Average Annual Hospitalization Rate Research Articles

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.

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.

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.

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.

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.

Effects of rotavirus vaccine on all-cause acute gastroenteritis and rotavirus hospitalizations in Israel: A nationwide analysis

BackgroundIn December 2010, the pentavalent rotavirus vaccine (RotaTeq) was added to the national immunization program in Israel. The study aim was to examine national reductions in all-cause acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) hospitalizations among children aged 0–59 months following the introduction of universal rotavirus immunization in Israel. MethodsWe extracted data from the Israel National Hospital Discharge Database. Hospitalization rates were calculated by dividing the annual number of all-cause AGE and RVGE hospitalizations by the number of children aged 0–59 months residing Israel. To assess rate reductions, we compared the mean hospitalization rate for the pre-vaccine years (2002–2008) with that for the universal vaccination years (2011–2017). Interrupted time-series analyses were undertaken. During 2008–2010 rotavirus vaccines were partially available. ResultsA total of 131,116 AGE hospitalizations were reported, of which 13,111 (10.0%) were coded as RVGE hospitalizations. The average annual all-cause AGE hospitalization rate during the pre-vaccine period was 147.9 (95% CI 146.7–149.0) per 10,000 children aged 0–59 months, and declined by 38.7–53.0% during the universal vaccination years. The average annual pre-vaccine RVGE hospitalization rate was 16.9 (95% CI 16.5–17.3) per 10,000 children, and declined by 89.1% during 2016–2017.Findings from interrupted time-series analyses showed significant impact of introducing universal rotavirus immunization on the declines of all-cause AGE and RVGE hospitalizations rates. A multivariable Autoregressive Integrated Moving Average model showed that the variable “immunization period” was a significant predictor of RVGE hospitalizations (t = 7.3, p < 0.001) for the universal vaccination years.The declines in hospitalizations rates of all-cause AGE were lower among Arab children compared to Jewish children, but the declines in RVGE rates were similar between the groups. ConclusionsNational hospitalization data demonstrated substantial and consistent reductions in all-cause AGE and RVGE hospitalizations following the implementation of universal rotavirus vaccination program.

Trends of traumatic spinal injury-related hospitalizations in Australian children over a 10-year period: a nationwide population-based cohort study

BACKGROUND CONTEXTDespite its potential to cause serious and life-long disability or death, population-based data on traumatic spinal injury in pediatric populations is scarce. PURPOSETo quantify and describe the incidence and cost of hospitalizations for traumatic spinal injury among Australian children, and to examine the trend over a 10-year period. STUDY DESIGNPopulation-based retrospective cohort study. PATIENT SAMPLEChildren aged ≤16 years who were hospitalized for traumatic spinal injury in Australia during 1 July 2002 to 30 June 2012. OUTCOME MEASURESAge-standardized hospital admission rates. METHODSThis study used linked hospitalization and mortality data. Age-standardized hospitalization rates were calculated with 95% confidence intervals (CIs). Negative binomial regression was used to examine change in temporal trends in hospitalization rates. RESULTSThere were 4,360 hospitalizations for pediatric traumatic spinal injury during the 10-year study period. Males and older children were more frequently hospitalized, and falls and road trauma accounted for almost three-quarters of hospitalizations. The average overall annual hospitalization rate was 9.43 (95% CI: 9.15–9.72) per 100,000 population, with an annual percent change of 1.2% (95% CI: −0.1% to 2.4%). There was an increase in the annual hospitalization rate for spinal dislocations, sprains, and strains (3.0% [95% CI: 0.8%–5.3%]) and among female children (1.7% [95% CI: 0.0%–3.4%]). The estimated total hospital treatment costs were AUD$43 million over the 10-year study period, with an estimated mean cost per child of AUD$9,867. CONCLUSIONSPediatric traumatic spinal injury is associated with significant morbidity and mortality. The burden of hospitalized pediatric traumatic spinal injury in Australia is rising, in particular spinal dislocations, sprains, and strains among female children. Targeted prevention strategies are needed to reduce the burden of pediatric traumatic spinal injury. It is recommended that a coordinated national strategy for preventing childhood traumatic spinal injury is developed and implemented in Australia.

Coccidioidomycosis Among American Indians and Alaska Natives, 2001-2014.

American Indians and Alaska Natives (AI/ANs) may be uniquely vulnerable to coccidioidomycosis given the large population residing in the Southwestern United States. We describe coccidioidomycosis-associated hospitalizations and outpatient visits during 2001-2014 in the Indian Health Service (IHS) system and compare hospitalizations with data from the Agency for Healthcare Research and Quality's National (Nationwide) Inpatient Sample (NIS). We identified hospitalizations in the IHS and the NIS and outpatient visits in the IHS using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 114.0-114.9. We calculated average annual hospitalization and outpatient visit rates per 1 000 000 population and used Poisson regression to calculate rate ratios (RRs) and 95% confidence intervals (CIs). We used multivariable logistic regression to assess factors associated with IHS hospitalization. AI/ANs had the highest average annual hospitalization rate (58.0; 95% CI, 49.5-66.6) of any racial/ethnic group in the NIS, compared with 13.4 (95% CI, 12.7-14.2) for non-Hispanic whites. IHS data showed a hospitalization rate of 37.0; the median length of stay (interquartile range) was 6 (3-10) days. The average annual outpatient visit rate in IHS was 764.2, and it increased from 529.9 in 2001 to 845.9 in 2014. Male sex, age ≥65 years, diabetes, and extrapulmonary or progressive coccidioidomycosis were independently associated with increased risk for hospitalization. Twenty-four percent of patients had ICD-9-CM codes for community-acquired pneumonia in the 3 months before coccidioidomycosis diagnosis. AI/ANs experience high coccidioidomycosis-associated hospitalization rates, high morbidity, and possible missed opportunities for earlier diagnosis. Yearly trends in IHS data were similar to the general increase in hospitalizations and reported cases nationwide in the same period.

Effect of Congenital Heart Disease Status on Trends in Pediatric Infective Endocarditis Hospitalizations in the United States Between 2000 and 2012.

The purpose of this study was to create national estimates for the incidence of pediatric infective endocarditis (IE) in the United States and to determine if these changed after the implementation of the 2007 American Heart Association IE guidelines. It also sought to determine the effect of congenital heart disease (CHD) status on outcomes in IE. Hospital discharges with the diagnosis of IE in patients<18years old from the Kids' Inpatient Database were identified from the years 2000, 2003, 2006, 2009, and 2012. Discharges were grouped into Pre- and Post-2007 groups to facilitate analysis surrounding the implementation of the guidelines in 2007. Patients were categorized by age, underlying CHD, and etiologic organism. Descriptive comparisons and changes in categorical variables were made between groups. Average annual IE hospitalization rates before and after the 2007 guidelines were 10.8 and 9.3 per 1,000,000 children, respectively. The proportion of IE patients with CHD was stable between time periods, (45% vs. 47%, p = 0.50). Mortality was higher in the Post-2007 time period for CHD patients than non-CHD patients (11.1% vs. 2.4%, respectively; p < 0.001), while there was no difference noted during the Pre-2007 time period (6.5% vs. 6.6%, respectively; p = 0.95). Streptococcus was more common among CHD patients than non-CHD patients (27% vs. 17%), while Staphylococcus was more common among non-CHD patients than CHD patients (34% vs. 24%, p < 0.001). Even though the incidence of IE was stable over time, mortality was higher in CHD patients after the implementation of the 2007 AHA IE prophylaxis guidelines.

Trends in Canadian infant pertussis hospitalizations in the pre- and post-acellular vaccine era, 1981–2016

ObjectiveThe acellular pertussis vaccine was introduced into the routine childhood immunization schedule across Canada in 1997–98 and adolescent booster doses were added between 1999 and 2005. We sought to assess the impact of these changes on infant pertussis hospitalizations and admissions to intensive care units (ICU) in Canada. MethodsHospitalizations with a primary diagnosis of pertussis were extracted from the Canadian Discharge Abstract Database (DAD) for cases with hospital discharge dates between 1981 and 2016 using relevant ICD-9 and ICD-10 codes. Only cases with age less than one year at time of admission were included. Disease severity was assessed by admission to ICU. Cases were categorized into two periods: pre-program implementation period (1981–1995) and the post-program implementation period (2006–2016). Incidence rates, risk ratios, and rate differences were calculated for each period and comparisons for the two periods were done using chi-squared and t-tests. Quasi Poisson analysis was used to investigate trends. ResultsWhen comparing the pre- and post-implementation periods, the average annual hospitalization rates for infants less than 1 year declined from 165.1 (95% CI 161.3, 168.9) to 33.6 (95% CI 31.6, 35.6) pertussis-related admissions per 100,000 population, with a corresponding reduction in the risk ratio of 4.9 (95% CI 4.6, 5.2). The risk of admission into an ICU was 1.58 times higher in the pre- versus post-implementation period while the highest reduction in average annual hospitalizations was 263.3 admissions per 100,000 population in infants 2 months of age. In the post-implementation period, infants less than 1 month of age had the highest average annual hospitalization rate at 126.6 (95% CI 113.1, 140.1) hospitalizations per 100,000 infants. ConclusionInfant pertussis hospitalizations have reduced greatly over time. Infants under 2 months of age remain the most at-risk age group for hospitalization and admission to ICU.

Burden of Pneumonia-Associated Hospitalizations: United States, 2001-2014

The epidemiology of pneumonia has likely evolved in recent years, reflecting an aging population, changes in population immunity, and socioeconomic disparities. Using the National (Nationwide) Inpatient Sample, estimated numbers and rates of pneumonia-associated hospitalizations for 2001-2014 were calculated. A pneumonia-associated hospitalization was defined as one in which the discharge record listed a principal diagnosis of pneumonia or a secondary diagnosis of pneumonia if the principal diagnosis was respiratory failure or sepsis. There were an estimated 20,361,181 (SE, 95,601) pneumonia-associated hospitalizations in the United States during 2001-2014 (average annual age-adjusted pneumonia-associated hospitalization rate of 464.8 per 100,000 population [95%CI, 462.5-467.1]). The average annual age-adjusted pneumonia-associated hospitalization rate decreased over the study period (P < .0001). In-hospital death occurred in 7.4%(SE, 0.03) of pneumonia-associated hospitalizations. Non-Hispanic American Indian/Alaskan Natives and non-Hispanic blacks had the highest average annual age-adjusted rates of pneumonia-associated hospitalization of all race/ethnicities at 439.2 (95%CI, 415.9-462.5) and 438.6 (95%CI, 432.5-444.7) per 100,000 population, respectively. During 2001-2014, the proportion of pneumonia-associated hospitalizations colisting an immunocompromising condition increased from 18.7%(SE, 0.2) in 2001 to 29.9%(SE, 0.2) in 2014. Total charges for pneumonia-associated hospitalizations in 2014 were over $84 billion. Pneumonia is a major cause of morbidity and mortality in the United States. Differences in rates and outcomes of pneumonia-associated hospitalizations between sociodemographic groups warrant further investigation. The immunocompromised population has emerged as a group experiencing a disproportionate burden of pneumonia-associated hospitalizations.

The Burden of Human Metapneumovirus and Respiratory Syncytial Virus Infections in Hospitalized Norwegian Children.

The burden of severe human metapneumovirus (HMPV) respiratory tract infections (RTIs) in European children has not been clarified. We assessed HMPV in Norwegian children and compared hospitalization rates for HMPV and respiratory syncytial virus (RSV). We prospectively enrolled children (<16 years old) hospitalized with RTI and asymptomatic controls (2006-2015). Nasopharyngeal aspirate samples were analyzed with polymerase chain reaction (PCR) tests for HMPV, RSV, and 17 other pathogens. We genotyped HMPV-positive samples and assessed shedding time in 32 HMPV-infected children. In children with RTI, HMPV was detected in 7.3% (267 of 3650) and RSV in 28.7% (1048 of 3650). Among controls, 2.1% (7 of 339) had low HMPV levels detected by PCR, but all were culture negative. HMPV primarily occurred from January to April and in regular epidemics. At least 2 HMPV subtypes occurred each season. The average annual hospitalization rates in children <5 years old with lower RTI were 1.9/1000 (HMPV) and 10.4/1000 (RSV). Among children with RTI, the median HMPV shedding time by PCR was 13 days (range, 6-28 days), but all were culture negative (noninfectious) after 13 days. HMPV appears in epidemics in Norwegian children, with a hospitalization rate 5 times lower than RSV. Low levels of HMPV are rarely detected in healthy children.

Abstract P341: Community Environment Associated with Cardiovascular Disease Hospitalization Rates in Denver, Colorado

Introduction: Hospitalization rates for acute myocardial infarction (AMI), coronary heart disease (CHD), and stroke have decreased over time, although trends are debatable for heart failure (HF). These trends are unequally distributed. There is a growing literature documenting the relationship between social and economic characteristics of people’s communities and cardiovascular disease (CVD). Based on a social ecological model of health through the life course, we descriptively examined associations between CVD hospitalization rates and patient characteristics and census tract (CT)-level community environment. Hypothesis: CVD hospitalization rates will be higher in community environments with higher percentages of individuals living below the federal poverty level, racial/ethnic minority groups, and non-residential (i.e., commercial/office, industrial, open space, public/civic, vacant, and miscellaneous space) vs. residential land use. Methods: Colorado Hospital Association (2009-2013) data were used to measure ICD-9 coded hospitalization rates (per 1,000) for Denver, Colorado residents ≥20 years. Data were merged with American Community Survey (2009-2013) and Denver County land use (2010) data. Using chi-square analysis, we examined associations between age-adjusted CVD hospitalization rates (N=15,521) and CT-level community environment (in quartiles) (N=144). Results: Denver’s annual CVD hospitalization rate was 6.6. Patient-level AMI (1.7), CHD (2.8), and HF (2.2) rates were higher among men. Women had higher stroke-related rates (2.4). Across CVD types, rates for those ≥65 years (6.5-13.5) were higher than middle-aged groups (2.1-3.4). Average annual age-adjusted AMI hospitalization rates were higher in CTs with the highest quartile of Hispanic Americans (2.0), Native Americans (1.9), and individuals below poverty (1.9). CHD rates were higher in CTs with higher percentages of Hispanic Americans (3.1), individuals below poverty (3.1), and Native Americans (3.1). HF rates were higher in CTs with higher percentages of industrial/office land use (3.5), individuals below poverty (3.3), and Hispanic Americans (3.2). Stroke rates were higher in CTs with higher percentages of Native Americans (3.0), industrial/office land use (3.0), and African Americans (3.0). The largest disparities for rate ratios comparing the highest to the lowest quartiles for each exposure by CVD outcome were the percentage of individuals below poverty (AMI 2.2; CHD 2.1; HF 2.4; Stroke 1.7), non-Hispanic Whites (AMI 0.7; CHD 0.7; HF 0.7; Stroke 0.7), Hispanic Americans (AMI 1.5; CHD 1.5; HF 1.5), and Native Americans (Stroke 1.30). Conclusions: In conclusion, associations exist between community environment and CVD hospitalization rates, suggesting opportunities for health policy development in Denver’s city government, council districts, and neighborhoods .

Chronic Liver Disease-Associated Hospitalizations Among Adults with Diabetes, National Inpatient Sample, 2001-2012.

Many people with diabetes have a variety of diabetes-related complications. Among the variety of conditions associated with diabetes, however, liver diseases are less well recognized. As such, we aimed to describe chronic liver disease (CLD)-associated hospitalization rates among U.S. adults with diabetes from 2001-2012. We used a nationally representative database of hospitalizations, the National Inpatient Sample, to determine CLD-associated hospitalization rates among U.S. adults aged ≥ 18 years with and without diabetes, from 2001-2012. Hospitalizations listing an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for CLD on the discharge record were selected for analysis and were further classified by diabetes status based on concurrent presence of a diabetes ICD-9-CM code. We calculated average annual age-adjusted hospitalization rates and 95% confidence intervals (CIs), and conducted a test for trend. For 2001-2012, the total age-adjusted CLD-associated hospitalization rate among adults with diabetes (1,680.9 per 100,000 population; 95% CI 1,577.2, 1,784.6) was approximately four times the rate of adults without diabetes (424.2 per 100,000 population; 95% CI 413.4, 435.1). Total age-adjusted hospitalization rates of adults with and without diabetes increased 59% and 48%, respectively, from 2001-2002 to 2011-2012 (p<0.001). Hepatitis C- and chronic hepatitis and cirrhosis-associated hospitalizations comprised the largest proportion of total CLD-associated hospitalizations among adults with and without diabetes. Providers should be aware of the potential existence of CLD among adults with diabetes and counsel patients on preventive methods to avoid progressive liver damage.

Abstract O.03: Monitoring the Occurrence of Kawasaki Syndrome in the United States

Objectives: To describe the occurrence of Kawasaki syndrome (KS) in the United States. Methods: The Kids’ Inpatient Database (KID; 2003, 2006, 2009, 2012) and the Nationwide Inpatient Sample (NIS; 2001-2011) were analyzed to determine KS-associated hospitalization rates and trends; the United States Centers for Disease Control and Prevention (CDC; 2010-July 2014) passive KS surveillance database was analyzed to assess the frequency of coronary artery abnormalities (CAAs) among reported KS cases meeting the CDC KS case definition. Results: The KS-associated hospitalization rate for children &lt;5 years of age using the KID was 18.1 (95% CI: 16.0-20.2) per 100,000 children in 2012, 20.0 (95% CI: 17.8-22.2) in 2009, 21.3 (95% CI: 18.9-23.7) in 2006, and 19.7 (95% CI: 17.7-21.7) in 2003. The 2012 KS-associated hospitalization rate was 21.0 (95% CI: 18.6-23.4) among males &lt;5 years of age and 15.0 (95% CI: 13.0-17.0) among females. Asians/Pacific Islanders had the highest rate among all racial groups, 29.8 (95% CI: 22.2-37.4). The average annual KS-associated hospitalization rate for children &lt;5 years of age using the NIS was constant from 2001-2011 at 18.8 per 100,000 per year (95% CI: 17.3-20.3; p=0.16) with peaks in 2005 (27.0 per 100,000; 95% CI: 19.3-34.7) and, to a lesser extent, in 2010 (22.6 per 100,000; 95% CI: 16.6-28.5). The CDC surveillance database included 497 physician-diagnosed KS cases &lt;18 years of age reported with onset occurring January 1, 2010 through July 31, 2014; about three-quarters (n=372) of the cases met the CDC KS case definition. Among KS cases meeting this definition that also contained complication data, 18.7% (69/369) had CAAs reported; among Asian/Pacific Islander children, 24.7% (18/73) had CAAs reported. Almost all KS cases in the database (98.1%, 363/370) were treated with intravenous immunoglobulin. Conclusions: Analyses of KID and NIS data did not indicate any increase in KS-associated hospitalization rates for children &lt;5 years of age in the United States through 2012. CAAs continue to occur at a comparable rate with past reports.

Lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general United States child population

BackgroundThe lower respiratory tract infection (LRTI)-associated hospitalization rate in American Indian and Alaska Native (AI/AN) children aged <5 years declined during 1998–2008, yet remained 1.6 times higher than the general US child population in 2006–2008.PurposeDescribe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years.MethodsA retrospective analysis of hospitalizations with discharge ICD-9-CM codes for LRTI for AI/AN children and for the general US child population <5 years during 2009–2011 was conducted using Indian Health Service direct and contract care inpatient data and the Nationwide Inpatient Sample, respectively. We calculated hospitalization rates and made comparisons to previously published 1998–1999 rates prior to pneumococcal conjugate vaccine introduction.ResultsThe average annual LRTI-associated hospitalization rate declined from 1998–1999 to 2009–2011 in AI/AN (35%, p<0.01) and the general US child population (19%, SE: 4.5%, p<0.01). The 2009–2011 AI/AN child average annual LRTI-associated hospitalization rate was 20.7 per 1,000, 1.5 times higher than the US child rate (13.7 95% CI: 12.6–14.8). The Alaska (38.9) and Southwest regions (27.3) had the highest rates. The disparity was greatest for infant (<1 year) pneumonia-associated and 2009–2010 H1N1 influenza-associated hospitalizations.ConclusionsAlthough the LRTI-associated hospitalization rate declined, the 2009–2011 AI/AN child rate remained higher than the US child rate, especially in the Alaska and Southwest regions. The residual disparity is likely multi-factorial and partly related to household crowding, indoor smoke exposure, lack of piped water and poverty. Implementation of interventions proven to reduce LRTI is needed among AI/AN children.

Epidemiology of Asthma Hospitalizations Among American Indian and Alaska Native People and the General United States Population

Asthma, a common chronic disease among adults and children in the United States, results in nearly one-half million hospitalizations annually. There has been no evaluation of asthma hospitalizations for American Indian and Alaska Native (AI/AN) people since a previous study using data for 1988-2002. In this study, we describe the epidemiology and trends for asthma hospitalizations among AI/AN people and the general US population for 2003-2011. Hospital discharge records with a first-listed diagnosis of asthma for 2003-2011 were examined for AI/AN people, using Indian Health Service (IHS) data, and for the general US population, using the Nationwide Inpatient Sample. Average annual crude and age-adjusted hospitalization rates were calculated. The average annual asthma hospitalization rates for AI/AN people and the general US population decreased from 2003-2005 to 2009-2011 (32% and 11% [SE, 3%], respectively). The average annual age-adjusted rate for 2009-2011 was lower for AI/AN people (7.6 per 10,000 population) compared with the general US population (13.2 per 10,000; 95% CI, 12.8-13.6). Age-specific AI/AN rates were highest among infants and children 1 to 4 years of age. IHS regional rates declined in all regions except Alaska. Asthma hospitalization rates are decreasing for AI/AN people and the general US population despite increasing prevalence rates. AI/AN people experienced a substantially lower age-adjusted asthma hospitalization rate compared with the general US population. Although the rates for AI/AN infants and children 1 to 4 years of age have declined substantially, they remain higher compared with other age groups. Improved disease management and awareness should help to further decrease asthma hospitalizations, particularly among young children.

Influenza-associated-excess-hospitalization in children, Wuxi city, Jiangsu province, 2005-2010

To estimate the rates due to influenza-associated-excess-hospitalization in children aged 0-14 years in Wuxi city,Jiangsu province in 2005-2010. We collected data on hospitalization due to influenza, pneumonia and other respiratory diseases from fourteen 2nd level or above hospitals in Wuxi, as well as data on influenza virological surveillance in southern China to fit the negative binomial regression models, to estimate the rate on influenza-associated-excess hospitalization. During 2005-2010, an average annual hospitalization rate appeared as 91.6‰ (79.2‰ -99.3‰). Among the total hospitalization eases, respiratory diseases accounted for 54.2%, while both influenza and pneumonia accounted for 38.1%. The average annual influenza- associated-excess-hospitalization rates due to influenza and pneumonia appeared as 1.28‰ (95% CI:0.29‰ -4.84‰), while 2.18‰ (95% CI:0.61‰ -6.79‰) due to respiratory diseases. In 2009, A (H1N1) pdm induced influenza pandemic caused 993 excess hospitalizations due to influenza/pneumonia and 1 042 excess hospitalizations due to respiratory diseases, with rates as 1.14‰ and 1.20‰ respectively. Both seasonal and pandemic A(H1N1)pdm influenza caused considerable burden on hospitalization in children aged 0-14 years inWuxi.

Impact of Varicella Vaccination on Varicella-related Hospitalizations Among American Indian/Alaska Native People

Routine childhood varicella vaccination, implemented in 1995, has resulted in significant declines in varicella-related hospitalizations in the United States. Varicella hospitalization rates among the American Indian (AI) and Alaska Native (AN) population have not been previously documented. We selected varicella-related hospitalizations, based on a published definition, from the Indian Health Service inpatient database for AI/ANs in the Alaska, Southwest and Northern Plains regions (1995-2010) and from the Nationwide Inpatient Sample for the general US population (2007-2010). We analyzed average annual hospitalization rates prevaccine (1995-1998) and postvaccine (2007-2010) for the AI/AN population, and postvaccine for the general US population. From 1995-1998 to 2007-2010, the average annual varicella-related hospitalization rate for AI/ANs in the 3 regions decreased 95% (0.66-0.03/10,000 persons); the postvaccine rate appears lower than the general US rate (0.06, 95% confidence interval: 0.05-0.06). The rate declined in all AI/AN pediatric age groups. Infants experienced the highest prevaccine (14.07) and postvaccine (0.83) hospitalization rates. Adults experienced low rates in both periods. Varicella vaccination rates in 19- to 35-month-old AI/AN children during fiscal years 2008-2010 were 88.1-91.0%. Widespread use of varicella vaccine in AI/AN children was accompanied by substantial declines in varicella-related hospitalizations consistent with high varicella vaccine effectiveness in preventing severe varicella outcomes.

Encephalitis-associated hospitalizations among American Indians and Alaska Natives.

Encephalitis produces considerable morbidity in the United States, but morbidity rates among American Indian/Alaska Native (AI/AN) people have not been described. Hospitalization records listing an encephalitis diagnosis were analyzed by using Indian Health Service direct/contract inpatient data. For 1998-2010, there were 436 encephalitis-associated hospitalizations among AI/AN people, an average annual age-adjusted hospitalization rate of 3.1/100,000 population. The rate for infants (11.9) was more than double that for any other age group. Death occurred for 4.1% of hospitalizations. Consistent with reports for the general U.S. population, the rate was high among infants and most (53.9%) hospitalizations were of unexplained etiology. The average annual rate during the study period appeared lower than for the general U.S. population, due particularly to lower rates in the elderly. Future community-based surveillance and mortality studies are needed to confirm these findings and examine reasons underlying the low rates of encephalitis in AI/AN people.