Comorbidity Characteristics Research Articles

Evaluating the utility of synthetic COVID-19 case data.

BackgroundConcerns about patient privacy have limited access to COVID-19 datasets. Data synthesis is one approach for making such data broadly available to the research community in a privacy protective manner.ObjectivesEvaluate the utility of synthetic data by comparing analysis results between real and synthetic data.MethodsA gradient boosted classification tree was built to predict death using Ontario’s 90 514 COVID-19 case records linked with community comorbidity, demographic, and socioeconomic characteristics. Model accuracy and relationships were evaluated, as well as privacy risks. The same model was developed on a synthesized dataset and compared to one from the original data.ResultsThe AUROC and AUPRC for the real data model were 0.945 [95% confidence interval (CI), 0.941–0.948] and 0.34 (95% CI, 0.313–0.368), respectively. The synthetic data model had AUROC and AUPRC of 0.94 (95% CI, 0.936–0.944) and 0.313 (95% CI, 0.286–0.342) with confidence interval overlap of 45.05% and 52.02% when compared with the real data. The most important predictors of death for the real and synthetic models were in descending order: age, days since January 1, 2020, type of exposure, and gender. The functional relationships were similar between the two data sets. Attribute disclosure risks were 0.0585, and membership disclosure risk was low.ConclusionsThis synthetic dataset could be used as a proxy for the real dataset.

Abstract P718: The Relationship Between Abdominal Obesity and Quality of Life and Recurrence After First-Ever Ischaemic Stroke: A Hospital-Based Prospective Study

Background and Objective: Both quality of life (Qol) and stroke recurrence are prognostic indicators for stroke survivor in different aspects. Studies have analyzed Qol and survival outcomes at the same time were sparse. And the comprehensive impact of abdominal obesity on Qol and recurrence remains unclear. The purpose of this study was to explore the comprehensive effect of abdominal obesity on the Qol and recurrence among ischaemic stroke survivors in China. Methods: Baseline information was collected with face-to-face interviews, Qol and obesity status for each patient were obtained through every 3 months via telephone follow-up, from 2010 to 2018. Qol was evaluated with the 12-item Short-Form Health Survey (SF-12), consists of physical component summary scores (PCS) and mental component summary scores (MCS). WC (waist circumference) were 2 categories (normal WC and abdominal obesity), according to Chinese-specific criteria. After establishing the linear mixed effect model and spline-PH model by R software, joint model model was used to explore the comprehensive effect of abdominal obesity on the Qol and recurrence. Results: According to the inclusion and exclusion criteria, 894 subjects were included in the study. At baseline, subjects were aged 17 to 89 years, and 487(54.47%) were abdominal obesity. During the study period, 195 (21.81%) patients recurred. Controlling for comorbidity and socio-demographic characteristics, abdominal obesity have similar effect on Qol and recurrence (overall effect: 0.162; HR: 1.176; 95%CI: 0.877~1.579). Similar results were obtained, when analysis of both PCS and recurrence (overall effect: 0.141; HR: 1.151, 95%CI: 0.857~1.547). As for the comprehensive effect on MCS and recurrence, abdominal obesity got higher risk than normal WC (overall effect: 1.280; HR: 3.597, 95%CI: 1.555~8.317). Conclusion: abdominal obesity increased comprehensive risk of MCS and recurrence, and abdominal obesity may have greater impact on the MCS of stroke survivors than PCS.

Factors associated with healthcare utilization and mortality in alcohol use disorder hospitalization

ObjectiveTo examine the outcomes of alcohol use disorder (AUD)-hospitalizations. MethodsWe used the U.S. National Inpatient Sample (NIS) data from 1998 to 2016 to examine predictors of Healthcare utilization (total hospital charges, discharge destination, length of hospital stay) and in-hospital mortality for AUD-hospitalization outcomes. We used logistic regression to assess the association of patient demographics (age, sex, race/ethnicity, household income), comorbidity (Deyo-Charlson index), insurance payer (Medicare, Medicaid, private, self-pay or other), and hospital characteristics (location/teaching status; hospital bed size; and region) with outcomes ResultsThere were 5,590,952 primary AUD-hospitalizations from 1998 to 2016; of these 106,419 (1.9 %) died in-hospital. The mean age was 48 years, 73 % were male, 59 % white, and 57 % had a Deyo-Charlson comorbidity score of zero. In multivariable-adjusted analyses of AUD-hospitalizations, older age, female sex, higher Deyo-Charlson index, rural location or hospitals with medium or large bed sizes were associated with significantly higher in-hospital mortality and healthcare utilization. Similarly, South or Western U.S. hospital location, White race, or high income quartile were associated with higher healthcare utilization. Compared to a private insurance payer, Medicare or Medicaid insurance payers were associated with higher healthcare utilization, but lower in-hospital mortality. ConclusionsWe identified several independent associations of modifiable and non-modifiable factors with healthcare utilization and mortality outcomes for AUD-hospitalizations. These findings provide an opportunity for prognosis, resource allocation and the development of interventions to improve outcomes of AUD-hospitalizations in the future.

Geographic variation in systemic therapy in men age 66 years and older with de novo metastatic castration-sensitive prostate cancer: A population-based study in a single payer health-system.

50 Background: Significant developments in the standard of care for patients with de novo metastatic castration-sensitive prostate cancer (mCSPC) have been reported over the past decade. Treatment intensification with systemic therapies in addition to androgen deprivation therapy (ADT) alone is guideline recommended for most patients. We studied the geographic variation in the use of systemic therapy for de novo mCSPC in Ontario, Canada, a single-payer health system. Methods: We performed a population-based study of men aged 66 years and older diagnosed with de novo mCSPC between 2014-2019. We linked population-based healthcare databases, as administered at the level of Local Health Integration Networks (LHINs) in Ontario, to examine treatment patterns following diagnosis of de novo mCSPC. We categorized initial mCSPC treatments as those begun within 60 days preceding and 6 months following diagnosis and examined the proportion of patients receiving LHRH alone, first generation anti-androgen (AA) alone, combined androgen blockade (CAB; LHRH + 1st gen AA), ADT + abiraterone acetate + prednisone (AAP), and, ADT + docetaxel (D). In aggregate, we considered LHRH alone, AA alone and CAB as “standard ADT”, and ADT + AAP and ADT + D as “ADT-plus”. Multinomial logistic regression analyses were used to examine the association between receiving systemic treatment intensification (“ADT-plus”) or no prostate cancer pharmacotherapy relative to ADT across geographic regions, while adjusting for baseline patient and disease characteristics. Results: We identified 3,556 men over 66 with de novo mCSPC. Overall, 2794 (78.6%) received standard ADT, 311 (8.7%) did not receive prostate cancer-directed pharmacotherapy, and 451 patients (12.7%) of patients received “ADT-plus”. Utilization of AAP increased from 0.5% to 3% following the LATITUDE data release in 2017, while D decreased from 12% to 10%. There was significant variation in treatment strategies between geographic regions in use of “ADT-plus” ranging from 7 to 20% (p < 0.0001), a difference which persisted after accounting for patient demographics, comorbidity, rurality, and disease characteristics (p = 0.036). Conclusions: Despite proven survival benefits in randomized controlled trials, intensified treatment with docetaxel or abiraterone in addition to ADT was infrequently utilized in this population-based study of men age 66 years and over with mCSPC.

Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways.

To provide insight into patient experiences of a general hospital-based alcohol specialist nurse intervention during alcohol detoxification, experiences of alcohol specialist nurse hospital-based follow-up appointments (Pathway A) as well as the experiences of patients who did not have access to this additional help post detoxification (Pathway B). A longitudinal qualitative study. A thematic analysis of semi-structured interviews (2016-2017) with 24 patient participants (N=12 in each pathway; purposive selection) 1-4weeks post-detoxification and at 3 and 6months, to identify patient experiences of these interventions. Participants gave accounts of how 'empathic' and 'straight talking' interactions with alcohol specialist nurses during detoxification helped them to 'open up' and orient towards change. After detoxification follow-up, outpatient appointments in the hospital setting were seen as supporting change in early recovery and engagement with a wider range of services. Those with no access to nurse follow-up described experiencing a 'void' in available help. Participants in both groups described barriers to engagement with community alcohol services, peer groups and access to help for mild-moderate mental health problems. Patient accounts indicate alcohol specialist nurse interventions during and after unplanned detoxification in a hospital setting can help orient patients towards change and support early recovery. Providing alcohol specialist nurse interventions in general hospitals offers one route to initiating recovery in alcohol-dependent patients. This has potential to improve the lives of those affected and to reduce related demands on hospital services, but further research is needed.

Novel association between asthma and osteoarthritis: a nationwide health and nutrition examination survey

BackgroundAsthma and osteoarthritis (OA) are medical conditions that inhibit physical activity and adversely affect quality of life. Despite the high prevalence, there are limited studies focusing on the comorbid condition and association between asthma and OA. The aim of this study was to assess the prevalence of OA co-occurring with asthma and to identify the relevant clinical considerations.MethodsAdult participants aged over 40 years who completed questionnaire assessments and spirometry tests were enrolled from the Korean National Health and Nutrition Examination Survey. Asthma and OA were defined based on the medical history of a diagnosis made by a doctor. Radiographic severities of OA were measured using the Kellgren–Lawrence grading system. Chronic obstructive pulmonary disease (COPD), as a comparative respiratory disease, was diagnosed based on the spirometric results.ResultsA total of 9344 subjects were enrolled, and the prevalence of asthma and COPD were 4.6% ± 0.3% and 12.0% ± 0.5%, respectively. The prevalence of OA in the asthma group was 31.9% ± 2.8%, which was significantly higher than that in the COPD (17.8% ± 1.5%) or control (16.2% ± 0.6%) groups. OA was more prevalent in patients with asthma after adjusting for age, sex, body mass index, and smoking status (OR 1.65; 95% CI 1.27–2.13). Furthermore, after adjustment of this model for the prescription of OA medication, OA remained independently associated with asthma (OR 1.56; 95% CI 1.10–2.20). Conversely, the relationship of OA medication with asthma was not significant (P = 0.64). This relationship was evident in patients with asthma without airflow limitation measured by spirometry (OR 1.97; 95% CI 1.32–2.93). Moreover, the radiographic severity of knee OA correlated with asthma (OR 1.10; 95% CI 1.0–‍‍1.21).ConclusionsOA shows a high prevalence in patients with asthma, higher than in patients with COPD or the controls. The comorbid characteristics of these two conditions need to be considered in clinical practice.

Association of daily step count and serum testosterone among men in the United States

PurposeTo describe the association between daily activity (i.e., daily step counts and accelerometer intensity measures) and serum TT levels in a representative sample of US adults aged 18 years or older.MethodsA retrospective cohort study was carried out utilizing the NHANES (National Health and Nutrition Examination Survey) 2003–2004 cycle. Physical activity was measured with a waist-worn uniaxial accelerometer (AM-7164; ActiGraph) for up to 7 days using a standardized protocol. Using linear and multivariable logistic regression controlling for relevant social, demographic, lifestyle, and comorbidity characteristics, we assessed the association between daily step counts and TT.ResultsA total of 279 subjects with a median age 46 (IQR: 33–56) were included in the analysis. 23.3% of the cohort had a low serum TT level (TT < 350 ng/dl). Compared to men who took <4000 steps per day, men who took >4000 or >8000 steps/day had a lower odd of being hypogonadal (OR 0.14, 95% CI: 0.07–0.49 and 0.08, 95%CI: 0.02–0.44, respectively). While a threshold effect was noted on average, TT increased 7 ng/dL for each additional 1000 steps taken daily (β-estimate: 0.007, 95% CI: 0.002–0.013).ConclusionsPatients with the lowest daily step counts had higher odds of being hypogonadal. The current work supports a possible association between daily steps, total testosterone, and hypogonadism for men in the US.

Regional variation in outcomes and healthcare resources utilization in, emergency department visits for syncope.

Management of patients with syncope lacks standardization. We sought to assess regional variation in hospitalization rates and resource utilization of patients with syncope. We identified adults with syncope using the Nationwide Emergency Department Sample from years 2006 to 2014. Demographics and comorbidity characteristics were compared across geographic regions in the US. Multiple regression was conducted to compare outcomes. 9,132,176 adults presented with syncope. Syncope in the Northeast (n=1,831,889) accounted for 20.1% of visits; 22.6% in the Midwest (n=2,060,940), 38.5% in the South (n=3,527,814) and 18.7% in the West (n=1,711,533). Mean age was 56years with 57.7% being female. The Northeast had the highest risk-adjusted hospitalization rate (24.5%) followed by the South (18.6%, ORadj 0.58; 95% CI 0.52-0.65, p<0.001), the Midwest (17.2%, ORadj 0.51; 95% CI 0.46-0.58, p<0.001) and West (15.8%, ORadj 0.45; 95% CI 0.39-0.51, p<0.001). Risk-adjusted rates of syncope hospitalizations significantly declined from 25.8% (95% CI 24.8%-26.7%) in 2006 to 11.7% (95% CI 11.0%-12.5%) in 2014 (Ptrend<0.001). The Northeast had the lowest risk-adjusted ED (Emergency Department) service charges per visit ($3320) followed by the Midwest ($4675, IRRadj 1.41; 95% CI 1.30-1.52, p<0.001), the West ($4814, IRRadj 1.45; 95% CI 1.31-1.60, p<0.001) and South ($4969, IRRadj 1.50; 95% CI 1.38-1.62, p<0.001). Service charges increased from $3047/visit (95% CI $2912-$3182) in 2006 to $6267/visit (95% CI $5947-$6586) in 2014 (Ptrend<0.001). Significant regional variability in hospitalization rates and ED service charges exist among patients with syncope. Standardizing practices may be needed to reduce variability.

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty.

BackgroundIn January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA.MethodsA retrospective review of 2266 patients (205 same-day discharge [SDD; 9.0%] and 2061 one-day length of stay [91.0%]) undergoing TKA at a regional medical center between July 2016 and September 2020 was conducted. Multiple logistic regression was used to evaluate predictors of SDD, as these patients represent those most likely to safely undergo TKA in an ASC.ResultsControlling for other demographics and comorbidities, patients with the following characteristics were at reduced odds of SDD: increased age (odds ratio [OR] = 0.935, P < .001), body mass index ≥35 (OR = 0.491, P = .002), female (OR = 0.535, P < .001), nonwhite race (OR = 0.456, P = .003), primary hypertension (OR = 0.710, P = .032), ≥3 comorbidities (OR = 0.507, P = .002), American Society of Anesthesiologists score ≥3 (OR = 0.378, P < .001). The model was deemed to be of adequate fit using the Hosmer and Lemeshow test (χ2 = 12.437, P = .112), and the area under the curve was found to be 0.773 indicating acceptable discrimination.ConclusionFor patients undergoing primary TKA, increased age, body mass index ≥35, female gender, nonwhite race, primary hypertension, ≥3 comorbidities, and American Society of Anesthesiologists score ≥3 decrease the likelihood of SDD. A predictive model based on readily available patient presentation and comorbidity characteristics may aid surgeons in identifying patients that are candidates for SDD or ASC-based TKA.

Clinical Documentation of Peanut Allergy Prevention in an Academic Learning Health System

Consensus guidelines recommend early peanut introduction (EPI) as an effective strategy for preventing peanut allergy. Real-world practice patterns of EPI guidance are poorly understood. We aimed to described EPI practice patterns within an academic learning health system. We queried the health system’s central data repository to identify individuals eligible to receive EPI guidance from 1/6/2017 - 03/30/2020: persons less than 12 months of age at the time of a clinical encounter for either a health supervision visit or a problem-based visit related to eczema. We used the Electronic Medical Record Search Engine (EMERSE) to search clinical notes for the word “peanut.” These were manually reviewed for EPI documentation and other practice pattern characteristics. Of a total of 18,149 individuals, 152 (0.8%, mean age 6.4 months) had clinical documentation of EPI guidance (72% clinical note, 20% patient instructions, 5% both, 3% telephone note). EPI guidance was performed by 61 providers among 6 specialties (43% pediatrics, 40% family medicine, 15% allergy/immunology, 2% other) in 24 unique practices. Of those who received EPI guidance, the following comorbid diagnoses and/or characteristics were documented: 35% eczema, 11% egg allergy, 21% family history of food allergy, 31% topical corticosteroid use. Twenty percent were referred to an allergist for peanut allergy risk assessment and 12% had a peanut IgE obtained. Clinical documentation of EPI counseling is low. Further dissemination and implementation efforts are needed to encourage providers to prioritize EPI and increase standard utilization of consensus guidelines.

Exploring the application of the Charlson Comorbidity Index to assess the patient population seen in a Veterans Affairs chiropractic residency program.

Chiropractic trainees require exposure to a diverse patient base, including patients with multiple medical conditions. The Veterans Affairs (VA) Chiropractic Residency Program aims for its doctor of chiropractic (DC) residents to gain experience managing a range of multimorbid cases, yet to our knowledge there are no published data on the comorbidity characteristics of patients seen by VA DC residents. We tested 2 approaches to obtaining Charlson Comorbidity Index (CCI) scores and compared CCI scores of resident patients with those of staff DCs at 1 VA medical center. Two processes of data collection to calculate CCI scores were developed. Time differences and agreement between methods were assessed. Comparison of CCI distribution between resident DC and staff DCs was done using 100 Monte Carlo simulation iterations of Fisher's exact test. Both methods were able to calculate CCI scores (n = 22). The automated method was faster than the manual (13 vs 78 seconds per patient). CCI scores agreement between methods was good (κ = 0.67). We failed to find a significant difference in the distribution of resident DC and staff DC patients (mean p = .377; 95% CI, .375-.379). CCI scores of a VA chiropractic resident's patients are measurable with both manual and automated methods, although automated may be preferred for its time efficiency. At the facility studied, the resident and staff DCs did not see patients with significantly different distributions of CCI scores. Applying CCI may give better insight into the characteristics of DC trainee patient populations.

Comorbidities of scars in China: a national study based on hospitalized cases.

BackgroundScar comorbidities seriously affect the physical and mental health of patients, but few studies have reported the exact epidemiological characteristics of scar comorbidities in China. This study aimed to investigate the prevalence of scar comorbidities in China.MethodsThe data of 177,586 scar cases between 2013 and 2018 were obtained from the Hospital Quality Monitoring System based on the 10th edition of the International Classification of Diseases coding system. The total distribution of scar comorbidities and their relationship with age, aetiology and body regions were analysed.ResultsSix comorbidities (contracture, malformation, ocular complications, adhesion, infection and others) were the main focus. In general, male patients outnumbered females and urban areas outnumbered rural areas. The proportion of contractures was the highest at 59,028 (33.24%). Students, workers and farmers made up the majority of the occupation. Han Chinese accounted for the majority of the ethnic. The highest proportion of scar contracture occurred at 1–1.9 years of age (58.97%), after which a significant downward trend was observed. However, starting from 50 years of age, ocular complications increased gradually and significantly, eventually reaching a peak of 34.49% in those aged >80 years. Scar contracture was the most common comorbidity according to aetiology, and the highest proportion was observed in patients who were scalded (29.33%). Contractures were also the most frequent comorbidity in hands (10.30%), lower limbs (6.97%), feet (6.80%) and upper limbs (6.02%). The mean and median hospitalization durations were 12.85 and 8 days, respectively.ConclusionsContractures were the most common comorbidities, and different comorbidities tended to occur at different ages and with different causative factors.

Psychiatric Comorbidity and Inpatient Characteristics of Older Adolescents with Opioid Use Disorders in the U.S

Objective: The opioid crisis has substantially affected health services utilization. Hospitalizations for opioid use disorders (OUD) have increased significantly among adolescents and youth in the United States. This study examined the characteristics of hospitalization for OUD among older adolescents with comorbid psychiatric disorders (CPD). Methods: This analysis focused on older adolescents where OUD was given as the primary reason for hospital admission. Multivariable logistic regressions were performed to identify demographic and clinical factors associated with OUD hospitalizations with CPD, using secondary data from the Nationwide Inpatient Sample. Results: CPD was documented in 58% of OUD adolescent inpatients. Mood and anxiety were the most common types of CPD. Several demographics variables discriminated between OUD inpatients with vs without CPD. The odds of having comorbid mood disorders were nearly 2 times greater for female than for male adolescents and were significantly higher for adolescents from Midwest regions compared with those from Northeast and West regions. Conclusions: Hospitalizations due to OUD were tripled for adolescents with CPD relative to adolescents without CPD; nearly half of the adolescents hospitalized with OUD had mood disorders. Specific primary care and access to mental health treatment strategies should target groups most at risk for both OUD and mood related disorders.

Trajectory of excess healthcare consultations, medication use, and work disability in newly diagnosed knee osteoarthritis: a matched longitudinal register-based study

To estimate the excess healthcare use and work disability attributable to knee osteoarthritis (OA) in the first 5years following diagnosis. Among individual aged 40-80 years who resided in Skåne on 31st December 2008, we identified those with a main diagnosis of knee OA during 2009-2014 and no previous diagnosis of any OA from 1998 (n=16,888). We created a comparison cohort matched (1:1) by sex, age, and municipality from individuals with no OA diagnosis (at any site) during 1998-2016. We compared healthcare use and net disability days for 60 months following diagnosis between the two groups. We applied a survival-adjusted regression technique controlling for sociodemographic characteristics as well as pre-diagnosis outcome and comorbidity. The estimated 5-year incremental effects of knee OA per-patient were 16.8 (95% CI: 15.8, 17.7) healthcare consultations, 0.7 (0.4, 1.1) inpatient days, 420 (372, 490) defined daily dose of prescribed medications, and 21.8 (15.2, 30.0) net disability days. Primary care consultations constituted about 73% of the excess healthcare consultations. Most of these incremental effects occurred in the first year after diagnosis. Better survival in the knee OA group accounted for 0.7 (95% CI: 0.5, 0.8) and 1.4 (0.7, 2.6) of the excess healthcare consultations and net disability days, respectively. Both estimated total and incremental resources use were generally greater for women than men with knee OA. Knee OA was associated with considerable excess healthcare use and work disability independent of pre-diagnosis resources use, comorbidity, and sociodemographic characteristics.

Quality of life in patients receiving percutaneous coronary intervention and optimal medical therapy in Ho Chi Minh City, Vietnam

This study assessed Health-Related Quality of Life (HRQOL) of patients with Acute Coronary Syndrome (ACS) 6 to 12 months after receiving Percutaneous Coronary Intervention (PCI) and/or Optimal Medical Therapy (OMT) at a hospital in Ho Chi Minh City, Vietnam. A cross-sectional study was conducted on 113 patients. Data on demographic, lifestyle behaviours, and HRQOL were collected using a structured questionnaire through face-to-face interviews. HRQOL was measured using EQ-5D-5L and EQ-VAS. Data on co-morbidity and other clinical characteristics were extracted from hospital records. Bivariate and multivariable linear regression models were run to test the differences in EQ-5D-5L utility index and EQ-VAS scores between PCI/OMT and OMT alone groups. EQ-5D-5L utility index and EQ-VAS scores were lower in PCI/OMT compared to OMT groups, although the differences were not clinically meaningful. Weight status, smoking, and physical activity were associated with EQ-5D-5L utility index score, whereas only physical activity was associated with EQ-VAS score. The findings suggested that improving sufficient physical activity levels and stopping smoking after PCI or/and OMT may help increase HRQOL among ACS patients.

Patients receiving a high burden of antibiotics in the community in Spain: a cross‐sectional study

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross‐sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient’s average age was 70 years; 52% were men; 60% smokers/ex‐smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty‐five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad‐spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally.

COVID-19 death in people with HIV: interpret cautiously

COVID-19 death in people with HIV: interpret cautiously

Assessment of Racial/Ethnic Disparities in Hospitalization and Mortality in Patients With COVID-19 in New York City

Black and Hispanic populations have higher rates of coronavirus disease 2019 (COVID-19) hospitalization and mortality than White populations but lower in-hospital case-fatality rates. The extent to which neighborhood characteristics and comorbidity explain these disparities is unclear. Outcomes in Asian American populations have not been explored. To compare COVID-19 outcomes based on race and ethnicity and assess the association of any disparities with comorbidity and neighborhood characteristics. This retrospective cohort study was conducted within the New York University Langone Health system, which includes over 260 outpatient practices and 4 acute care hospitals. All patients within the system's integrated health record who were tested for severe acute respiratory syndrome coronavirus 2 between March 1, 2020, and April 8, 2020, were identified and followed up through May 13, 2020. Data were analyzed in June 2020. Among 11 547 patients tested, outcomes were compared by race and ethnicity and examined against differences by age, sex, body mass index, comorbidity, insurance type, and neighborhood socioeconomic status. Race and ethnicity categorized using self-reported electronic health record data (ie, non-Hispanic White, non-Hispanic Black, Hispanic, Asian, and multiracial/other patients). The likelihood of receiving a positive test, hospitalization, and critical illness (defined as a composite of care in the intensive care unit, use of mechanical ventilation, discharge to hospice, or death). Among 9722 patients (mean [SD] age, 50.7 [17.5] years; 58.8% women), 4843 (49.8%) were positive for COVID-19; 2623 (54.2%) of those were admitted for hospitalization (1047 [39.9%] White, 375 [14.3%] Black, 715 [27.3%] Hispanic, 180 [6.9%] Asian, 207 [7.9%] multiracial/other). In fully adjusted models, Black patients (odds ratio [OR], 1.3; 95% CI, 1.2-1.6) and Hispanic patients (OR, 1.5; 95% CI, 1.3-1.7) were more likely than White patients to test positive. Among those who tested positive, odds of hospitalization were similar among White, Hispanic, and Black patients, but higher among Asian (OR, 1.6, 95% CI, 1.1-2.3) and multiracial patients (OR, 1.4; 95% CI, 1.0-1.9) compared with White patients. Among those hospitalized, Black patients were less likely than White patients to have severe illness (OR, 0.6; 95% CI, 0.4-0.8) and to die or be discharged to hospice (hazard ratio, 0.7; 95% CI, 0.6-0.9). In this cohort study of patients in a large health system in New York City, Black and Hispanic patients were more likely, and Asian patients less likely, than White patients to test positive; once hospitalized, Black patients were less likely than White patients to have critical illness or die after adjustment for comorbidity and neighborhood characteristics. This supports the assertion that existing structural determinants pervasive in Black and Hispanic communities may explain the disproportionately higher out-of-hospital deaths due to COVID-19 infections in these populations.

The effects and reliability of the hydroxychloroquine-azithromycin combination on the cardiac conduction system in patients with coronavirus disease 2019

Aim: The COVID-19 virus influenced the world since late 2019 and affected millions of people. Although there is no unambiguous evidence in the treatment of COVID-19, the combination of hydroxychloroquine and azithromycin entered the protocols globally to reduce virus replication and take advantage of its immunomodulatory effects. It has been stated that both drugs extend QTc. However, the frequency of QTc prolongation in combinational drug use, and its effect on the primary endpoint, as well as the predictive values of QTc prolongation are not clear. Methods: A total of 135 patients who received hydroxychloroquine, azithromycin, and oseltamivir for suspected / definitive COVID-19 with viral pneumonia were examined in this single-center, retrospective study, Results: The mean age was 55.6 (19.1) years, and 61 (45%) patients were female. According to the initial ECG values, the QTc1 value was 422.44 (35.72) ms, while the QTc2 value was 446.91 (36.71) ms (P500 ms was 6 (4.4%). The number of patients with prolongation in QTc values >60 ms was 7 (5.1%). The frequency of prolongation in QTc was 26% in intensive care unit patients, and 2% in low-risk patients in the inpatient unit. An elevation in troponin values >14 ng/L and a low GFR are predictors for QTc prolongation. None of these patients developed malignant arrhythmia or sudden cardiac death. Conclusion: Hydroxychloroquine and azithromycin combinations used in COVID-19 patients cause a prolongation in the QTc. The incidence of prolongation in QTc varies according to the comorbid characteristics and clinical status of the patients. Before starting hydroxychloroquine and azithromycin, the risk factors and clinical status of the patients should be well evaluated.

Pre-operative Hypoalbuminemia Is Associated with Complications Following Proximal Humerus Fracture Surgery: An Analysis of 919 Patients.

Proximal humerus fractures are among the most common presenting fractures to orthopedic surgeons in the USA. Hypoalbuminemia is accepted as a nutrition marker associated with post-operative complications following common orthopedic interventions. Thus, the authors sought to (1) describe the national demographic trends of patients undergoing surgical fixation for proximal humerus fracture and (2) investigate the association between pre-operative hypoalbuminemia, a malnutrition marker, and post-operative complications within 1year of surgical intervention. The PearlDiver Humana Claims Database was queried to identify a nationally representative cohort of patients who underwent surgical intervention for proximal humerus fractures from 2008 to 2015. Demographic and comorbid characteristics were collected. Pearson's χ-squared analysis was used to compare rates of 90-day and 1-year outcomes between hypoalbuminemia (albumin ≤ 3.5mg/dL) and control groups. Multivariate logistic regression was then used to determine the isolated effect that hypoalbuminemia had on post-operative outcomes. Of the 3337 patients identified, 919 (27.5%) had available serum albumin data. Seventy (7.6%) patients had hypoalbuminemia. Hypoalbuminemia was more likely to be associated with post-operative sepsis (7.1% vs. 1.5%, respectively) and pneumonia (15.7% vs. 4.6) compared with controls. Additionally, hypoalbuminemia was associated with increased 90-day rates of discharge to extended care (4.3% vs. 0.8), emergency room visits (38.6% vs. 21.7), and total cost ($24,051.96 ± 24,972.74 vs. $15,429.74 ± 24,492.30). Our study suggests hypoalbuminemia is associated with an increased risk of complications, specifically pneumonia and sepsis, and total health care costs in patients undergoing surgery for proximal humerus fractures. These findings provide insight for individualized patient care that will aid in evaluating the potential risk of surgical complications in an effort to improve outcomes and reduce costs.