Average Annual Hospitalization Research Articles

P-35. Influenza Hospitalizations among Adults aged 18-64 Years and the Potential Benefit of Recombinant Vaccines: USA, 2012-13 through 2022-23

Abstract Background Influenza can cause severe illness across all age groups. Despite the universal influenza vaccine recommendation in the USA since 2010, vaccination rates among adults aged 18-64 remain low compared to children and the elderly. Given the prevalence of chronic medical conditions (CMC) that heighten the risk of severe outcomes in this population, we aim to document influenza hospitalizations among US adults aged 18-64 and establish the number of additional cases that could be averted by replacing standard dose (SD) with recombinant influenza vaccine (RIV). Additional averted hospitalizations among adults aged 18-64 when using recombinant influenza vaccine, by varying relative vaccine effectiveness estimates* *. Dashed line represents point estimates of relative vaccine effectiveness reported in the literature comparing recombinant influenza vaccine vs. standard dose vaccine. Shaded area around the line represents 95% Confidence Interval. Based on CDC vaccine effectiveness estimates, similar absolute vaccine effectiveness was assumed for both groups (18-49 and 50-64 years). Dunkle LM, Izikson R, Patriarca P, Goldenthal KL, Muse D, Callahan J, et al. Efficacy of Recombinant Influenza Vaccine in Adults 50 Years of Age or Older. N Engl J Med. 2017;376:2427–36. Hsiao A, Yee A, Fireman B, Hansen J, Lewis N, Klein NP. Recombinant or Standard-Dose Influenza Vaccine in Adults under 65 Years of Age. N Engl J Med. 2023;389:2245–55. Zimmerman RK, Nowalk MP, Dauer K, Clarke L, Raviotta JM, Balasubramani GK. Vaccine effective-ness of recombinant and standard dose influenza vaccines against influenza related hospitalization using a retrospective test-negative design. Vaccine. 2023;41:5134–40. Methods We used data from the US Centers for Disease Control and Prevention (CDC) on influenza-related hospitalizations from 2012-13 through 2022-23 (excluding 2020-21 season due to lack of influenza virus circulation) and evaluated pooled absolute vaccine effectiveness (aVE). We estimated influenza hospitalizations for those with CMC aged 18-49, applying US CMC prevalence rates from literature. For those aged 50-64, hospitalization estimates were based on CDC data, considering the entire group at-risk due to age and high prevalence of CMC. Using a decision-tree model with varying relative VE (rVE), we assessed the additional benefit of using RIV instead of SD in averting influenza-related hospitalizations among adults aged 18-64. Results Over the past decade, the CDC has reported annual influenza related hospitalizations ranging from 37,000 to 204,000 among those aged 18-64. This age group contributed from 21% to 47% of all-age hospitalizations during this period, with higher percentages observed during seasons dominated by H1N1pdm09. Average annual hospitalization rates per 100,000 population were 123.5 for those aged 50-64, and 82.2 for those aged 18-49 with CMC. The adoption of RIV for adults aged 18-64 could prevent additional influenza-related hospitalizations, with the magnitude of benefit depending on the rVE for the season (e.g. 47% [95% Confidence interval 34-71] averted influenza hospitalizations based upon 30% rVE, Figure). Conclusion The impact of influenza hospitalizations among adults aged 18-64 cannot be understated. The use of RIV or other enhanced influenza vaccine for non-elderly high-risk groups should be considered. Further research is warranted. Disclosures Laurence Torcel-Pagnon, Msc, Sanofi: Employee|Sanofi: Stocks/Bonds (Private Company) Laurent Coudeville, phD, Sanofi: Employee|Sanofi: Stocks/Bonds (Private Company) Sandra S. Chaves, MD, MSc, Sanofi: Employee|Sanofi: Employee|Sanofi: Stocks/Bonds (Private Company)|Sanofi: Stocks/Bonds (Private Company)

Clinical profile of herpes zoster-related hospitalizations and complications: A French population-based database study

To estimate the incidence of hospitalization with a diagnosis of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in France between 2013 and 2020, overall and stratified by age-group and immune status. Retrospective observational, database study, using the French hospital discharge database, which includes private and public data for all day-care and inpatient stays. Adults aged ≥18 years, hospitalized between January 1, 2013, and December 31, 2020, with a diagnosis of HZ or PHN, were included. Overall, 62 077 adults had a first hospitalization with a diagnosis of HZ or PHN during the observation period. HZ and/or PHN incidence ranged between 14.6 and 16.3 hospitalizations/100 000 persons and was highest in people aged ≥80 years (97.6 hospitalizations/100 000 persons). The immunocompromised (IC) population accounted for 22% of the overall study population. IC patients had longer lengths of stay for HZ per episode compared with non-IC patients (15.5±19.4 days vs 12.2±13.5 days) and higher in-patient mortality (8% vs 4%). Average annual hospitalization costs per patient were higher in the IC vs non-IC population (€8018 vs €5603). Older age increases hospitalization rates up to 6-fold and IC status increases in-patient mortality up to two-fold. The study was conducted by HEVA and data were provided by ATIH according to French regulatory and data protection procedures.

Impact of medical-nursing combined policy pilot on hospitalization frequency of middle-aged and older patients with chronic diseases: a quasi-experimental study based on China Health and Retirement Longitudinal Study.

To address the growing burden of older adult care, the Chinese government has introduced a policy that integrates medical care with elder care, launching two batches of national pilot projects. A majority of the older adult population suffers from one or more chronic diseases, with many experiencing multiple chronic conditions, necessitating support from both elder care and medical services. Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2020, this study employs the difference-in-difference (DID) model to analyze the impact of the integrated medical-nursing policy on the physical health of older patients with chronic diseases. The study found that the average annual number of hospitalizations for older individuals with one or more chronic diseases was 0.276. The integrated medical-nursing policy reduced hospitalizations by 0.0405. Additionally, the average annual hospitalization rate for older individuals with two or more chronic diseases was 0.339, higher than the former group. The integrated medical-nursing policy reduced hospitalizations by 0.0738 in this group. The pilot study demonstrates that the implementation of the integrated medical-nursing policy has significantly improved the physical health of older patients with chronic diseases. The government should promote these policies on a larger scale, explore various forms of integrated medical care, and provide more comprehensive medical and elder care services for older patients with chronic diseases.

Incidence and prevalence of systemic lupus erythematosus in urban China, 2013–2017: A nationwide population-based study

Systemic lupus erythematosus (SLE) is becoming a growing public health concern due to increasing disease and economic burdens. Epidemiological information about SLE, especially its incidence rate, is limited in developing countries. In the current study, we sought to investigate the incidence, prevalence, and economic burdens of SLE in urban China. We conducted a nationwide population-based cohort study using databases from Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance between 2013 and 2017, covering approximately 300 million residents in 23 provincial regions in China. Incidence rate and prevalence were standardized by age and gender to China’s 2010 national census data. Additionally, we calculated the average annual costs and hospital visit rates. A total of 132,258 SLE patients were identified during the study period, with a mean age of 43.03 years (standard deviation: 15.29 years). Of these patients, 81.33% were women. In 2017, the standardized incidence rate of SLE in China was 14.09 (95% confidence interval (CI), 11.95–16.41) per 100,000 person-years, with a higher incidence in women than in men (26.41 vs. 5.92 per 100,000 person-years). Standardized prevalence in 2017 was 47.61 (41.77–53.83), 94.16 (80.67–108.69), and 17.86 (13.84–22.38) per 100,000 people in the overall, female, and male populations, respectively. The average annual rates of increase in prevalence were 21.50%, 19.72%, and 25.67% from 2013 to 2017 in the overall, female, and male populations, respectively. The age-specific incidence rates peaked at 30–49 years old in women and 40–59 years old in men. SLE incident and prevalent cases were most common in North-West China and less common in southern and eastern China. Distinct variations in incidence rates across different regions are also consistent with the varying levels of ultraviolet radiation exposure in China. Additionally, the average estimated annual per-capita cost was 1599.34 US dollars in SLE patients, with the highest costs observed in adolescent and young adult patients among different age groups. The SLE population in China is rapidly expanding, and younger at onset, especially in women, which has placed significant burdens on China’s healthcare system.

The Trends, Clinicopathological Features, and Treatment Outcomes of Patients with Prostate Cancer in Lokoja, Nigeria.

Prostate cancer (PCa) was the most common noncutaneous cancer among Nigerian men in 2020. Despite this high incidence, documented rates may be an underestimation. This study aimed to determine the hospital incidence rate, trends, and characterise the clinicopathologic features, and treatment outcomes of patients with PCa in our institution. A 5-year retrospective review of patients managed for PCa at the Federal Teaching Hospital, Lokoja (FTHL), Nigeria, from 2016 to 2020. Medical abstraction was done on clinicopathologic features, treatment received, serum prostate specific antigen (PSA) at diagnosis, 3, and 7 months of androgen deprivation therapy (ADT). Data obtained were analysed using SPSS 25, and trends analysis of the annual incidence rate and number of patients with PCa in the period was done using joinpoint regression modelling. Of 89 patients, 83 had complete medical records. The average annual hospital incidence rate was 174/100,000, and the mean age at diagnosis was 70.4 years. Locally advanced disease was found in 81.9% of patients, and tumours were ISUP grade groups 4 and 5 in 54.2% of patients. ADT was done in 62.6% of the patients, while 28.9% of the patients defaulted after diagnosis. The mean serum PSA was 71.9 ng/mL (7.7-156) at diagnosis and was 11.1 ng/mL (0.1-102) and 15.3 ng/mL at 3 and 7 months of ADT, respectively. Only 40.6% of the treated patients had a serum PSA ≤ 4 ng/mL at 7 months of ADT. Patients with PCa in FTHL, Nigeria, have mostly locally advanced disease at diagnosis. Over half have a high-grade pattern and fail to achieve a serum PSA ≤ 4 ng/mL after 7 months of ADT.

The Incidence, Mortality and Medical Expenditure in Patients with Asthma in Taiwan: Ten-year Nationwide Study

BackgroundThis study examines incidence, mortality, medical expenditure and prescription patterns for asthma on a national scale, particularly in Asian countries for asthma is limited. Our aim is to investigate incidence, mortality, prescription patterns and provide a comprehensive overview of healthcare utilization trends for asthma from 2009 to 2018.MethodsWe included patients diagnosed with asthma between 2009 and 2018. We excluded patients with missing demographic data. Our analysis covered comorbidities, including diabetes mellitus, hypertension, allergic rhinitis, eczema, atopic dermatitis, coronary artery disease, congestive heart failure, chronic kidney disease, chronic hepatitis, stroke, and cancer. Investigated medications comprised oral and intravenous steroids, short-acting beta-agonists, inhaled corticosteroids (ICS), combinations of ICS and long-acting beta-agonists, long-acting muscarinic antagonists, and leukotriene receptor antagonists montelukast. We also assessed the number of outpatient visits, emergency visits, and hospitalizations per year, as well as the average length of hospitalization and average medical costs.ResultsThe study included a final count of 88,244 subjects from 1,998,311 randomly selected samples between 2000 and 2019. Over the past decade, there was a gradual decline in newly diagnosed asthma patients per year, from 10,140 to 6,487. The mean age annually increased from 47.59 in 2009 to 53.41 in 2018. Over 55% of the patients were female. Eczema was diagnosed in over 55% of the patients. Around 90% of the patients used oral steroids, with a peak of 97.29% in 2018, while the usage of ICS varied between 86.20% and 91.75%. Intravenous steroids use rose from 40.94% in 2009 to 54.14% in 2018. The average annual hospital stay ranged from 9 to 12 days, with a maximum of 12.26 days in 2013. Lastly, the average medical expenses per year ranged from New Taiwan dollars 5558 to 7921.ConclusionsIn summary, both asthma incidence and all-cause mortality rates decreased in Taiwan from 2009 to 2018. Further analysis of medical expenses in patients with asthma who required multiple hospitalizations annually revealed an increase in outpatient and emergency visits and hospitalizations, along with longer hospital stays and higher medical costs.

Respiratory Syncytial Virus-Associated Hospitalizations Among Children

Respiratory syncytial virus (RSV) is the leading cause of hospitalization in US infants. Accurate estimates of severe RSV disease inform policy decisions for RSV prevention. We conducted prospective surveillance for children <5 years old with acute respiratory illness from 2016 to 2020 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested midturbinate nasal ± throat swabs by reverse transcription polymerase chain reaction for RSV and other respiratory viruses. We describe characteristics of children hospitalized with RSV, risk factors for ICU admission, and estimate RSV-associated hospitalization rates. Among 13 524 acute respiratory illness inpatients <5 years old, 4243 (31.4%) were RSV-positive; 2751 (64.8%) of RSV-positive children had no underlying condition or history of prematurity. The average annual RSV-associated hospitalization rate was 4.0 (95% confidence interval [CI]: 3.8-4.1) per 1000 children <5 years, was highest among children 0 to 2 months old (23.8 [95% CI: 22.5-25.2] per 1000) and decreased with increasing age. Higher RSV-associated hospitalization rates were found in premature versus term children (rate ratio = 1.95 [95% CI: 1.76-2.11]). Risk factors for ICU admission among RSV-positive inpatients included: age 0 to 2 and 3 to 5 months (adjusted odds ratio [aOR] = 1.97 [95% CI: 1.54-2.52] and aOR = 1.56 [95% CI: 1.18-2.06], respectively, compared with 24-59 months), prematurity (aOR = 1.32 [95% CI: 1.08-1.60]) and comorbid conditions (aOR = 1.35 [95% CI: 1.10-1.66]). Younger infants and premature children experienced the highest rates of RSV-associated hospitalization and had increased risk of ICU admission. RSV prevention products are needed to reduce RSV-associated morbidity in young infants.

Mesh-based inguinal hernia repairs in an integrated healthcare system and surgeon and hospital volume: a cohort study of 110,808 patients from over a decade.

The aim of this study was to describe a cohort of patients who underwent inguinal hernia repair within a United States-based integrated healthcare system (IHS) and evaluate the risk for postoperative events by surgeon and hospital volume within each surgical approach, open, laparoscopic, and robotic. Patients aged ≥ 18years who underwent their first inguinal hernia repair were identified for a cohort study (2010-2020). Average annual surgeon and hospital volume were broken into quartiles with the lowest volume quartile as the reference group. Multiple Cox regression evaluated risk for ipsilateral reoperation following repair by volume. All analyses werestratified by surgical approach (open, laparoscopic, and robotic). 110,808 patients underwent 131,629 inguinal hernia repairs during the study years; procedures were performed by 897 surgeons at 36 hospitals. Most repairs were open (65.4%), followed by laparoscopic (33.5%) and robotic (1.1%). Reoperation rates at 5 and 10years of follow-up were 2.4% and 3.4%, respectively; rates were similar across surgical groups. In adjusted analysis, surgeons with higher laparoscopic volumes had a lower reoperation risk (27-46average annual repairs: hazard ratio [HR] = 0.63, 95% confidence interval [CI] 0.53-0.74; ≥ 47 repairs: HR 0.53, 95% CI 0.44-0.64) compared to those in the lowest volume quartile (< 14 averageannualrepairs). No differences in reoperation rates were observed in reference to surgeon or hospital volume following open or robotic inguinal hernia repair. High-volume surgeons may reduce reoperation risk following laparoscopic inguinal hernia repair. We hope to better identify additional risk factors for inguinal hernia repair complications and improve patient outcomes with future studies.

Estimation of seasonal influenza disease burden using sentinel site data in Pakistan 2017-2019: A cross-sectional study.

The influenza A(H1N1)pdm09 pandemic highlighted the need for reliable disease burden estimation from low- and middle-income countries like Pakistan. We designed retrospective age-stratified estimation of influenza-related severe acute respiratory infections (SARIs) incidence in Islamabad Pakistan 2017-2019. The catchment area was mapped on SARI data from one designated influenza sentinel site and other healthcare facilities in the Islamabad region. The incidence rate was calculated as per 100,000 for each age group with 95% confidence interval. The catchment population for the sentinel site was 0.7 million against the total denominator of 1.015 million, and incidence rates were adjusted. During January 2017 to December 2019, among 13,905 hospitalizations, 6715 (48%) patients were enrolled; 1208 of these (18%) were positive for influenza. During 2017, influenza A/H3 dominated with 52% detections followed by A(H1N1)pdm09 (35%) and influenza B (13%). Furthermore, elderly 65+ years age group had highest hospitalizations and influenza positive. The incidence rates of all cause respiratory and influenza-related SARI were highest among children >5years; highest incidence was found in 0 to 11 month/year group with 424/100,000 cases and lowest in 5-15 years 56/100,000. The estimated average annual influenza-associated hospitalization percentage was 29.3% during the study period. Influenza accounts for a significant proportion of respiratory morbidity and hospitalization. These estimates would enable governments for evidence-based decisions and priority allocation of health resources. It is necessary to test for other respiratory pathogens for more clear disease burden estimation.

Burden of Severe Illness Associated With Laboratory-Confirmed Influenza in Adults Aged 50-64 Years, 2010-2011 to 2016-2017.

Understanding the burden of influenza is necessary to optimize recommendations for influenza vaccination. We describe the epidemiology of severe influenza in 50- to 64-year-old residents of metropolitan Toronto and Peel region, Canada, over 7 influenza seasons. Prospective population-based surveillance for hospitalization associated with laboratory-confirmed influenza was conducted from September 2010 to August 2017. Conditions increasing risk of influenza complications were as defined by Canada's National Advisory Committee on Immunization. Age-specific prevalence of medical conditions was estimated using Ontario health administrative data. Population rates were estimated using Statistics Canada data. Over 7 seasons, 1228 hospitalizations occurred in patients aged 50-64 years: 40% due to A(H3N2), 30% A(H1N1), and 22% influenza B. The average annual hospitalization rate was 15.6, 20.9, and 33.2 per 100 000 in patients aged 50-54, 55-59, and 60-64 years, respectively; average annual mortality was 0.9/100 000. Overall, 33% of patients had received current season influenza vaccine; 963 (86%) had ≥1 underlying condition increasing influenza complication risk. The most common underlying medical conditions were chronic lung disease (38%) and diabetes mellitus (31%); 25% of patients were immunocompromised. The average annual hospitalization rate was 6.1/100 000 in those without and 41/100 000 in those with any underlying condition, and highest in those with renal disease or immunocompromise (138 and 281 per 100 000, respectively). The case fatality rate in hospitalized patients was 4.4%; median length of stay was 4 days (interquartile range, 2-8 days). The burden of severe influenza in 50- to 64-year-olds remains significant despite our universal publicly funded vaccination program. These data may assist in improving estimates of the cost-effectiveness of new strategies to reduce this burden.

A Population-Based Study Using Belgian Cancer Registry Data Supports Centralization of Esophageal Cancer Surgery in Belgium.

Esophageal cancer surgery outcomes benefit from higher hospital volumes. Despite the evidence, organization of national health care often is complex and depends on various factors. The volume-outcome results of this population-based study supported national health policy measures regarding concentration of esophageal resections in Belgium. The Belgian Cancer Registry (BCR) database was linked to administrative data on cancer treatment. All Belgian patients with newly diagnosed esophageal cancer in 2008-2018 undergoing resection were allocated to the hospital at which surgery was performed. The study assessed hospital volume association with 90-day mortality and 5-year overall survival, classifying average annual hospital volume of resections as low (LV, <6), medium (MV, 6-19), or high (HV, ≥20) and as a continuous covariate in the regression models. The study included 4156 patients who had surgery in 79hospitals (2 HV hospitals [37% of all surgeries], 12 MV hospitals [30% of all surgeries], and 65 LV hospitals [33% of all surgeries]). Adjusted 90-day mortality in HV hospitals was lower than in LV hospitals (odds ratio [OR], 0.37; 95% CI, 0.21-0.65; p = 0.001). Case-mix adjusted 5-year survival was superior in HV versus LV (hazard ratio [HR], 0.43; 95% CI, 0.31-0.60; p < 0.001). The continuous model demonstrated a lower 90-day mortality (OR, 0.40; 95% CI, 0.23-0.71; p = 0.002) and a superior 5-year survival (HR, 0.45; 95% CI, 0.33-0.63; p < 0.001) in hospitals with volumes of 40 or more resections annually. Population-based data from the BCR confirmed a strong volume-outcome association for esophageal resections. Improved 5-year survival in centers with annual volumes of 20 or more resections was driven mainly by the achievement of superior 90-day mortality. These findings supported centralization of esophageal resections in Belgium.

Comparative Effect of Multi-Dose Contrast Median on Contrast-Enhanced Computed Tomography Workflow of Nurses and Hospital Efficiency: A Multi-CenterReal-World Prospective Observational Study in China.

This study aims to evaluate and compare computed tomography (CT)-contrast operational workflow and hospital imaging efficiency when using a multi-dose bulk IV contrast delivery system and when using a single-dose packaging contrast. A multi-center prospective observational study was conducted in six regions in China. The operating time and workflow of radiology nursing staff were evaluated and observed using an investigational tool and recorded by the investigators using a stopwatch. Nursing staff's knowledge and the imaging capabilities of hospitals were collected using a questionnaire. Rate, t-test, χ 2 test, and partial correlation analysis were used to describe the knowledge of nursing staff. The operation time and frequency of the two contrast agent packages were further compared using the Stata 15.0 software. A total of 42 radiology nurses and 1,167 CT contrast-operating procedures in six provinces in China were evaluated. The total operating times for the 100 ml contrast agent versus the 200 ml contrast agent were 80.67 s and 63.81 s, respectively (P < 0.01). According to the average annual hospital CT scans (49,807 scans) and the power injector (PI) market share, approximately 233 h yearly could be saved in a hospital. Regarding CT contrast knowledge, approximately 57.14% nurses expressed their willingness to use multi-dose packaging contrast agents. Through difference and correlation analysis on real-world data, this study suggests that, considering safety, the use of a multi-dose bulk IV contrast agent is more time-saving and efficient for Chinese nurses and medical institutions compared with that of a single-dose package.

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.

Asthma burden according to treatment steps in the French population-based cohort CONSTANCES

BackgroundData on health care consumption and costs of asthma in the French population are scarce. ObjectivesThe study objective was to describe the burden of asthma according to GINA treatment steps in the CONSTANCES cohort. MethodsData from 162,725 participants included between 2012 and 2019 were extracted. Participants were considered as current asthmatics if asthma was reported at inclusion and asthma symptoms and/or treatments were reported in 2019. Participants were classified in three categories according to GINA treatment steps. The results were compared to non-asthmatic participants matched with a propensity score calculated on age, sex, region of residence, precariousness score and year of inclusion. ResultsAmong 162,725 participants aged 18–69 years, 6783 asthmatics (1566 not treated for asthma, 2444 + 251 GINA steps 1 + 2, 1054 + 1315 GINA steps 3 + 4, and 153 GINA step 5) were matched with 6783 controls. Average annual ambulatory cost and average annual hospitalization cost were respectively €1925 and €719 for asthmatics versus €1376 and €511 for participants without asthma (p < 0,0001). Cardiovascular risk factors, co-morbidities, visits and hospitalizations were higher for asthma participants as compared to controls and increased with GINA steps, as well as inpatient and outpatient costs. However, for cardiovascular risk factors and co-morbidities, differences were non-significant in multivariate analyses. Pharmacy costs were ten times higher for GINA step 5 participants than for GINA steps 1–2 participants: €3187 versus €393 (p < 0,0001). Conclusionmean cost of asthma was estimated at €757 per patient/year and increased with GINA treatment step.

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.

Epidemiology and trends of ocular trauma hospitalizations in Chile from 2001 to 2020

To describe and analyze the characteristics and trends of hospital admissions for ocular trauma in Chile between 2001 and 2020. We assessed hospitalizations due to ocular trauma in Chile using data from the hospital discharge registry of Chile's Department of Statistics and Health (DEIS). The JoinPoint regression analysis software was used to perform a trend analysis. From 2001 to 2020, a total of 37,425 patients were hospitalized in Chile with a diagnosis of "Injury of eye and orbit". The mean age was 36.7years, the mean length of stay was 6.85days, 82.4% of the patients were males, and 30.5% were open globe injuries. The average annual hospitalization rate over this period was 11.1/100,000 in the entire population (95% CI: 9.6-12.7), 18.7/100,000 in men (95% CI: 16-21.3) and 3.9/100,000 in women (95% CI: 3.3-4.5). Based on JoinPoint analysis, two temporal trends were identified for hospital admissions. Between 2001 and 2009, hospital admissions decreased 0.1% per year (P=0.876) and between 2009 and 2020 decreased 8.4% per year (P<0.001). On average, hospitalization rates decreased 5.3% per year (P<0.001) over the entire study period. Trauma is a significant cause of ocular morbidity in Chile, occurring mainly in middle-aged men. Since 2009, a significant decrease has been observed in hospitalization rates for ocular trauma in Chile.

Increasing prevalence and burden of bronchiectasis in urban Chinese adults, 2013–2017: a nationwide population-based cohort study

BackgroundWhile the prevalence and disease burden of bronchiectasis are increasing, data in the world’s largest population are lacking. We aimed to investigate the prevalence and disease burden of bronchiectasis in Chinese adults.MethodsWe conducted a population-based study using data between 2013 and 2017 from the national databases of Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance in China. Data from over 380 million patients aged 18 years and older during the study period were analyzed, and a total of 383,926 bronchiectasis patients were identified. Primary outcomes included the age- and sex-specific prevalence of bronchiectasis. Annual visits and hospitalizations, as well as annual costs were also calculated.ResultsThe prevalence of bronchiectasis in Chinese adults increased 2.31-fold, from 75.48 (62.26, 88.69) per 100,000 in 2013 to 174.45 (137.02, 211.88) per 100,000 in 2017. The increase was more remarkable for patients aged over 50 years in both genders. The per-capita total cost and hospitalization cost of patients with bronchiectasis increased 2.18-fold and 1.83-fold from 2013 to 2017, respectively, mostly driven by non-bronchiectasis costs. The average annual hospitalization ranged from 1.20 to 1.24 times during the 5 years.ConclusionThe prevalence and disease burden of bronchiectasis in Chinese urban adults ≥ 18 years had increased significantly between 2013 and 2017.

Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma.

The COVID-19 pandemic has disproportionately affected the socially and environmentally vulnerable, including through indirect effects on other health conditions. Asthma is one such condition, which may be exacerbated by both prolonged adverse in-home exposures if quarantining in unhealthy homes and prolonged outdoor exposures if the ambient air quality is unhealthy or hazardous. As both are often the case in Environmental Justice (EJ) communities, here we have analyzed data at the census tract (CT) level for Louisiana to assess any correlation between social and environmental vulnerability, and health issues like COVID-19 and asthma. Higher Social Vulnerability Index (SVI), Particulate Matter less than 2.5 μm in diameter (PM2.5) and Ozone levels were associated with higher rates of cumulative COVID-19 incidence at various time points during the pandemic, as well as higher average annual asthma hospitalization rates and estimated asthma prevalence. Further, cumulative COVID-19 incidence during the first three months of the pandemic was moderately correlated with both asthma hospitalizations and estimated prevalence, suggesting similar underlying factors may be affecting both conditions. Additionally, 137 CTs were identified where social and environmental vulnerabilities co-existed, of which 75 (55%) had high estimated prevalence of asthma. These areas are likely to benefit from asthma outreach that considers both social and environmental risk factors. Fifteen out of the 137 CTs (11%) not only had higher estimated prevalence of asthma but also a high burden of COVID-19. Further research in these areas may help to elucidate any common social determinants of health that underlie both asthma and COVID-19 burdens, as well as better clarify the possible role of the environment as related to the COVID-19 burden in Louisiana.

Association of health insurance coverage and probability of dying in an emergency department or hospital from a motor vehicle traffic injury.

ObjectiveDescribe the association of health insurance coverage with the odds of mortality in an emergency department (ED) or hospital for adult victims of a motor vehicle crash.MethodsThis cross‐sectional study pooled and averaged 6 years of data, 2009–2014, from the Nationwide Emergency Department Sample (NEDS). Our analysis was restricted to patients 20–85 years old that were treated in an ED for an injury sustained from a motor vehicle traffic crash (N = 2,203,407 average annual hospital discharges). The outcome variables were whether the motor vehicle crash victim died in the ED or hospital. The predictor variable was health insurance status that was measured as uninsured, Medicare, Medicaid, private insurance, and other health insurance.ResultsMost patients that died had some form of health insurance with less than a quarter classified as uninsured (23%). Nearly half of the patients that died had private insurance (48%) followed by Medicare (13%), Medicaid (9%), and other insurance (8%). Compared to the uninsured, the multivariate adjusted odds ratios (ORs) for death were significantly (P < 0.001) lower for Medicare (OR = 0.83, 95% confidence interval [CI] = 0.76–0.92), Medicaid (OR = 0.76, 95% CI = 0.69–0.84), private insurance (OR = 0.63, 95% CI = 0.58–0.68), and other insurance (OR = O.61, 95% CI = 0.54–0.70).ConclusionAfter accounting for hospital and patient characteristics, lack of health insurance was associated with a higher likelihood of death for patients admitted to an ED or hospital for injuries sustained from a motor vehicle crash.

P-121: Healthcare resource utilization and morbidities in patients with idiopathic Multicentric Castleman Disease

<h3>Background</h3> Human herpesvirus-8-negative/idiopathic multicentric Castleman disease (iMCD) is a heterogeneous group of diseases characterized by a proinflammatory hypercytokinemic state with a wide range of systemic manifestations ranging from generalized lymphadenopathy to death in severe cases. Limited data have shown increased prevalence of organ dysfunction and cancers in iMCD patients. The objective of this study was to assess healthcare resource utilization and patterns of iMCD-related morbidities in a real-world setting. <h3>Methods</h3> Retrospective analysis of administrative claims for <i>~</i>31 million US patients enrolled from 1/1/2017-12/31/2019. Patients were identified as iMCD if they had an ICD-10 code for Castleman disease (CD) and ≥2 codes corresponding to minor criteria from the iMCD consensus diagnostic criteria. Exclusion criteria were history of HIV or HHV-8. Index diagnosis date (IDD) was defined as the first time a patient received a diagnosis for CD using the new ICD-10 code (D47.Z2) or the general ICD-9 code for lymphadenopathy (785.6) that included CD, whichever was diagnosed first between 2006 and 2019. Included patients were followed for up to 5 years from IDD. <h3>Results</h3> We identified 271 iMCD patients, 161 women (59%) and 110 men (41%), mean age 51 years (range: 6-90). Average post-diagnosis follow up was 2.8 years after IDD (range: 0.3-14.1). Within first year of iMCD diagnosis, 49.1% of patients required inpatient hospitalization and 54.6% had at least one emergency room visit. Over a five-year period following initial iMCD diagnosis, patients had an average annual hospitalization rate and emergency room visit rate of 23.9% and 30.5%, respectively. The annual rate of hospitalizations and emergency room visits for the entire database of <i>~</i>31 million patients were 9.0% and 20.6%, respectively. The average annual prevalence of morbidities in the iMCD cohort (vs. prevalence in entire database) was 5.7% (vs. 0.3%) for hematologic malignancies, 4.6% (vs. 2.5%) for non-hematologic malignancies, 3.9% (vs. 0.6%) for thromboses, 2.6% (vs. 0.6%) for renal failure, and 1.9% (vs. 0.5%) for respiratory failure. Based on an average annual iMCD incidence of 3.1 (95% CI, 1.2-9.0) cases per million and average prevalence of 9.7 (95% CI, 5.3-18.6) cases per million, we estimated the average duration of documented disease as 3.1 years after diagnosis. <h3>Conclusion</h3> We found a high rate of hospitalizations, emergency room visits, organ dysfunction, and malignancy in the five years following iMCD diagnosis, compared to the general population. The average duration of documented disease was 3.1 years, which may reflect a combination of poor survival, changes in health insurance, miscoding, or resolution of symptomatic disease. Further studies are needed to compare outcomes to age-matched controls and determine whether these adverse outcomes are broadly seen across iMCD patients or instead attributable to a smaller subset of more severe cases.