Chronic Comorbid Conditions Research Articles

Determinants of Health-Related Quality of Life among Black Individuals with Low-Incomes, Excess Weight, and Comorbid Chronic Conditions

Determinants of Health-Related Quality of Life among Black Individuals with Low-Incomes, Excess Weight, and Comorbid Chronic Conditions

Readmission Rates After Expedited Postpartum Discharge.

To characterize national trends in expedited postpartum discharge and, secondarily, to identify predictors of expedited postpartum discharge and assess whether expedited postpartum discharge was associated with postpartum readmissions within 60 days of delivery hospitalization discharge. Birth hospitalizations and subsequent 60-day postpartum readmissions were extracted from the 2016-2020 Nationwide Readmissions Database for this retrospective cohort study. Postpartum discharge was categorized as expedited (less than 2 days after vaginal birth or less than 3 days after cesarean birth), routine (2 days after vaginal birth or 3 days after cesarean birth), or prolonged (more than 2 days after vaginal birth or more than 3 days after cesarean birth). Trends in expedited discharge were assessed over the study period with joinpoint regression. Unadjusted and adjusted logistic regression models were performed to assess clinical, hospital, and demographic predictors of expedited postpartum discharge. Sixty-day postpartum readmission risk was calculated, and adjusted regression models were performed to evaluate the association between expedited postpartum discharge and readmission. Of 17.9 million birth hospitalizations, 32.9% had expedited postpartum discharge. The overall 60-day postpartum readmission rate after delivery hospitalization discharge was 1.7% for all patients, 1.4% for expedited postpartum discharge, 1.6% for routine discharge, and 3.3% for prolonged discharge. Rates of expedited postpartum increased from 29.1% in 2016 to 31.4% in 2019 and to 43.8% in 2020. This trend was not significant (average annual percent change: 9.9%, 95% CI, -1.6% to 23.7%), although rates of expedited discharge were significantly higher in 2020 than in 2016-2019 ( P <.01). Younger and older age, chronic comorbid conditions, mental health conditions, and obstetric complications (eg, transfusion, chorioamnionitis or endometritis) were associated with lower likelihood of expedited postpartum discharge. Expedited postpartum discharge was associated with 14% lower adjusted odds of 60-day postpartum readmission compared with routine discharge (adjusted odds ratio 0.86, 95% CI, 0.85-0.88). Rates of expedited postpartum discharge increased significantly in 2020 compared with 2016-2019 and were not associated with 60-day postpartum readmission. These findings suggest that broader use of expedited postpartum discharge has not resulted in increased risk of postpartum readmissions.

Telehealth Mindfulness-Based Interventions for Chronic Pain

Although mindfulness-based interventions (MBIs) are evidence-based treatments for chronic pain and comorbid conditions, implementing them at scale poses many challenges, such as the need for dedicated space and trained instructors. To examine group and self-paced, scalable, telehealth MBIs, for veterans with chronic pain, compared to usual care. This was a randomized clinical trial of veterans with moderate to severe chronic pain, recruited from 3 Veterans Affairs facilities from November 2020 to May 2022. Follow-up was completed in August 2023. Two 8-week telehealth MBIs (group and self-paced) were compared to usual care (control). The group MBI was done via videoconference with prerecorded mindfulness education and skill training videos by an experienced instructor, accompanied by facilitated discussions. The self-paced MBI was similar but completed asynchronously and supplemented by 3 individual facilitator calls. The primary outcome was pain-related function using the Brief Pain Inventory interference scale at 3 time points: 10 weeks, 6 months, and 1 year. Secondary outcomes included biopsychosocial outcomes: pain intensity, physical function, anxiety, fatigue, sleep disturbance, participation in social roles and activities, depression, patient ratings of improvement of pain, and posttraumatic stress disorder. Among 811 veterans randomized (mean [SD] age, 54.6 [12.9] years; 387 [47.7%] women), 694 participants (85.6%) completed the trial. Averaged across all 3 time points, pain interference scores were significantly lower for both MBIs compared to usual care (group MBI vs control difference: -0.4 [95% CI, -0.7 to -0.2]; self-paced vs control difference: -0.7 [95% CI, -1.0 to -0.4]). Additionally, both MBI arms had significantly better scores on the following secondary outcomes: pain intensity, patient global impression of change, physical function, fatigue, sleep disturbance, social roles and activities, depression, and posttraumatic stress disorder. Both group and self-paced MBIs did not significantly differ from one another. The probability of 30% improvement from baseline compared to control was greater for group MBI at 10 weeks and 6 months, and for self-paced MBI, at all 3 time points. In this randomized clinical trial, scalable telehealth MBIs improved pain-related function and biopsychosocial outcomes compared to usual care among veterans with chronic pain. Relatively low-resource telehealth-based MBIs could help accelerate and improve the implementation of nonpharmacological pain treatment in health care systems. ClinicalTrials.gov Identifier: NCT04526158.

Late-Term Outcomes of Surgical Treatment of Infective Endocarditis.

Background: This study aims to evaluate the long-term outcomes of surgical interventions in patients with infective endocarditis (IE) who underwent surgical treatment and to determine the treatment approach for new patients. Patients and Methods: We retrospectively examined the long-term results of patients who underwent surgical treatment for IE between 2007 and 2017. The evaluation included late-term outcomes of IE surgery, surgical procedures, complications, the postoperative period, and clinical findings. Results: The study included 20 patients (12 male, 8 female) with a mean age of 45.1 ± 17.25. The most common cardiac risk factors for endocarditis development were the presence of prosthetic valves and heart valve disease. In addition, non-cardiac risk factors included chronic renal failure, systemic lupus erythematosus, and pemphigus vulgaris. Preoperative and postoperative laboratory findings were compared with in terms of morbidity and mortality, revealing no significant differences. The most prevalent preoperative laboratory findings were anemia (100%), elevated CRP (100%), and leukocytosis (50%). Anemia persisted as the most common laboratory finding in the postoperative evaluation. Conclusion: Our study identified comorbid chronic medical conditions, neurological complications because of IE, postoperative impaired left ventricular function, and treatment strategies such as monotherapy as poor prognostic factors in patients who underwent surgical treatment for IE. The management of IE is observed to be complex in the presence of comorbidities and complications, adversely affecting both survival and quality of life.

Feasibility of Provision and Vaccine Hesitancy at a Central Hospital COVID-19 Vaccination Site in South Africa after Four Waves of the Pandemic.

As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic. Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments. To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital. Mixed-methods study using quantitative and qualitative methods. Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% (n = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters. This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient-clinician engagement about the benefits of vaccination is essential to reach highly vulnerable populations routinely attending hospital outpatient departments with an appropriate vaccination program.

An interpretable predictive deep learning platform for pediatric metabolic diseases.

Metabolic disease in children is increasing worldwide and predisposes a wide array of chronic comorbid conditions with severe impacts on quality of life. Tools for early detection are needed to promptly intervene to prevent or slow the development of these long-term complications. No clinically available tools are currently in widespread use that can predict the onset of metabolic diseases in pediatric patients. Here, we use interpretable deep learning, leveraging longitudinal clinical measurements, demographical data, and diagnosis codes from electronic health record data from a large integrated health system to predict the onset of prediabetes, type 2 diabetes (T2D), and metabolic syndrome in pediatric cohorts. The cohort included 49517 children with overweight or obesity aged 2-18 (54.9% male, 73% Caucasian), with a median follow-up time of 7.5 years and mean body mass index (BMI) percentile of 88.6%. Our model demonstrated area under receiver operating characteristic curve (AUC) accuracies up to 0.87, 0.79, and 0.79 for predicting T2D, metabolic syndrome, and prediabetes, respectively. Whereas most risk calculators use only recently available data, incorporating longitudinal data improved AUCs by 13.04%, 11.48%, and 11.67% for T2D, syndrome, and prediabetes, respectively, versus models using the most recent BMI (P < 2.2 × 10-16). Despite most risk calculators using only the most recent data, incorporating longitudinal data improved the model accuracies because utilizing trajectories provides a more comprehensive characterization of the patient's health history. Our interpretable model indicated that BMI trajectories were consistently identified as one of the most influential features for prediction, highlighting the advantages of incorporating longitudinal data when available.

Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions.

India is a large middle-income country and has surpassed China in overall population, comprising 20% of the global population (over 1.43 billion people). India is experiencing a major demographic shift in its aging population. Chronic diseases are common among older adults and can be persistent over the life course, lead to the onset of disability, and be costly. Among older adults in India, the existence of multiple comorbid chronic conditions (i.e., multimorbidity) is rapidly growing and represents a burgeoning public health burden. Prior research identified greater rates of multimorbidity (e.g., overweight/obesity diabetes, hypertension, cardiovascular disease, stroke, and malignancies) in minority populations in the United States (U.S.); however, limited studies have attempted to characterize multimorbidity among older adult sub-populations residing in India. To address this gap, we conducted a narrative review of studies on multimorbidity using the data from the Longitudinal Aging Study of India (LASI), the largest nationally representative longitudinal survey study of adults in India. Our definition of multimorbidity was the presence of more than two conditions in the same person. Our findings, based on 15 reviewed studies, aim to (1) characterize the definition and measurement of multimorbidity and to ascertain its prevalence in ethnically and culturally diverse sub-populations in India; (2) identify adverse outcomes associated with multimorbidity in the Indian adult population; and (3) identify gaps, opportunities, and future directions.

Prevalence and outcomes of chronic comorbid conditions in patients with sepsis in Korea: a nationwide cohort study from 2011 to 2016

BackgroundChronic comorbid conditions are common in patients with sepsis and may affect the outcomes. This study aimed to evaluate the prevalence and outcomes of common comorbidities in patients with sepsis.MethodsWe conducted a nationwide retrospective cohort study. Using data from the National Health Insurance Service of Korea. Adult patients (age ≥ 18 years) who were hospitalized in tertiary or general hospitals with a diagnosis of sepsis between 2011 and 2016 were analyzed. After screening of all International Classification of Diseases 10th revision codes for comorbidities, we identified hypertension, diabetes mellitus (DM), liver cirrhosis (LC), chronic kidney disease (CKD), and malignancy as prevalent comorbidities.ResultsOverall, 373,539 patients diagnosed with sepsis were hospitalized in Korea between 2011 and 2016. Among them, 46.7% had hypertension, 23.6% had DM, 7.4% had LC, 13.7% had CKD, and 30.7% had malignancy. In-hospital mortality rates for patients with hypertension, DM, LC, CKD, and malignancy were 25.5%, 25.2%, 34.5%, 28.0%, and 33.3%, respectively, showing a decreasing trend over time (P < 0.001). After adjusting for baseline characteristics, male sex, older age, use of mechanical ventilation, and continuous renal replacement therapy, LC, CKD, and malignancy were significantly associated with in-hospital mortality.ConclusionsHypertension is the most prevalent comorbidity in patients with sepsis, and it is associated with an increased survival rate. Additionally, liver cirrhosis, chronic kidney disease, and malignancy result in higher mortality rates than hypertension and DM, and are significant risk factors for in-hospital mortality in patients with sepsis.

The importance of comprehensive cancer survivorship care plans in general practice.

The number of people living with or beyond cancer are expected to rise. General practice-led cancer survivorship plans have been proposed as a way to address ongoing healthcare needs (including physical and psychosocial care) and care coordination, as well as the prevention and management of other chronic illnesses. The aim of this paper is to discuss the role of general practice in the long-term care of cancer survivors and provide a summary of recommendations for comprehensive cancer survivorship careplanning in general practice. General practice provides cancer survivors with ongoing support within their community from pre-diagnosis onwards. It is recommended that comprehensive cancer survivorship care plans include the cancer treatment summary and follow-up care planning; the management of other comorbid chronic conditions; health promotion and disease prevention with tailoring to shared goals; and the cancer survivor's unique situation.

Assessment of Depressive Symptoms and Sociodemographic Correlates of Adult Patients Attending a National Health Insurance Clinic at a Tertiary Hospital, Southwest Nigeria.

Depression affects individuals across all age groups, genders, and socio-economic backgrounds. Socio-demographic correlates of depression may include factors such as age, gender, education level, income, and marital status. These factors, including the presence of chronic diseases, have been shown to impact the prevalence and severity of depression. This study assessed the prevalence of depressive symptoms and its association with socio-demographic correlates and co-morbid chronic medical conditions among adult patients attending a National Health Insurance Clinic of a tertiary health facility in Southwest Nigeria. A hospital-based descriptive cross-sectional study was conducted between April - May 2023 in which 250 consenting adult patients were recruited using a systematic random sampling technique. Respondents' information on socio-demographic profiles and awareness of co-morbid medical conditions were assessed using semi-structured interviewer-administered questionnaires. Depressive symptoms were determined using the Patient Health Questionnaire. Data were analyzed using SPSS version 20. The strength of the association between independent and dependent variables was measured using chi-square and the p-value was set as <0.05. The mean age of respondents was 38.96±13.096 years (range: 18-80 years). There were 159 (63.6%) females. The prevalence of depressive symptoms was 44.8%. There was a statistically significant association between age, gender, marital status, monthly income, presence of chronic diseases, and depressive symptoms. The prevalence of depressive symptoms among adult patients attending the National health insurance clinic was 44.8%. These findings call for health policies to integrate and strengthen mental health in NHIA primary care.

A study of clinical profile of acute medical illnesses in geriatric patients

Background: Population aging is transforming the world. Elderly people are the most rapidly growing population group worldwide, which eventually include India also. The objective of the study was to provide the health care needs of this growing numbers of the vulnerable heterogeneous population, reliable data are still lacking and with recognition of the need the present study was designed. Materials and methods: A prospective observational study which was conducted at the department of medicine, Civil Hospital, Ahmedabad for the duration of 2 years, in which total 100 patients who was ≥65 years of age with acute emergency illness were included and data were collected. Results: Patients had common symptoms like breathlessness (45%) and giddiness (39%) and commonly encountered clinical conditions were cerebrovascular stroke (31%) and acute LVF (19%). Hypertension was the most common disease associated with CV stroke, acute LVF and IHD. Hypertension (44) and hypertension and diabetes (40) together were the commonly encountered co-morbidities. Most patients with co-morbidities were found complaint to their medicines. Among study participants, 87% of diabetics had also hypertension as compared to 81.5% nondiabetics who were suffering from hypertension. Conclusion: Most common acute medical illness in geriatric population is due to the chronic co-morbid conditions. It is crucial to maintain chronic morbidity in a timely manner to minimize the complication. Post-acute care may be aimed to promote the functional recovery of older adults, prevent unnecessary hospital readmission, and avoid premature admission to a long-term care facility.

BARRIERS AND SOCIETAL FACTORS SURROUNDING LONG-STAY RESIDENT DISCHARGE TO THE COMMUNITY IN LOUISIANA

Abstract The focus of this study is to determine the resident characteristics and societal factors that prevent long-stay residents (LSR) from discharging to the community based on the LSR in Louisiana (LA) compared to the United States (US). This study will also explore solutions that can assist LSR in successfully discharging to the community. Discharge to the community from a skilled nursing facility is influenced by functional status, health of the resident, and the availability of community-based services. About 20% of LSR (&amp;gt;100 days) discharge to the community from skilled nursing facilities (SNF), while that number is more than doubled for short-stay residents. Current data provides little information about the odds of a LSR returning to the community. CMS data shows that LSR in LA have higher rates of Activities of Daily Living Decline (ADL) (LA-18.83%/US-14.68%), Antipsychotic Use (LA-16.9%/US-14.58%), and Pressure Ulcers (LA-9.4%/US-2.4%) than the national average. LSR exhibiting these characteristics are less likely to be discharged to the community. Additional characteristics of this population include high levels of comorbid chronic conditions that are difficult to manage outside of the facility, and having Medicaid (LA-71.5%/US-61.1%) as their payer status, a known barrier to community discharge. States should increase the availability of home health and community-based services that cater to the Medicaid population. Assisted living facilities are a great alternative to living “at home”. Additional research should be conducted to examine affordable assisted living options in more states for long-stay Medicaid residents who desire to live independently in the community.

Comorbid Chronic Conditions and Subjective Cognitive Decline‐ A Snap‐shot

AbstractBackgroundRapidly increasing aging population in Delaware forecasts not only an increased burden of Alzheimer’s disease and related dementias (ADRD) but also a sharp rise in comorbid chronic conditions. Estimating the burden and characteristics of this “dual burden” is critical. Subjective Cognitive Decline (SCD)—a population‐based measure‐ was used to measure ADRD. The primary objective was to study prevalence of selected chronic conditions among Delaware adults with SCD in order to compare the prevalence of chronic conditions among people with and without SCD.MethodData for Delaware were obtained from the 2020 Behavioral Risk Factor Surveillance System. Respondents aged 45 years or older who answered the SCD screening question as “yes” or “no” were included in the analyses. Participants were identified as having a diagnosed chronic disease if they had been told by a doctor or other health care provider that they ever had angina; arthritis; asthma; cancer; chronic kidney disease; chronic obstructive pulmonary disease; diabetes; heart attack; and stroke. Descriptive statistics examined sociodemographic characteristics and chronic conditions in Delawareans with and without SCD.ResultNearly 1 in 12 of Delaware adults reported SCD. Compared with those without SCD, Delawareans with SCD were two or three times more likely to have angina, heart attack, stroke, diabetes, asthma, COPD, cancer, arthritis, or kidney disease. Nearly eighty percent of Delawareans with SCD have at least one other chronic health condition. More than seventy ‐five percent of Delawareans with SCD were two times as likely to have any one of the selected chronic conditions as compared to those without SCD. Adults with comorbid chronic conditions and SCD were more likely to report functional limitations.ConclusionBy 2030 the proportion of Delawareans over 60 will nearly double. Study results can facilitate timely targeted interventions to address the burden of SCD and comorbid chronic conditions in Delaware.

The virtual adaptation of Innovations in Dementia Empowerment and Action – IDEA

AbstractBackgroundIn contrast to their counterparts in the general population, sexual and gender minority (SGM) older adults and their care partners, have distinct susceptibilities that complicate living with dementia, including significant disparities in comorbid chronic conditions, social isolation, and systemic marginalization, such as discrimination and limited access to health services and supports. We developed a culturally responsive, psychosocial behavioral intervention for SGM older adults living with dementia and their care partners, the first‐ever randomized controlled clinical trial (RCT), Innovations in Dementia Empowerment and Action (IDEA). Initially designed to be delivered (and initially delivered) in‐person and in‐home, challenges associated with COVID‐19 (e.g., quarantining, socially isolating) also provided a unique opportunity to adapt and recalibrate IDEA to be fully delivered via virtual technologies.MethodWe were guided by principles of accessibility, quality, ease of delivery, and sustainability to ensure rigor during the adaptation process. Implementation needs included identifying a HIPPA‐compliant online virtual platform that was easy to use; adapting elements and materials in the intervention manual as needed; providing training for intervention coaches in best practices for virtual delivery; and training participants in the use of virtual technologies.ResultPreliminary findings suggest intervention coaches and most participants deemed the adapted intervention and virtual delivery to be acceptable. of IDEA. Only two of 22 dyads expressed discomfort with the virtual delivery to the degree they chose not to participate. Regarding difficulty in delivering the intervention virtually, 87% of coaches indicated that it was not at all or only a little difficult;12% somewhat difficult; and only 1% difficult. Virtual delivery also allowed us to expand beyond our initial 3‐site catchment area to 28 states, which also greatly increased access for rural and isolated SGM.ConclusionDelivering the adapted IDEA intervention virtually provided preliminary, potentially beneficial evidence to advance dementia interventions to address the growing, diverse population of people living with dementia and their care partners. Further systematic research is required to fully evaluate the benefits and limitations of virtual dementia interventions, including whether specific subgroups are better served by differing delivery modalities.

864. Can Population Risk Factors be Directly Applied to Guide Individual Patient’s Diagnosis and Treatment in Clinical Practice? – the Need to Re-Direct Epidemiology Research for Clinical Application in the Future

Abstract Background The implementation of population risk factor-guided diagnostic approach and treatment regimen has been widely considered in clinical practice to treat individual patient. However, the meaning of these risk factors, which are primarily developed from population-based epidemiology studies and thus presented probability and risk/odds ratio, are hard to interpret in clinical settings for individual patient. In this study, we provided an example of risk analysis for COVID-19 early intervention, in which the diagnostic accuracy of a population risk factor-based treatment regimen and an individual risk factor-based treatment regimen were compared, and the associated benefits and costs were evaluated. Methods The treatment regimen guided by the population risk factors was defined as such, that every COVID-19 patient aged ≥65 years old, and/or with at least one of the pre-selected chronic co-morbid conditions will be given a 500 mg/8 mL dose of the monoclonal antibody therapy, Sotrovimab intravenous, to prevent fatal outcome. The individual risk factor-based treatment regimen was determined using logistic regression model. We set the cost of Sotrovimab as $315.00 per patient, and the total cost including medication, hospital and infusion center administration charges, and charges for medical staffs as $2,000.00 per patient. Results Our study showed that the treatment regimen guided by population risk factors had resulted in a large amount of patient misclassification, with only 51.9% overall diagnostic accuracy, which is close to a random chance. However, by using the precision approach we developed for individual patient, the diagnostic accuracy was improved to 75%. Population risk factor-based treatment regimen prevented 1,570 more patients from a fatal outcome, however, it added 8 million dollars of cost for Sotrovimab and overall additional 54 million dollars of total cost. Conclusion Population level risk analysis provided inadequate information for individual patient’s diagnosis and treatment in clinical practice. Future research needs to focus on developing personalized diagnostic and treatment approach. We anticipate the improved clinical prediction by adding additional laboratory biomarkers to the individual precision diagnostic approach we developed. Disclosures All Authors: No reported disclosures

Extra pulmonary versus pulmonary presentation of COVID-19 patients: comparative study

BackgroundThe respiratory system is the most frequently affected system by COVID-19. However, a variety of extra-pulmonary systems can be influenced by COVID-19 with subsequent morbidity and mortality.AimThis study aim is to report the most frequent extra pulmonary presentations of COVID-19 with comparison to patients with primary pulmonary presentation. Risk factors for ICU admission in both groups were examined.MethodsIn this prospective comparative cross-sectional study, detailed demographics, medical history, clinical assessment, and computed tomography (CT) scan of the chest were done to all recruited patients with COVID-19.ResultThis study included a total of 1664 confirmed COVID-19 patients. The patients were categorized into two groups. Patients with pulmonary manifestations included 716 patients while 948 patients presented with extrapulmonary manifestations. Patients in the extrapulmonary group were older. The prevalence of certain chronic comorbid conditions was higher in the extra pulmonary group as cardiac, CNS, hepatic, and renal diseases, while chronic respiratory disorders were more prevalent in the pulmonary group (P value: < 0.0001). No significant difference in CT severity score between both groups. CORAD 5 was predominant in the pulmonary group (P value: < 0.0001). Most cases in both groups required hospital admission either inward or in ICU with higher frequency of ICU admission was observed in the pulmonary group. The significant risk factors for ICU admission in both groups were critically ill category of patients, CT severity, low oxygen saturation level, and the presence of comorbid chronic disease (P < 0.0001 with adjusted Odds ratio). CNS, cardiac, renal, and metabolic dysfunctions exert significant risk for ICU admission in the extrapulmonary group.ConclusionAtypical or non-respiratory manifestations could be the presentation of a respiratory pathogen as reported in COVID-19. Our work highlights the extrapulmonary presentation of COVID-19. Older male patients were more prone to present with extra pulmonary symptoms. CNS, cardiac, renal, and metabolic dysfunctions were the most affected systems. This could impact the level of care required for patient management and the extent of resource utility.

Disease awareness and healthcare utilization in rural South Africa: a comparative analysis of HIV and diabetes in the HAALSI cohort

BackgroundStudies from rural South Africa indicate that people living with HIV (PLHIV) may have better health outcomes than those without, potentially due to the frequent healthcare visits necessitated by infection. Here, we examined the association between HIV status and healthcare utilization, using diabetes as an illustrative comparator of another high-burden, healthcare-intensive disease.MethodsOur exposure of interest was awareness of positive disease status for both HIV and diabetes. We identified 742 individuals who were HIV-positive and aware of their status and 305 who had diabetes and were aware of their status. HIV-positive status was further grouped by viral suppression. For each disease, we estimated the association with (1) other comorbid, chronic conditions, (2) health facility visits, (3) household-level healthcare expenditure, and (4) per-visit healthcare expenditure. We used log-binomial regression models to estimate prevalence ratios for co-morbid chronic conditions. Linear regression models were used for all other outcomes.ResultsVirally suppressed PLHIV had decreased prevalence of chronic conditions, increased public clinic visits [β = 0.59, 95% CI: 0.5, 0.7], and reduced per-visit private clinic spending [β = -60, 95% CI: -83, -6] compared to those without HIV. No differences were observed in hospitalizations and per-visit spending at hospitals and public clinics between virally suppressed PLHIV and non-PLHIV. Conversely, diabetic individuals had increased prevalence of chronic conditions, increased visits across facility types, increased household-level expenditures (β = 88 R, 95% CI: 29, 154), per-visit hospital spending (β = 54 R, 95% CI: 7, 155), and per-visit public clinic spending (β = 31 R, 95% CI: 2, 74) compared to those without diabetes.ConclusionsOur results suggest that older adult PLHIV may visit public clinics more often than their HIV-negative counterparts but spend similarly on a per-visit basis. This provides preliminary evidence that the positive health outcomes observed among PLHIV in rural South Africa may be explained by different healthcare engagement patterns. Through our illustrative comparison between PLHIV and diabetics, we show that shifting disease burdens towards chronic and historically underfunded diseases, like diabetes, may be changing the landscape of health expenditure inequities.

Abstract 14214: Comparative Analysis of Artificial Intelligence Techniques for ST Segment Elevation Myocardial Infarction and Their Risk of Mortality: A Nationwide Analysis

Introduction: ST segment elevation myocardial infarction (STEMI) significantly contributes to patient morbidity and mortality nationwide. Determining which patient characteristics lead to an increased mortality rate is vital, and the use of artificial intelligence may highlight overlooked characteristics. Purpose: To investigate risk factor discordance between Multivariate Logistic Regression (MLR) and Multilayer Perceptron (MLP) Neural Networks in order to determine patient characteristics that lead to increased mortality. Methods: Patient data was collected from 2011-2018 from the National inpatient database (NIS) using International Classification of Disease Codes (ICD-9 and ICD-10). We selected patients hospitalized with STEMI. MLR and MLP models were used to tabulate adjusted odds ratios and Normalized Importance Scores respectively. Area under the curve (AUC) was calculated to determine if select comorbid conditions were associated with increased risk of mortality. Results: A total of 925,161 patients were included in our analysis. Our patient population was predominantly Caucasian, with males constituting 61% of our patient population. Notable contributors to mortality via MLR analysis include cardiogenic shock, AKI, ESRD, cirrhosis and pay status. Notable contributors to mortality via MLP analysis include cardiogenic shock, AKI, ESRD, hyperlipidemia and race. Overall MLP model classification accuracy is rated at 95.2%. Receiver operator AUC is calculated at 0.85. Conclusion: We found that patients STEMI had similar risk factors associated with mortality between MLR and MLP, however there was a discordance. This was predominantly in weighing certain socioeconomic risk factors as well as chronic comorbid conditions. This begets further analysis to optimize predictive capabilities.

EVALUATION OF THE POTENTIAL ASSOCIATED FACTORS CONTRIBUTING TO VARIOUS SIDE EFFECTS OF COVID-19 VACCINES IN BANGLADESH

Objective: Due to questions about the safety and possible side effects of COVID-19 vaccines, initially, most individuals with chronic comorbid conditions showed unwillingness to vaccination. Though COVID-19 vaccines were found safe in clinical trials, real-world results still need to be explored to generate and further analyze the safety and efficacy profile of these vaccines. Our study aimed to evaluate and associate the various side effects of COVID-19 vaccines at different covariate levels along with comorbid conditions. Methods: This cross-sectional study aimed to evaluate the side effects of COVID-19 vaccines in Bangladesh using data collected from a sample of vaccinated individuals through a structured questionnaire. The data were analyzed using descriptive statistics, bivariate analysis with a chi-square test, and multiple logistic regression model to identify the frequency, severity, and duration of side effects, as well as the associations between side effects and potential predictors. Our study investigated the side effects of four prominent approved COVID-19 vaccines in Bangladesh. Results: The findings revealed that Sinopharm was the most administered vaccine, accounting for 55% of the respondents. The majority of participants (38%) reported experiencing mild side effects, such as pain at the injection site, fatigue, and headache, while only 13% required hospitalization due to severe side effects. Significant associations were observed between vaccine type and variables such as gender, age group, concomitant health complications, prior COVID-19 history, physician's recommendation, and adverse consequences. Logistic regression analysis identified significant associations between the presence of side effects and variables such as concomitant health complications (OR=3.2 p-value: 0.011) and concomitant medications (OR=0.38, p-value: 0.039). Conclusion: These results provide valuable insights to help guide vaccination strategies and ensure vaccine safety in Bangladesh. Further investigation into these aspects in larger and more diverse groups is necessary, taking longitudinal follow-up and the objective evaluation of side effects into consideration.

Exploring the intention and hesitancy to receive a booster dose of COVID-19 vaccine among patients with comorbid disease conditions using a health belief model

BackgroundDespite the fact that the WHO recommends that adults over the age of 18 have to receive a booster dose of the COVID-19 vaccine. The willingness and intention to accept a booster dose of the COVID-19 vaccine remain major issues among the general population, particularly patients with comorbid disease conditions. The aim of this study was to assess the patterns regarding COVID-19 infection and vaccination, along with the intention and hesitancy to receive a booster dose of the COVID-19 vaccine among patients with comorbid disease conditions in Istanbul, Türkiye. MethodsThis was a descriptive, cross-sectional study conducted among patients with comorbid disease conditions using a three-part, structured, validated questionnaire. Vaccine hesitancy from a booster dose of the COVID-19 vaccine was assessed using the Health Belief Model (HBM), based on a 5-point Likert-type scale. ResultsThe study enrolled 162 participants with a mean age of 57.2 ± 13.3 years. 97% of the respondents received the COVID-19 vaccine. Almost half of respondents (51.2%) reported receiving information about a booster dose of the COVID-19 vaccine. HBM among the participants with comorbidities showed a significant agreement regarding the perceived susceptibility (P < 0.0001), perceived severity (P < 0.0001) and perceived benefits (P < 0.0001) to receive a booster vaccine dose. There was a statistically significant correlation between the intention to receive a booster vaccine dose and education level (university education; P < 0.0001). ConclusionA vast and significant majority of patients with chronic comorbid disease conditions who received the COVID-19 vaccine reported an intention to receive a booster dose.