteness. Multiple admissions were more common in Aboriginal children. Excess admissions in Aboriginal children were observed during the wet season in the Kimberley and during summer in metropolitan areas. Our study findings show that skin infections are a significant cause of severe disease, requiring hospitalization in Western Australian children, with Aboriginal children at a particularly high risk. Improved community-level prevention of skin infections and the provision of effective primary care are crucial in reducing the burden of skin infection associated hospitalizations. The contribution of sociodemographic and environmental risk factors warrant further investigation.

Change in Care Transition Practice for Patients With Nonspecific Chest Pain After Emergency Department Evaluation 2006 to 2012.

From 2005 to 2010 health care financing shifts in the United States may have affected care transition practices for emergency department (ED) patients with nonspecific chest pain (CP) after ED evaluation. Despite being less acutely ill than those with myocardial infarction, these patients' management can be challenging. The risk of missing acute coronary syndrome is considerable enough to often warrant admission. Diagnostic advances and reimbursement limitations on the use of inpatient admission are encouraging the use of alternative ED care transition practices. In the setting of these health care changes, we hypothesized that there is a decline in inpatient admission rates for patients with nonspecific CP after ED evaluation. We retrospectively used the Nationwide ED Sample to quantify total and annual inpatient hospital admission rates from 2006 to 2012 for patients with a final ED diagnosis of nonspecific CP. We assessed the change in admission rates over time and stratified by facility characteristics including safety-net hospital status, U.S. geographic region, urban/teaching status, trauma-level designation, and hospital funding status. The admission rate for all patients with a final ED diagnosis of nonspecific CP declined from 19.2% in 2006 to 11.3% in 2012. Variability across regions was observed, while metropolitan teaching hospitals and trauma centers reflected lower admission rates. There was a 41.1% decline in inpatient hospital admission for patients with nonspecific CP after ED evaluation. This reduction is temporally associated with national policy changes affecting reimbursement for inpatient admissions.

Trends in Hospital Utilization and Costs among Pediatric Palliative Care Recipients.

Few previous studies have explored how pediatric palliative care (PPC) influences hospital utilization. We evaluated this among PPC recipients in a single center. This is a retrospective cohort study of 109 patients ≥2 years of age who received PPC consultation at a large quaternary children's hospital from April 2009 to September 2010. We assessed frequencies of hospital admissions and emergency department (ED) visits, use of intensive interventions, and hospital costs. Generalized estimating equations were used to compare outcomes in the two years before and after PPC consultation, stratifying by whether a patient survived two or more years following PPC enrollment. Median age at PPC consultation was 13 years (interquartile range 6-18); 56.0% were male (n = 61), 69.7% white non-Hispanic (n = 76). Fifty-nine percent (n = 64) of patients died during the study period. Overall, annual hospital admission rates decreased from 4.6 (95% confidence interval [CI] 4.0-5.4) before PPC consultation to 3.7 (95% CI 3.4-4.4) after (p = 0.025). Annual ED visits decreased from 0.9 (95% CI 0.7-1.2) to 0.6 (95% CI 0.4-0.8) (p = 0.030). Survivors had significantly decreased hospital admissions [rate ratio (RR) 0.57 (95% CI 0.45-0.73), p < 0.001] and ED visits [RR 0.33 (95% CI 0.20-0.54), p < 0.001]. Decedents had increased intensive care unit use (p = 0.029) but decreased operations (p = 0.002); survivors experienced no change in these outcomes after PPC consultation. Hospital costs remained stable for all (p = 0.929). PPC involvement may contribute to decreased hospital and ED use, without escalating costs. These outcomes are most evident in survivors. Hence, PPC may have a measurable long-term impact on hospital use in seriously ill children.