Burden Of Medical Comorbidity Research Articles

Serving Those Who Served: Enhancing Colorectal Surgery Care for Veterans

AbstractThe Department of Veterans Affairs (VA) is the largest provider of integrated health care services in the United States and its mission is to honor veterans by providing timely, effective, and high-quality health care that improves individuals' health and functionality. The VA provides comprehensive primary and specialty care, including colorectal surgery services, to eligible veterans who suffer from a disproportionately high burden of medical comorbidities and often belong to vulnerable populations, including individuals of low socioeconomic status, those who identify as lesbian, gay, bisexual, transgender, and questioning, racial minorities, and those suffering from severe mental health illness. There are many challenges to caring for a population of veterans with benign and malignant colorectal disease due to both patient and system level factors. Despite these challenges, the VA has demonstrated a commitment to ensuring culturally competent, equitable, and inclusive care and to conducting research that establishes evidence-based best practices in the management of colorectal diseases. These efforts have led to outcomes for patients undergoing care for colorectal diseases within the VA that are par with or better than civilian outcomes. The VA is uniquely positioned on a system level to provide nationwide efforts that improve care delivery and serve those who served.

Factors Associated with Acute Telemental Health Consultations in Older Veterans.

The United States Veterans Health Administration is a leader in the use of telemental health (TMH) to enhance access to mental healthcare amidst a nationwide shortage of mental health professionals. The Tennessee Valley Veterans Affairs (VA) Health System piloted TMH in its emergency department (ED) and urgent care clinic (UCC) in 2019, with full 24/7 availability beginning March 1, 2020. Following implementation, preliminary data demonstrated that veterans ≥65years old were less likely to receive TMH than younger patients. We sought to examine factors associated with older veterans receiving TMH consultations in acute, unscheduled, outpatient settings to identify limitations in the current process. This was a retrospective cohort study conducted within the Tennessee Valley VA Health System. We included veterans ≥55years who received a mental health consultation in the ED or UCC from April 1, 2020-September 30, 2022. Telemental health was administered by a mental health clinician (attending physician, resident physician, nurse practitioner, or physician assistant) via iPad, whereas in-person evaluations were performed in the ED. We examined the influence of patient demographics, visit timing, chief complaint, and psychiatric history on TMH, using multivariable logistic regression. Of the 254 patients included in this analysis, 177 (69.7%) received TMH. Veterans with high-risk chief complaints (suicidal ideation, homicidal ideation, or agitation) were less likely to receive TMH consultation (adjusted odds ratio [AOR]: 0.47, 95% confidence interval [CI] 0.24-0.95). Compared to attending physicians, nurse practitioners and physician assistants were associated with increased TMH use (AOR 4.81, 95% CI 2.04-11.36), whereas consultation by resident physicians was associated with decreased TMH use (AOR 0.04, 95% CI 0.00-0.59). The UCC used TMH for all but one encounter. Patient characteristics including their visit timing, gender, additional medical complaints, comorbidity burden, and number of psychoactive medications did not influence use of TMH. High-risk chief complaints, location, and type of mental health clinician may be key determinants of telemental health use in older adults. This may help expand mental healthcare access to areas with a shortage of mental health professionals and prevent potentially avoidable transfers in low-acuity situations. Further studies and interventions may optimize TMH for older patients to ensure safe, equitable mental health care.

Substance Use Disorders among Adolescents in the United States: 2000-2019.

Substance use disorders (SUDs) are characterized by impairment caused by the recurrent use of alcohol, illicit drugs, or both. SUDs are pervasive and endemic among US adolescents, with potentially negative health and social consequences. Although the term experimentation normalizes adolescent substance abuse, the long-term consequences of this behavior beginning in adolescence can be detrimental to not only the adolescent but also the adult into which he or she develops. Our objective was to examine the epidemiology of SUD among hospitalized US adolescents, 13 to 19 years of age, during the time period 2000-2019. A case-control study was conducted using 5,260,104 hospital discharge records (394,952 SUD and 4,865,152 non-SUD) from the 2000-2019 Kids' Inpatient Database. SUD and clinical outcomes variables were identified based on the International Classification of Diseases, Ninth/Tenth Revisions, Clinical Modification, coding. SUD rates (per 1000 discharges) were calculated and adjusted odds ratios (aORs) with their 95% confidence intervals (CIs) were computed using logistic regression models for predictors of SUDs among hospitalized adolescents. The prevalence of SUDs was estimated to be 75.10 cases per 1000 discharges (95% CI 74.86-75.31). Demographically, the highest crude rates (per 1000 discharges) were seen among Native American (139.58) and White (91.97) patients. Adolescent patients who experienced SUD were twice as likely as nonusers to be 16 to 19 years of age (aOR 2.2, 95% CI 2.13-2.19) or to be male (aOR 2.2, 95% CI 2.22-2.27). SUD was significantly associated with cooccurring conditions, including anxiety (aOR 2.5, 95% CI 2.48-2.53), depression (aOR 2.3, 95% CI 2.30-2.35), mood disorder (aOR 2.17, 95% CI 2.14-2.20), schizophrenia (aOR 2.6, 95% CI 2.52-2.64), sexually transmitted infections (aOR 2.3, 95% CI 2.23-2.45), hepatitis (aOR 3.0, 95% CI 2.87-3.15), and suicide (aOR 1.33, 95% CI 1.30-1.35). The study examined the epidemiology, risk factors, and common characteristics of hospitalized adolescent patients with SUDs. The high burden of psychiatric and medical comorbidities observed among this patient group warrants designing effective and comprehensive substance use prevention and treatment programs for youths.

Severity-of-Illness Scores and Discharge Disposition in Patients Admitted to Long-Term Acute Care Hospitals.

After an intensive care unit (ICU) admission, nearly 20% of survivors of chronic critical illness require admission to a long-term acute care hospital (LTACH) for continued subspecialty care. The effect of the burden of medical comorbidities on discharge disposition after LTACH admission remains unclear. A retrospective cohort study was performed involving patients with chronic critical illness who were discharged from the medical ICU and admitted to an LTACH between 2016 and 2018. The patients' Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Nutrition Risk in the Critically Ill (NUTRIC), and Charlson Comorbidity Index (CCI) scores at the time of LTACH admission were calculated from electronic medical records. The mean scores on each instrument were compared by discharge disposition. A total of 156 patients were admitted to the LTACH from the medical ICU between 2016 and 2018. They had a mean (SD) age of 61.5 (13.3) years, a mean (SD) body mass index of 28.1 (8.3), a median (IQR) ICU stay of 16.3 (1-108) days, and a median (IQR) LTACH stay of 38.2 (1-227) days. Patients who were discharged home had lower mean (SD) APACHE II (14.6 [5.0] vs 18.2 [5.4], P = .01), SOFA (3.3 [2.1] vs 4.6 [2.1], P = .03), NUTRIC (3.3 [1.4] vs 4.6 [1.4], P = .001), and CCI (4.3 [2.5] vs 6.1 [2.8], P = .02) scores on admission to the LTACH than those who were not discharged home. Severity-of-illness scores on admission to an LTACH can be used to predict patients' likelihood of being discharged home.

339 Dupilumab 16-week efficacy and safety are robust and consistent in adults over 60 years of age with moderate-to-severe atopic dermatitis

Abstract Atopic dermatitis (AD) may be more common than previously thought in adults aged ≥60 years, a population underrepresented in clinical trials. Rigorous demonstration of efficacy and safety in older adults is clinically important due to distinct disease presentations in this group, age-related immune shifts, changes in drug metabolism and risks associated with a heightened burden of medical comorbidities and polypharmacy. Treatment options providing efficacy with acceptable safety profiles are of particular importance. Here, we report the efficacy and safety of dupilumab for the treatment of moderate-to-severe AD in patients aged ≥60 years. Data were pooled from four randomized, placebo-controlled dupilumab trials in patients with moderate-to-severe AD (LIBERTY AD SOLO 1 & 2 [NCT02277743, NCT02277769], LIBERTY AD CAFÉ [NCT02755649] and LIBERTY AD CHRONOS [NCT02260986]). Patients aged ≥60 years (N = 183) received dupilumab 300 mg weekly (qw), every 2 weeks (q2w) or a placebo. Topical corticosteroids (TCSs) were permitted in LIBERTY AD CAFÉ and LIBERTY AD CHRONOS. Reported efficacy measures include the percentage of patients achieving a 75% reduction in Eczema Area and Severity Index (EASI-75), mean change in Peak Pruritus Numerical Rating Scale (PP-NRS) scores, and mean change in Dermatology Life Quality Index (DLQI). Safety data are also presented. Among patients aged ≥60 years, significant increases in EASI-75 responses were observed in patients treated with dupilumab 300 mg qw (61.6%) and 300 mg q2w (63.0%) vs. placebo (14.3%; P < 0.0001 for both) at week 16. Least squares (LS) mean change (± standard error [SE]) in PP-NRS scores was significantly greater in patients treated with dupilumab 300 mg qw (−1.6 [0.2]) and 300 mg q2w (−1.7 [0.3]) vs. placebo (−0.9 [0.3]; P < 0.05 for both) at week 2. Improvements continued to week 16 in patients treated with dupilumab 300 mg qw (−4.0 [0.3]) and 300 mg q2w (−3.8 [0.3]) vs. placebo (−1.7 [0.3]; P < 0.0001 for both). Similarly, significant improvement (LS mean change [±SE]) in DLQI was seen in patients treated with dupilumab 300 mg qw (−5.0 [0.6]) and 300 mg q2w (−6.0 [0.7]) vs. placebo (−2.8 [0.6]; P < 0.01 vs. qw and P < 0.001 vs. q2w) at week 2; improvements continued to week 16 in patients treated with dupilumab 300 mg qw (−8.0 [0.6]) and 300 mg q2w (−9.65 [0.7]) vs. placebo (−3.3 [0.7]; P < 0.0001 for both). 52 (72.2%) patients in the 300 mg qw treatment group, 32 (58.2%) patients in the 300 mg q2w treatment group, and 40 (71.4%) patients in the placebo group experienced ≥1 TEAE. The two most common treatment-emergent adverse events (TEAEs) were injection-site reactions (13.9%) and nasopharyngitis (9.7%) during 300 mg qw dupilumab treatment; dermatitis atopic (20.0%) and nasopharyngitis (5.5%) during 300 mg q2w dupilumab treatment; and dermatitis atopic (30.4%) and upper respiratory tract infection (7.1%) during placebo treatment. 3 (4.2%) patients during 300 mg qw dupilumab treatment and 2 (3.6%) patients during 300 mg q2w dupilumab treatment discontinued treatment permanently as a result of TEAEs. Dupilumab efficacy and safety profiles in patients aged ≥60 years were generally consistent with that seen in patients aged <60 years with atopic dermatitis, and have been previously reported. Dupilumab, with or without TCS, improves AD signs, symptoms and quality of life with a consistent and acceptable safety profile in patients aged ≥60 years with moderate-to-severe AD.

Approach to acute psychosis in older adults.

Approach to acute psychosis in older adults.

Characterization of Pre- and Postpandemic 30-Day Follow-Up After Elective Bariatric Surgery: a Retrospective MBSAQIP Analysis of 834,646 Patients.

Effects of the COVID-19 pandemic on rates of early postoperative follow-up after bariatric surgery are poorly understood. Our study characterizes 30-day follow-up after bariatric surgery prior to COVID-19 (years 2015-2019) and during the pandemic of COVID-19 (year 2020) and evaluates general predictive factors of short-term follow-up. Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2020. Cohorts were divided into pre-pandemic and pandemic years and patients with and without 30-day follow-up. Multivariable logistic regression analysis was used to identify general factors independently predictive of 30-day follow-up. The primary aim was to evaluate the impact of the COVID-19 pandemic on short-term 30-day follow-up adherence. A secondary outcome was to characterize general short-term postoperative 30-day follow-up associated with elective bariatric surgery and identify independent predictors of 30-day follow-up among bariatric surgery patients using multivariable logistic regression analysis. A total of 834,646 patients were identified. Follow-up rates significantly increased in the COVID era in 2020 (p < 0.0001). Patients who achieved 30-day follow-up were older and had an increased burden of medical comorbidities, including non-insulin and insulin-dependent diabetes mellitus, hypertension, dyslipidemia, as well as increased BMI compared to patients lacking follow-up. The cohort with successful 30-day follow-up was more likely to receive gastric bypass and had increased rates of metabolic comorbidities. After adjusting for comorbidities, the greatest independent predictors of follow-up were the 2020 COVID-19 era year, Asian race, black race, and gastroesophageal reflux disease. After adjusting for comorbidities, the 2020 COVID-19 era year was one of the greatest predictors of follow-up after bariatric surgery. Postoperative follow-up rates after elective bariatric surgery are excellent at > 95% and increased during the 2020 COVID-19 era year. Several independent predictors of follow-up were identified which may help in development of strategies aimed to mitigate lack of postoperative follow-up.

Association of Subjective Cognitive Decline With Progression to Dementia in a Cognitively Unimpaired Multiracial Community Sample.

This prospective study seeks to examine the utility of subjective cognitive decline (SCD) as a marker of future progression to dementia in a community-based cohort of non-Latinx White, non-Latinx Black, and Latinx individuals. Debate surrounds the utility of SCD, the subjective perception of decline in one's cognition before such impairment is evident in traditional neuropsychological assessments, as an early indicator of impending Alzheimer disease. Unfortunately, most studies examining SCD have been conducted in non-Latinx White samples and commonly exclude groups of individuals shown to be most vulnerable to dementia. Participants were enrolled into this cohort study from the Washington Heights-Inwood Columbia Aging Project if they were cognitively unimpaired, had baseline measurement of SCD, and self-identified as non-Latinx White, non-Latinx Black, or Latinx. SCD was measured as a continuous sum of 10 items assessing cognitive complaints. Competing risk models tested the main effects of baseline SCD on progression to dementia. Models were adjusted for age, sex/gender, years of education, medical comorbidity burden, enrollment cohort, and baseline memory test performance with death jointly modelled as a function of race/ethnicity. A total of 4,043 (1,063 non-Latinx White, 1,267 non-Latinx Black, and 1,713 Latinx) participants were selected for this study with a mean age of 75 years, 67% women, and with a mean follow-up of 5 years. Higher baseline SCD was associated with increased rates of incident dementia over time in the full sample (hazard ratio [HR] 1.085, CI 1.047-1.125, p < 0.001) and within Latinx (HR 1.084, CI 1.039-1.130, p < 0.001) and non-Latinx Black individuals (HR 1.099, CI 1.012-1.194, p = 0.024). Overall results of this study support SCD as a prodromal marker of dementia in a multiracial community sample, and in Latinx and non-Latinx Black individuals in particular. Because models examining the risk of dementia were adjusted for baseline memory test performance, the results support the idea that SCD, a subjective reflection of one's own current cognitive functioning, contributes information above and beyond standard memory testing. Current findings highlight the importance of carefully evaluating any memory concerns raised by older adults during routine visits and underscore the potential utility of screening older adults for SCD.

Peripherally Inserted Central Line Catheters following Hand and Wrist Infections.

The PearlDiver Patients Records Database was queried to identify patients who underwent treatment for infection of the hand, wrist, and forearm between 2010 and 2018. Logistic regression analysis was utilized to evaluate the association of patient-related risk factors with PICC utilization, complications, readmissions, and length of stay (LOS). A total of 24,665 patients with an upper extremity infection were included in the study. Ultimately, 416 patients required a PICC placement (1.69%). Patients with older age, male gender, certain medical comorbidities, and infection involving deeper structures were more likely to require a PICC. Ninety-day all-cause medical complication rates were significantly higher for the PICC group (19.7% versus 6.7%) compared to those without. Any hospital readmission rates were significantly higher for PICC group at 90 days (28.4% versus 6.3%) and 1 year (35.8% versus 10.9%). Readmission rates remained slightly higher at 1 year for both groups. The PICC group demonstrated significantly longer LOS by 2 days (7.72 days versus 5.14 days). While not required for the majority of hand, wrist, and forearm infections, PICC placement is associated with increased medical complications, more frequent hospital readmissions, and longer LOS.

Risk of suicide attempts and self-harm after 1.4 million general medical hospitalizations of men with mental illness

BackgroundThe short-term risk of suicide after medical hospital discharge is four times higher among men compared with women. As previous work has identified female-specific antecedents of suicide-related behavior after medical hospitalization of women with serious mental illness, we examined predictors among a similar population of men with multimorbidity. MethodsClassification and regression tree (CART) models were developed and validated using electronic health records (EHRs) from 1,423,161 medical (non-psychiatric) hospitalizations of men ≥ 18-years-old with an existing diagnosis of a depressive disorder, bipolar disorder, or chronic psychosis. Hospitalizations occurred between 2009 and 2017. Risk groups were evaluated using an independent testing set. The primary outcome was readmission within one year associated with ICD-9 or -10 code for self-harm or attempt. ResultsThe 1-year readmission rate for intentional self-harm and suicide attempt was 3.9% (55,337/1,423,161 hospitalizations). The classification model discriminated risk with area under the curve (AUC) 0.73 (Confidence Interval [95%CI] 0.68–0.74), accuracy 0.82 (95%CI 0.71–0.83), sensitivity 82.6% (95%CI 81.2–84), and specificity 83.1% (95%CI 81.7–84.5). Strongest predictors were medical comorbidity, prior self-harm, age, and prior hospitalization. Men with greater medical comorbidity burden and prior self-harm were at highest risk (Odds Ratio [OR] 3.10, 95%CI 3.02–3.18), as were men < 62-years-old with few medical comorbidities (OR 1.11 95%CI 1.08–1.13). LimitationsThe study focused on medical hospitalizations for suicide attempt and thus captured only severe attempts resulting in hospitalization. ConclusionsAfter medical hospitalization, men with serious mental illness experienced a high risk of self-harm (1:25 hospitalizations). Risk was particularly elevated among younger patients without prior medical conditions and older patients with medical comorbidity and prior self-harm.

Antipsychotics and Medical Comorbidity: A Retrospective Study in an Urban Outpatient Psychiatry Clinic.

Patients with psychotic disorders have increased rates of medical comorbidities. In this cross-sectional study, we investigated the relationship between antipsychotics and medical comorbidities among patients with psychotic disorders in an urban psychiatry clinic in Atlanta, Georgia (n = 860). Each antipsychotic group was compared to a group of patients from the same sample who were not on any antipsychotic, and logistic regression models were constructed for each comorbidity. Ziprasidone was associated with diabetes (aOR 2.56, 95% CI 1.03-6.38) and obesity (aOR 3.19, 95% CI 1.37-7.41). Aripiprazole was associated with obesity (aOR 2.39, 95% CI 1.27-4.51). Clozapine was associated with GERD (aOR 3.59, 95% CI 1.11-11.61), movement disorders (aOR 4.44, 95% CI 1.02-19.32), and arrythmias (4.89, 95% CI 1.44-16.64). Two antipsychotics that are considered weight neutral, ziprasidone and aripiprazole, were associated with cardiometabolic comorbidities. This study suggests that research is warranted to study the association between antipsychotics, medical comorbidity, and psychotic symptom burden.

HYPOGLYCEMIA IS ASSOCIATED WITH INCREASED IN-HOSPITAL MORTALITY IN PATIENTS WITH ACUTE PANCREATITIS ADMITTED TO THE ICU: A NATIONWIDE STUDY

HYPOGLYCEMIA IS ASSOCIATED WITH INCREASED IN-HOSPITAL MORTALITY IN PATIENTS WITH ACUTE PANCREATITIS ADMITTED TO THE ICU: A NATIONWIDE STUDY

Factors associated with COVID-19 Infection among a national population of individuals with schizophrenia or schizoaffective disorder in the United States

BackgroundIndividuals with schizophrenia are a vulnerable and under-served population who are also at risk for severe morbidity and mortality following COVID-19 infection. Our research was designed to identify factors that put individuals with schizophrenia at increased risk of COVID-19 infection.MethodsThis study was a retrospective cohort analysis of medical and pharmacy claims among 493,796 individuals residing in the United States with schizophrenia or schizoaffective disorder, between January 1, 2019 and June 30, 2020. A confirmed diagnosis of COVID-19 infection by September 30, 2020 was regressed on demographics, social determinants, comorbidity, and pre-pandemic (December 2019 – February 2020) healthcare utilization characteristics.ResultsA total of 35,249 (7.1%) individuals were diagnosed with COVID-19. Elevated odds of COVID-19 infection were associated with age, increasing consistently from 40-49 years (OR: 1.16) to 80+ years (OR:5.92), male sex (OR: 1.08), Medicaid (OR: 2.17) or Medicare (OR: 1.23) insurance, African American race (OR: 1.42), Hispanic ethnicity (OR: 1.23), and higher Charlson Comorbidity Index. Select psychiatric comorbidities (depressive disorder, adjustment disorder, bipolar disorder, anxiety, and sleep-wake disorder) were associated with elevated odds of infection, while alcohol use disorder and PTSD were associated with lower odds. A pre-pandemic psychiatry (OR:0.56) or community mental health center (OR:0.55) visit were associated with lower odds as was antipsychotic treatment with long-acting injectable antipsychotic (OR: 0.72) and oral antipsychotic (OR: 0.62).ConclusionsAmong individuals with schizophrenia, risk of COVID-19 infection was substantially higher among those with fewer economic resources, with greater medical and psychiatric comorbidity burden, and those who resided in African American or Hispanic communities. In contrast, individuals actively engaged in psychiatric treatment had substantially lower likelihood of infection. These results provide insights for healthcare providers that can translate into improved identification of at-risk individuals and interventions to reduce the risk and consequences of COVID-19 infection.

Cancer PD1/PD-L1 inhibitor efficacy as stratified by smoking status: A population large database study.

2594 Background: Delineating clinical factors that predict immune checkpoint inhibitor (ICI) cancer therapy response is a pressing need and smoking is a known factor. In this study we leveraged a large international (heavily US) database to perform the largest study to date for all cancers and major cancer sub-sites/types. Methods: Utilizing the TriNetX electronic health records database with 84.3M patients we tested the hypotheses that ICI response stratifies based on smoking, and continued smoking after ICI. Queries were constructed using billing codes for all cancer types treated with an ICI with and without smoking. The smoking cohort was subsequently sub-stratified for continuing vs cessation of smoking after ICI. Next, using ICI therapy as the index event, odds ratios (OR) with 95% confidence intervals for death, and treatment related secondary outcomes were calculated between 0.5-5 years after ICI treatment. Statistics were calculated using TriNetX's integrated statistical platform before and after 1:1 propensity score matching (PSM) for smoking related co-morbidities. Results: The OR for death after ICI therapy for smokers ( n 13336) vs non-smokers ( n 38973) for any cancer type was 1.27(1.21-1.34) and decreased to 1.11(1.04-1.19) after PSM. Further sub-stratifying the smoking cohort for continued vs cessation of smoking yielded ORs of 1.13(1.03-1.24) and 1.12(1.01-1.24) before and after PSM respectively. Secondary outcomes included ablative surgery, chemotherapy, radiation, and secondary neoplasm. ORs for receiving chemotherapy, and developing secondary neoplasm were most consistently statistically significant across comparisons. Conclusions: Smoking adversely potentiates cancer outcomes after ICI therapy. PSM for smoking related comorbid conditions decreased the magnitude of this association although the findings remained clinically and statistically significant. This highlights the key role in smoking related co-morbid conditions as prognostic clinical characteristics. Furthermore, this suggests that smoking affects ICI on a mechanistic/biological level beyond increasing burden of medical comorbidities. Lastly, as smoking cessation also improved outcomes after PSM this further suggests that washout of smoke toxins has a mechanistic/biological effect on ICI activity. [Table: see text]

Critical care in obstetrics.

Leading causes of intensive care unit (ICU) admission include hemorrhage, hypertensive disorders of pregnancy, and sepsis. Although the incidence of ICU admission in pregnancy may be low, this does not account for critical illness in labor and delivery or maternity unit suites, which is as high as 1-3%. Most admissions, for example, to an ICU unit occur in the postpartum period, where studies have shown a range from 62 to 92% of admissions occurring during this period. A total of 60% of maternal deaths have been reported as preventable, with a delay in diagnosis and prompt medical treatment cited as primary factors, prompting for early recognition of high-risk obstetric patients. Recently, comorbidity-based screening tools, which quantify a patient's medical comorbidity burden, have been developed and validated in predicting ICU admission and death. Noninvasive ultrasonography such as point-of-care ultrasonography becomes essential in determining hemodynamic status, guides resuscitation, and manages cardiovascular dysfunction.

Risk of Severe COVID-19 Disease and the Pandemic's Impact on Service Utilization Among a Longitudinal Cohort of Persons with HIV-Washington, DC.

People with HIV (PWH) have a high burden of medical comorbidities, potentially putting them at increased risk for severe COVID-19. Additionally, during the COVID-19 pandemic, HIV care delivery has been restructured and the impact on HIV outcomes is unknown. The objectives of this study were first, to examine the risk of severe COVID-19 among PWH, using a definition incorporating clinical risk factors, and second, to examine the pandemic’s impact on HIV care. We used data from the DC Cohort, a large cohort of people receiving HIV care in Washington, DC. We found that a high proportion of participants across all age groups qualified as increased (58%) or high risk (34%) for severe COVID-19. Between 2019 and 2020, encounters increased (17.7%, increasing to 23.5% of active DC Cohort participants had an encounter) while laboratory utilization decreased (14.4%, decreasing to 11.4% of active DC Cohort participants had an HIV RNA test performed). Implications of our work include the importance of protecting vulnerable people with HIV from acquiring COVID-19 and potentially manifesting severe complications through strategies including vaccination. Additionally, acknowledging that HIV service delivery will likely be changed long-term by the pandemic, adaptation is required to ensure continued progress towards 90-90-90 goals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10461-022-03662-0.

Association of Motor and Nonmotor Symptoms With Health-Related Quality of Life in a Large Online Cohort of People With Parkinson Disease

Background and ObjectivesThere is growing interest in health-related quality of life (HRQOL) as a comprehensive view of the patient's well-being, guiding concept for the treating clinician, and therapeutic trial outcome measure for patients with Parkinson disease (PwPD). The key determinants of HRQOL have not been investigated in large populations of PwPD. Our objective was to evaluate correlates of HRQOL in a large, online cohort of PwPD.MethodsAs part of an ongoing online cohort study, we performed a cross-sectional analysis at enrollment of 23,058 PwPD. We conducted univariate and stepwise multivariate linear regression analyses of HRQOL as measured by the EQ-5D-5L tool. In addition, we performed an interaction analysis to evaluate heterogeneity of the effect of motor symptoms on HRQOL and Spearman correlation analysis to evaluate the association of nonmotor symptoms with HRQOL.ResultsIn the multivariate linear regression model, participants with moderate or severe depression, more severe motor symptoms, and a higher burden of medical comorbidities had the most substantially decreased HRQOL as measured by the EQ index (β −0.11, −0.18, −0.02, −0.01, respectively; p < 0.001 for all). An interaction analysis showed that more severe motor symptoms had a higher effect on individuals with female sex, lower educational level, lower income, more severe depression, or more severe cognitive impairment (p ≤ 0.01 for interaction terms). Neuropsychiatric symptoms and falls had the most negative associations with HRQOL (ρ −0.31 to 0.37; p < 0.0001).DiscussionPotentially treatable motor and nonmotor symptoms, particularly neuropsychiatric symptoms, account for a large amount of the variation in HRQOL in PwPD. Motor symptoms may have differential effects on HRQOL in different demographic and clinical subpopulations, highlighting important areas for future health disparities research. Our findings provide targets for clinician intervention and future research on symptom management to optimize HRQOL in PD.Classification of EvidenceThis study provides Class II evidence that motor and neuropsychiatric symptoms are associated with HRQOL in PwPD.

Differences in Stroke or Systemic Thromboembolism Readmission Risk After Hospitalization for Atrial Fibrillation and Atrial Flutter

BackgroundAlthough atrial fibrillation (AF) and atrial flutter (AFL) are different arrhythmias, they are assumed to confer the same risk of stroke and systemic thromboembolism (STE) despite a lack of available evidence. In this study, we investigated the difference in the risk of stroke or STE after AF and AFL hospitalizations.MethodologyThe National Readmission Database (NRD) 2018 was used to identify AF and AFL patients using appropriate International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and were followed until the end of the calendar year to identify stroke or STE readmissions. Survival estimates were calculated, and a Cox proportional hazards model was used to calculate the adjusted hazards ratio (aHR) and compare the risk of stroke or STE readmissions between AF and AFL groups.ResultsA total of 215,810 AF and 15,292 AFL patients were identified. AFL patients were more likely to be younger (66 vs. 70 years), male (68% vs. 47%), and had higher prevalence of obesity (25% vs. 22%), obstructive sleep apnea (14% vs. 12%), diabetes mellitus (31% vs. 26%), and alcohol use (6.9% vs. 5.5%) (all p < 0.01). After adjusting for potential patient and hospital-level characteristics, there was a statistically significant decrease in one-year stroke or STE readmission risk in AFL patients compared to AF patients (aHR 0.79 (0.66-0.95); p = 0.01).ConclusionsAFL patients are commonly younger males with a higher burden of medical comorbidity. There is a decrease in the one-year risk of stroke or STE events in AFL patients compared to AF. The predictors of stroke and STE are similar in both AFL and AF groups. Further studies with longer follow-up and anticoagulation data are needed to verify the results.

Are there important differences in comorbidity between surgical and medical inpatients?

Scientific and technological advances are changing medical practice and transforming hospitals, and both the age and comorbidities of hospitalized patients are rapidly increasing. The increasing complexity of these patients and the scant clinical differences between medical and surgical inpatients calls for changes in the organization and delivery of in-hospital care. Our objective has been to assess differences in age and comorbidity between surgical and medical inpatients. Retrospective, observational, descriptive study in patients aged ≥16 years discharged from all medical and surgical services during 2019, except for obstetrics and intensive care. All data were obtained from the hospital's minimum basic data set and analyzed using univariate analysis. The study included 31,264 patients: 16,397 from the medical area and 14,867 from the surgical area. Those in the surgical area were 8 years younger (62.69 years [95% CI 62.4-62.98]), with a slightly higher proportion of women (OR 1.12 [95% CI 1.07-1.17]) compared to the medical area, and fewer non-scheduled admissions (OR 0.11 [95% CI 0.10-0.12]). There were no significant differences in comorbidity burden between study groups. Patients in the surgical area have a high burden of medical comorbidity, similar to those in the medical area. This information is important for surgeons and anesthetists, and should compel hospitals to change the current organizational model.

Hypertension among adults enrolled in HIV care in northern Tanzania: comorbidities, cardiovascular risk, and knowledge, attitudes and practices.

Cite this articlePreeti Manavalan et al. Hypertension among adults enrolled in HIV care in northern Tanzania: comorbidities, cardiovascular risk, and knowledge, attitudes and practices. Pan African Medical Journal. 2022;41(285). 10.11604/pamj.2022.41.285.26952Introductionthe epidemiology of non-communicable diseases (NCDs) among people living with HIV (PLHIV) in sub-Saharan Africa is poorly described. In this observational study we examined a cohort of hypertensive PLHIV in northern Tanzania and described comorbidities, cardiovascular risk, and hypertension knowledge, attitudes and practices.Methodsconsecutive patients attending an HIV clinic were screened for hypertension; those who met hypertension study criteria were enrolled. Participants completed a hypertension knowledge, attitudes and practices survey, and underwent height, weight, and waist circumference measurements and urine dipstick, fasting blood sugar, and lipid panel analyses. Kidney disease was defined as 1+ proteinuria, diabetes mellitus was defined as fasting glucose >126mg/dL, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk was defined per the Pooled Cohorts Equations.Resultsof 555 screened patients, 105 met hypertension criteria and 91 (86.7%) were enrolled. The prevalence of diabetes mellitus, kidney disease, and overweight or obesity was 8.8%, 28.6%, and 86.7%, respectively. Almost all participants (n=86, 94.5%) had two or more medical comorbidities. More than half (n=39, 52.7%) had intermediate or high 10-year risk for an ASCVD event. While only 3 (3.3%) participants were able to define hypertension correctly, most would seek care at a medical facility (n=89, 97.8%) and take medication chronically for hypertension (n=79, 87.8%).Conclusionwe found a high burden of medical comorbidity and ASCVD risk among hypertensive PLHIV in northern Tanzania. Integration of routine NCD screening in the HIV clinical setting, in combination with large-scale educational campaigns, has the potential to impact clinical outcomes in this high-risk population.