Estimates Of Burden Research Articles

National and Local Direct Medical Cost Burden of COPD in the United States From 2016 to 2019 and Projections Through 2029

BackgroundDespite the significant burden posed by chronic obstructive pulmonary disease (COPD) to healthcare systems, there is a lack of up-to-date information quantifying the general COPD burden, costs, and long-term projections to various stakeholders in the United States. Research QuestionWhat are the updated state-specific and nationwide estimates of the COPD disease burden and direct costs in 2019, along with projections of COPD-attributable medical costs through 2029? Study Design and MethodsA cross-sectional, retrospective study design using the 2016-2019 Medical Expenditure Panel Survey (MEPS), 2019 American Community Survey (ACS), and 2019 Behavioral Risk Factor Surveillance System (BRFSS) data was applied to generate COPD-attributable expenditure estimates. Cost projections for the years 2020 to 2029 were based on 2017 National Population Projections reported by the Census Bureau and all costs were adjusted to 2019 US dollars. ResultsIn total, 4,135 people living with COPD were included, of which a higher proportion had other concurrent conditions such as cardiovascular-related conditions compared to people without COPD (N=86,021). Overall, in 2019, COPD-attributable medical costs after adjusting for demographics and 19 concurrent conditions (including COPD-related and non-COPD-related conditions) were estimated at $31.3 billion, with state-specific cost estimates reporting wide variation: from $44.8 million in Alaska to $3.1 billion in Florida. Nationwide COPD-attributable medical costs borne by payer type were as follows: private insurance, $11.4 billion; Medicare, $10.8 billion; Medicaid, $3.0 billion. Projections of national medical costs attributable to COPD are reported to increase to $60.5 billion in 2029. InterpretationUnderstanding the current disease and economic burden of COPD in the US, along with the projected costs attributable to COPD in the next decade, will highlight unmet needs and gaps in care that help inform healthcare decision-makers in planning future actions to alleviate this disease burden.

Analysis of the Economic Burden of COVID-19 on the Workers of a Teaching Hospital in the Centre of Italy: Changes in Productivity Loss and Healthcare Costs Pre and Post Vaccination Campaign.

Introduction: Following the concerning levels of spread and severity of the infection, on 11 March 2020, the World Health Organisation declared the COVID-19 outbreak a pandemic. In response to the pandemic, governments adopted several mitigation strategies. The pandemic posed a great threat to the Italian healthcare workforce (HW), with Italy being one of the hardest-hit countries. The aim of this study is to estimate the economic burden of COVID-19 on the workforce of a teaching hospital in Central Italy. Two periods are compared: 1 March 2020-9 February 2021 vs. 10 February 2021-31 March 2022. Methods: This study is conducted from a societal perspective. The database (n = 3298) of COVID-19-confirmed cases among the HW was obtained from the occupational health office of the hospital. The first entry on the database refers to 1 March 2020. Cost data were used to assess the economic burden of COVID-19 on the hospital workforce. They include two main groups: hourly salaries and medical expenses. The cost of productivity loss, hospital admission, at-home treatments, and contact tracing and screening tests were computed for the first and second periods of the analysis. Results: The total economic burden during the first period is estimated to be around EUR 3.8 million and in the second period EUR 4 million. However, the average cost per person is smaller in the second period (EUR 1561.78) compared to the first one (EUR 5906). In both periods, the cost of productivity loss is the largest component of the economic burden (55% and 57%). The cost of hospital admission decreased by more than 60% in the second period. Conclusion: Outcomes of the analysis suggest that the economic burden of COVID-19 on the HW is higher in the first period of analysis compared to the second period. The main reason could be identified in the shift from more severe and critical confirmed cases to more asymptomatic, mild, and moderate cases. The causes of this shift are not easily detectable. Vaccination, variants of the virus, and an individual's determinants of health could all be causes of the decrease in the economic burden of COVID-19 on the HW. COVID-19 can generate a high economic burden on healthcare workers and, more generally, on HWs. However, a comprehensive estimate of the economic burden of the pandemic needs to integrate the mental health repercussions and the long-term COVID-19 that will become evident in the coming years.

Tobacco industry accountability for marine pollution: country and global estimates

BackgroundCommercial cigarette filters are single-use plastics and the main component of cigarette butts, the most common trash item collected worldwide. Governments bear the economic burden of managing the waste and...

Global, regional, and national burden of infertility attributable to PCOS, 1990-2019.

What is the current burden of infertility attributable to PCOS at global, regional, and national levels by age and socio-demographic index (SDI) across 21 regions and 204 countries and territories? The burden of infertility attributable to PCOS increased from 6.00 million prevalent cases in 1990 to 12.13 million in 2019 globally and increased sharply in most regions and nations. PCOS is the most common cause of anovulatory infertility, affecting up to 80% of women with anovulation. No comprehensive and detailed epidemiological estimates of infertility attributable to PCOS in reproductive women aged 15-49 years by age and SDI, at the global, regional, and national level, have been reported. An age- and SDI-stratified systematic analysis of the prevalence and years lived with disability (YLD) of infertility attributable to PCOS across 21 regions and 204 countries and territories from 1990 to 2019 has been performed. The prevalence and YLD of female infertility attributable to PCOS in reproductive women aged 15-49 years from 1990 to 2019 were retrieved directly from the Global Burden of Diseases 2019. The number, rates per 100 000 persons, and average annual percentage changes (AAPCs) of prevalence and YLD were estimated at the global, regional, and national levels. Globally, the prevalent cases of infertility attributable to PCOS among women of reproductive age (15-49 years) doubled from 1990 to 2019, with 6.00 million prevalent cases in 1900 and 12.13 million in 2019. The global age-standardized prevalence rates (ASPRs) of infertility attributable to PCOS were 223.50/100 000 persons in 1990 and 308.25/100 000 persons in 2019. At global level, the YLDs of infertility attributable to PCOS increased by 98.0% from 35.20 thousand in 1990 to 69.70 thousand in 2019. The burden of infertility attributable to PCOS in the high SDI region was significantly higher than that in the other four SDI regions. The greatest annual increases in rates of ASPR and age-standardized YLD rate were observed in the middle SDI region (AAPC 1.96 [95% CI 1.87-2.06], 1.94 [1.87-2.00], respectively) and the low-middle SDI region (AAPC 1.96 [1.90-2.03], 1.90 [1.85-1.94], respectively). The regional highest ASPR and the age-standardized YLD rate of infertility were observed in High-income Asia Pacific. The national highest ASPR and the age-standardized YLD rate of infertility were observed in Italy. Positive associations were observed between these burden estimates and the SDI level (all P < 0.001). Although the Global Burden of Diseases 2019 has tried its best to collect all available data, some countries have limited data, which may result in an underestimation of the burden of infertility attributable to PCOS. The diagnostic criteria of PCOS are constantly changing, which may induce bias in infertility attributable to PCOS. No information on the PCOS phenotype is provided in the Global Burden of Diseases 2019, so we cannot estimate the infertility attributable to a specific PCOS phenotype. Detection bias would lead to a higher prevalence of PCOS and infertility attributable to PCOS in developed countries with well-established medical systems and greater willingness of the populace to seek medical attention. Thus, health resource allocation for infertility attributable to PCOS in low-prevalence areas should not be ignored. The global burden of infertility attributable to PCOS increased sharply from 1990 to 2019. Effective health interventions and efficient preventative and managerial strategies should be established to reduce the burden of infertility attributable to PCOS. Weight control is suggested to reduce the burden of infertility attributable to PCOS, especially in the high SDI region. This study was supported by the National Key Research and Development Program of China (grant number, 2022YFC2704100) and the National Natural Science Foundation of China (Nos 82001498 and 82371648). The authors declare no competing interests. N/A.

2629. Estimation of Hospitalization and Mortality Burden of RSV in Adults in Spain between 2015–2019

Abstract Background Respiratory syncytial virus (RSV) can cause serious respiratory illness and complications of cardiovascular diseases, especially in older adults. RSV burden in adults is underestimated, due to nonspecific symptoms and infrequent testing. We retrospectively estimated the RSV-attributable incidence of hospitalizations and deaths applying two model-based approaches. Methods Analyzing nationwide data from hospital discharges (2016–2019) and mortality (2015–2019), we estimated the RSV-attributable incidence rate of cardiorespiratory hospitalizations and deaths stratified by age and disease subgroups (5 respiratory;5 circulatory). We used a quasi-Poisson regression model, accounting for seasonal fluctuations and RSV and influenza activity. A hierarchical Bayesian model was run as a sensitivity analysis. Results RSV-attributable incidence rates of hospitalizations increased with age. The highest incidence was observed in those aged ≥80 years admitted for respiratory diseases (representing 9-10% of all respiratory hospitalizations, vs 3% in 18-49 age group). Considering secondary outcomes, rates were higher for chronic heart failure and arrythmias among the oldest age group, while among younger age groups they were higher for chronic obstructive pulmonary disease (COPD) exacerbation (50-59 and 60-79 years) and pneumonia/influenza/bronchitis (18-49 years)(Table). RSV-attributable mortality rates were higher for circulatory compared with respiratory causes in all age groups, especially due to chronic heart failure exacerbation (age ≥80 years) and acute coronary event/myocardial infarction (age 60-79 years). Bayesian model had less optimal model fit and tended to obtain lower estimates for hospitalizations that were substantially lower than prospective estimates from other high-income countries. Conclusion These model-based estimates are comparable to those from observational studies and suggest that RSV causes a considerable burden of hospitalizations in adults. Like other respiratory viruses (e.g, influenza and SARS-CoV-2), RSV contributes to both respiratory and circulatory hospitalizations. This suggest that efficacious vaccines could have a high public health impact. Disclosures Mariana Haeberer, PhD, Pfizer: Employee Robin Bruyndonckx, n/a, P95: RB is an employee of P95, paid by Pfizer to conduct the study Aleksandra Polkowska-Kramek, n/a, P95: APK is an employee of P95, paid by Pfizer to conduct the study Charles Nuttens, n/a, Pfizer: CN is an employee of Pfizer, the sponsor of this study Thao Mai Phuong Tran, n/a, P95: TMPT is an employee of P95, paid by Pfizer to conduct the study Worku Biyadgie Ewnetu, n/a, P95: WBE is an employee of P95, paid by Pfizer to conduct the study Caihua Liang, MD, PhD, Pfizer: CL is an employee of Pfizer, the sponsor of this study Cristina Mendez Diez, PhD, Pfizer: Employee Bradford D. Gessner, M.D., M.P.H., Pfizer: I am an employee of Pfizer|Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: EB is an employee of Pfizer, the sponsor of this study|Pfizer: Stocks/Bonds

Costs of Fatal and Nonfatal Firearm Injuries in the U.S., 2019 and 2020

Firearm-related injuries are among the five leading causes of death for people aged 1-44 years in the U.S. The immediate and long-term harms of firearm injuries pose an economic burden on society. Fatal and nonfatal firearm injury costs in the U.S. were estimated providing up-to-date economic burden estimates. Counts of nonfatal firearm injuries were obtained from the 2019-2020 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Data on nonfatal injury intent were obtained from the National Electronic Injury Surveillance System - Firearm Injury Surveillance System. Counts of deaths (firearm as underlying cause) were obtained from the 2019-2020 multiple cause-of-death mortality data from the National Vital Statistics System. Analyses were conducted in 2023. The total cost of firearm related injuries and deaths in the U.S. for 2020 was $493.2 billion, a 16 percent increase compared with 2019. There are significant disparities in the cost of firearm deaths in 2019-2020, with non-Hispanic Black people, males, and young and middle-aged groups being the most affected. Most of the nonfatal firearm injury-related costs are attributed to hospitalization. These findings highlight the racial/ethnic differences in fatal firearm injuries and the disproportionate cost burden to urban areas. Addressing this important public health problem can help ameliorate the costs to our society from the rising rates of firearm injuries.

Potential role of 68Ga-PSMA PET/CT in metastatic renal cell cancer: A prospective study

PurposeProstate-specific membrane antigen (PSMA), in addition to its utility in prostate cancer, is also an angiogenic imaging marker for hypervascular tumors like renal cell carcinoma (RCC). Our study aims to assess the potential role of 68Ga-PSMA-11 positron emission tomography (PET)/CT in metastatic RCC and compare it with contrast-enhanced computed tomography (CECT). MethodsBiopsy-proven RCC patients with known or suspected distant metastases who underwent 68Ga-PSMA-11 PET/CT for staging/restaging were prospectively recruited. Those patients who had undergone 18F-FDG PET/CT within six weeks of 68Ga-PSMA PET/CT were also included retrospectively for comparative analysis. A patient-based and lesion-based analysis was done to compare the lesion detection rates of CECT, 68Ga-PSMA-11 PET and 18F-FDG PET. PET-based quantitative parameters were also compared between both the PET modalities. Impact of baseline parameters on survival was assessed using Cox regression analysis. A p-value of < 0.05 was considered significant. ResultsThirty-seven patients with median age 60 years ± 13 years (range = 26–76 years) were included in the study. Twenty-seven patients had clear cell (cc) RCC, six had papillary RCC (pRCC), and one each had an eosinophilic variant of ccRCC, collecting duct RCC, translocation RCC and poorly differentiated RCC. 68Ga-PSMA-11 PET performed better in detecting marrow and equivocal bone lesions and worse in detecting liver lesions compared to CECT. 68Ga-PSMA-11 PET-based angiogenic tumor burden estimation using Total Lesion-PSMA (TL-PSMA) and PSMA-Total volume (PSMA-TV) had a prognostic impact on the survival of patients. 68Ga-PSMA-11 PET also detected more lesions and showed significantly higher SUVmax than 18F-FDG PET. Conclusion68Ga-PSMA-11 PET/CT performs better than CECT and 18F-FDG PET/CT in metastatic evaluation and has prognostic value in the management of clear cell RCC.

Leveraging diverse cell-death patterns to predict the prognosis, immunotherapy and drug sensitivity of clear cell renal cell carcinoma

Clear cell renal cell carcinoma (ccRCC) poses clinical challenges due to its varied prognosis, tumor microenvironment attributes, and responses to immunotherapy. We established a novel Programmed Cell Death-related Signature (PRS) for ccRCC assessment, derived through the Least Absolute Shrinkage and Selection Operator (LASSO) regression method. We validated PRS using the E-MTAB-1980 dataset and created PCD-related clusters via non-negative matrix factorization (NMF). Our investigation included an in-depth analysis of immune infiltration scores using various algorithms. Additionally, we integrated data from the Cancer Immunome Atlas (TCIA) for ccRCC immunotherapy insights and leveraged the Genomics of Drug Sensitivity in Cancer (GDSC) database to assess drug sensitivity models. We complemented our findings with single-cell sequencing data and employed the Clinical Proteomic Tumor Analysis Consortium (CPTAC) and qRT-PCR to compare gene expression profiles between cancerous and paracancerous tissues. PRS serves as a valuable tool for prognostication, immune characterization, tumor mutation burden estimation, immunotherapy response prediction, and drug sensitivity assessment in ccRCC. We identify five genes with significant roles in cancer promotion and three genes with cancer-suppressive properties, further validated by qRT-PCR and CPTAC analyses, showcasing gene expression differences in ccRCC tissues. Our study introduces an innovative PCD model that amalgamates diverse cell death patterns to provide accurate predictions for clinical outcomes, mutational profiles, and immune characteristics in ccRCC. Our findings hold promise for advancing personalized treatment strategies in ccRCC patients.

Contribution of the Rapid LAMP-Based Diagnostic Test (RLDT) to the Evaluation of Enterotoxigenic Escherichia coli (ETEC) and Shigella in Childhood Diarrhea in the Peri-Urban Area of Ouagadougou, Burkina Faso.

The estimates of enterotoxigenic Escherichia coli (ETEC) and Shigella burden in developing countries are limited by the lack of rapid, accessible, and sensitive diagnostics and surveillance tools. We used a "Rapid LAMP based Diagnostic Test (RLDT)" to detect ETEC and Shigella in diarrheal and non-diarrheal stool samples from a 12-month longitudinal cohort of children under five years of age in a peri-urban area of Ouagadougou in Burkina Faso (West Africa). To allow comparison with the RLDT-Shigella results, conventional culture methods were used to identify Shigella strains in the stool samples. As conventional culture alone cannot detect ETEC cases, a subset of E. coli-like colonies was tested using conventional PCR to detect ETEC toxins genes. Of the 165 stool samples analyzed for ETEC, 24.9% were positive when using RLDT against 4.2% when using culture followed by PCR. ETEC toxin distribution when using RLDT was STp 17.6% (29/165), LT 11.5% (19/165), and STh 8.5% (14/165). Of the 263 specimens tested for Shigella, 44.8% were positive when using RLDT against 23.2% when using culture. The sensitivity and specificity of the RLDT compared to culture (followed by PCR for ETEC) were 93.44% and 69.8% for Shigella and 83.7% and 77.9% for ETEC, respectively. This study indicates that both Shigella and ETEC are substantially underdiagnosed when using conventional culture and highlights the potential contribution of the new RLDT method to improve enteric disease burden estimation and to guide future efforts to prevent and control bacterial enteric infection and disease.

Restriction site associated DNA sequencing for tumour mutation burden estimation and mutation signature analysis.

Genome-wide measures of genetic disruption such as tumour mutation burden (TMB) and mutation signatures are emerging as useful biomarkers to stratify patients for treatment. Clinicians commonly use cancer gene panels for tumour mutation burden estimation, and whole genome sequencing is the gold standard for mutation signature analysis. However, the accuracy and cost associated with these assays limits their utility at scale. WGS data from 560 breast cancer patients was used for in silico library simulations to evaluate the accuracy of an FDA approved cancer gene panel as well as restriction enzyme associated DNA sequencing (RADseq) libraries for TMB estimation and mutation signature analysis. We also transfected a mouse mammary cell line with APOBEC enzymes and sequenced resulting clones to evaluate the efficacy of RADseq in an experimental setting. RADseq had improved accuracy of TMB estimation and derivation of mutation profiles when compared to the FDA approved cancer panel. Using simulated immune checkpoint blockade (ICB) trials, we show that inaccurate TMB estimation leads to a reduction in power for deriving an optimal TMB cutoff to stratify patients for immune checkpoint blockade treatment. Additionally, prioritisation of APOBEC hypermutated tumours in these trials optimises TMB cutoff determination for breast cancer. The utility of RADseq in an experimental setting was also demonstrated, based on characterisation of an APOBEC mutation signature in an APOBEC3A transfected mouse cell line. In conclusion, our work demonstrates that RADseq has the potential to be used as a cost-effective, accurate solution for TMB estimation and mutation signature analysis by both clinicians and basic researchers.

Analysis of years of life lost due to premature cancer mortality in the Russian Federation

Background. Burden of disease estimation allows analyses to be carried out integrally, including cause and effect assessment. the rate of life years lost due to premature mortality is part of the burden of disease analysis. given that the burden of cancer is steadily increasing, analysis of the number of years lost makes it possible to identify new strategic directions, as well as to adjust decisions already made, in the health care of cancer patients.Purpose: to estimate the loss of life expectancy as a result of premature mortality from cancer in the population of the Russian Federation.Material and Methods. the analysis was carried out using international statistical databases for disease burden estimation, databases of the Federal state statistics service (Rosstat). to determine the target groups of priority reduction of mortality from neoplasms in the Russian Federation, an estimation of the lost years of life expectancy as a result of premature mortality in the form of the e† (e-dagger) indicator was carried out. the analyzed period of the study was 2010–2019.Results. the Russian Federation is characterized by the smallest share of losses from cancer in the structure of losses from all causes of death compared to the analyzed countries (Japan, France, germany, latvia, lithuania, estonia). However, the share of losses has been intensively increasing for 10 years (in 2010 – 14.79 %, in 2019 – 17.54 %). in comparison with the analyzed countries, Russia is more characterised by losses from cancer at a younger age, with the highest value of life years lost in the age group 60–64 years. the age-standardized number of years lost in men in Russia is 67.1 % higher than in women. in the age group from 25 to 49 years of age, the loss of life expectancy due to cancer in women is higher and accounts for 0.4 years (or 19 %) of all losses, which is not typical of other age groups in which losses in men prevail. A significant regional differentiation of mortality in the constituent entities of the Russian Federation has been revealed, which is also reflected in the number of years lost.Conclusion. the potential of preventive strategies in the Russian Federation has not been fully realized – the loss of life years in young and middle age requires the correction of measures to improve preventive services and oncological care. the revealed regional differentiation allows us to identify regions with high losses for priority solutions.

Addressing Biases in Ambient PM2.5 Exposure and Associated Health Burden Estimates by Filling Satellite AOD Retrieval Gaps over India.

Ambient PM2.5 exposure statistics in countries with limited ground monitors are derived from satellite aerosol optical depth (AOD) products that have spatial gaps. Here, we quantified the biases in PM2.5 exposure and associated health burden in India due to the sampling gaps in AOD retrieved by a Moderate Resolution Imaging Spectroradiometer. We filled the sampling gaps and derived PM2.5 in recent years (2017-2022) over India, which showed fivefold cross-validation R2 of 0.92 and root mean square error (RMSE) of 11.8 μg m-3 on an annual scale against ground-based measurements. If the missing AOD values are not accounted for, the exposure would be overestimated by 19.1%, translating to an overestimation in the mortality burden by 93,986 (95% confidence interval: 78,638-110,597) during these years. With the gap-filled data, we found that the rising ambient PM2.5 trend in India has started showing a sign of stabilization in recent years. However, a reduction in population-weighted exposure balanced out the effect of the increasing population and maintained the mortality burden attributable to ambient PM2.5 for 2022 (991,058:798,220-1,183,896) comparable to the 2017 level (1,014,766:812,186-1,217,346). Therefore, a decline in exposure alone is not sufficient to significantly reduce the health burden attributable to ambient PM2.5 in India.

Global-, regional- and country-level estimates of the work-related burden of diseases and accidents in 2019.

This study provides the global-, regional- and country-level estimates on the work-related burden of diseases and accidents for 2019, including deaths, disability adjusted life years (DALY) and economic losses. Data on occupational illnesses and injuries from international organizations, institutions, and public websites were used. Risk ratios (RR) and population attributable fractions (PAF) for the risk factor-outcome pairs were derived from the literature. Estimated mortality and DALY for a group of seven major diseases covering 120 risk-outcome pairs attributable to work were calculated for 181 countries. Globally, 2.9 million deaths were attributed to work, with 2.58 million deaths due to work-related diseases and 0.32 million related to occupational injuries. Globally, work-related diseases with a long latency period are increasing, while the number of occupational injuries has decreased. Work-related circulatory diseases were the major cause of 912 000 deaths globally, followed by 843 000 work-related malignant neoplasms. In high-income, American, Eastern European and Western Pacific World Health Organization (WHO) regions, however, work-related malignant neoplasms comprised the biggest disease group. DALY attributable to work were estimated to be 180 million in 2019, with an associated economic loss of 5.8% of global GDP. New estimates of psychosocial factors increased the global loss. The burden of work-related diseases and injuries increased by 26% from 2.3 million annual deaths in 2014 to 2.9 million in 2019. The DALY attributable to work have also substantially increased from 123 million in 2014 to 180 million in 2019 (47% increase). We found large regional and country variations.

BIOM-27. CELL-FREE DNA-BASED LIQUID BIOPSIES FOR THE REAL-TIME TRACKING OF TUMOR BURDEN AND TREATMENT RESPONSE IN GLIOBLASTOMA

Abstract Cell-free DNA (cfDNA) are short fragments of DNA that are released by apoptotic or necrotic cells into bodily fluids. It has emerged as a potential diagnostic tool allowing for the detection and analysis of tumor-derived biomarkers in cancer. Despite the detailed view provided by clinical imaging, its inability to quantify tumor burden and distinguish between pseudo-progression and pseudo-response poses a challenge for patients. In this study, we sought to investigate the effectiveness of cfDNA as a liquid biopsy tool to track tumor burden and disease progression in real time in different glioblastoma models and through different types of biofluids. To examine the feasibility of cfDNA-based tumor tracking we cultivated several patient-derived glioblastoma lines, purified cfDNA and performed sequencing. Further analysis revealed that dead cells were associated with an elevated cfDNA yield and altered fragment size profiles. Genomic sequencing revealed consistent variants shared across serial cfDNA timepoints, strengthening the suggestion that cfDNA can be used as a non-invasive biomarker. In order to demonstrate the clinical implications of our methodology, we collected a preliminary batch of n = 43 longitudinal intraventricular cerebrospinal fluid (CSF) samples from a patient that underwent CAR-T treatment over the span of two years. We observed a marked increase in cfDNA yield post-treatment compared to samples taken prior to treatment administration. Furthermore, cfDNA-based estimates of tumor burden measured as allele fraction specific to the tumor, tracked with clinical imaging-based tumor size estimates. These preliminary findings provide compelling evidence supporting the clinical utility of cfDNA analysis in monitoring the effectiveness and dynamics of CAR-T treatment. By tracking cfDNA levels in CSF, we can identify patterns reflecting treatment response and aid in assessing the therapeutic efficiency of CAR-T treatment in glioma patients. Further investigations with larger patient cohorts and more comprehensive data analysis to validate these findings are actively underway.

Cost Associated with Geriatric Traumatic Brain Injury in Developing Countries: An Observational Study

Traumatic brain injury (TBI) in the geriatric population is a serious public health problem and has a huge impact on mortality and morbidity. A retrospective cohort study including patients aged above 65 admitted to a tertiary specialized trauma center, in the period from January 2016 to 31 December 2019. The data collected include patients' demographics, diagnosis, Glasgow Coma Scale (GCS) on arrival, length of stay, investigations, and type of surgery done. Total number of TBI cases in our study is 145. The most frequent single diagnosis was subdural hematoma (85). Subsequently, it was the costliest diagnosis with an average cost of 3569 USD per patient. Length of stay on average was 17.11 ± 41hours, with the majority (109 patients) having nonprolonged hospital stay (<14days). Most of those managed by observation have below-average costs compared to other patients (P<0.001). Complete blood count was the highly requested test with a total cost 5070 $ in the study period. And head computed tomography had the highest total cost 58,864 $. 21 craniotomies and 30 burr holes were made with a total cost of 30,000 and 25,325 respectively. Patients with lower GCS (64.6%) have below-average hospitalization costs compared to those who got high GCS scores (P<0.001). This study provides the first estimates of the financial burden of Geriatric TBI in the region, which signifies the importance of developing strategies to prevent TBIs and help in resource allocation and healthcare policy formation.

The global burden of heart failure: a systematic analysis for the Global Burden of Disease Study 2021

Abstract Background Heart failure is a common reason for hospitalization and is associated with high health care costs and high symptom burden. Updated estimates of global and regional prevalence and underlying causes of HF may be helpful in guiding health policy and investment priorities. Purpose To provide comparable and consistent estimates of heart failure burden as part of the Global Burden of Disease (GBD) 2021. Methods We identified all available data on prevalence, incidence, and mortality for heart failure in the general population. Sources included published scientific literature, administrative records from national health systems, and vital registration data. We generated estimates of heart failure prevalence using DisMod-MR 2.1, a geospatial modelling software program. We then estimated the proportion of prevalent heart failure due to each of 27 underlying aetiologies to produce age-, sex-, location-, year-, and aetiology-specific estimates of heart failure burden. Results In 2021, there were 56.5 million (95% Uncertainty Interval (UI): 49.7 million to 63.7 million) prevalent cases of heart failure globally. There were 27.3 million (24.0 to 30.8) prevalent cases in females and 29.2 million (25.6 to 33.0) cases among males. Age-standardized prevalence increased from 647.9 (556.3 to 739.9) per 100,000 in 1990 to 682.7 (602.8 to 766.8) per 100,000 in 2021. The North Africa and Middle East super region had the highest age-standardized prevalence in 2021 (780.5 per 100,000 (658.7 to 907.6)) and South Asia had the lowest age-standardized prevalence (600.1 per 100,000 (526.5 to 671.4)). In 2021, Ischaemic heart disease, hypertensive heart disease, and other cardiomyopathy were responsible for the majority of prevalent heart failure cases worldwide, at 33.8% (28.4% to 38.3%), 22.6% (19.0% to 27.1%), and 8.2% (7.0% to 9.6%), respectively. Country specific estimates for both sexes combined in 2021 are shown in the map. Conclusion Heart failure is a highly prevalent condition, particularly in older age groups. As populations age and risk profiles change around the world, knowledge of the global epidemiology of heart failure will be critical in preventing or treating its underlying aetiologies in order to decrease its overall burden.Heart failure prevalence, 2021

Abstract 18813: Economic Burden of Pregnancy Among Privately Insured Women With Congenital Heart Disease

Background: Women with congenital heart defects (CHD) are increasingly reaching childbearing age. Understanding their healthcare costs in pregnancy may inform resource allocation, financial planning, and pre-conception counseling. Methods: We used 2010-2016 US commercially insured beneficiaries’ data within the IBM ® MarketScan® database to identify pregnancies among 18-55-year-old women with CHD and matched controls without CHD. We assessed baseline characteristics, cardiac and noncardiac conditions, pregnancy related conditions, birth outcomes, and cesarean section. We estimated total and out-of-pocket (OOP) costs, compiled and adjusted to 2016 medical component of the consumer price index. Negative binomial mixed model was used. Results: There were 6385 pregnancies in 5077 women with CHD (672 pregnancies among severe and 5713 among nonsevere) and 9438 pregnancies in 7737 controls. Compared to controls, pregnancies with CHD were more likely to be 35+ years of age at delivery, resided in the Northeast and West regions, had flexible insurance plans, cardiac conditions, noncardiac conditions, birth outcomes, pregnancy related conditions and cesarean sections, while there was no difference in the year of delivery and gestational diabetes rates. After adjusting for all covariates, having CHD was an independent predictor of higher adjusted pregnancy-related cost ratio for total (1.49, 95% confidence interval [CI] 1.40, 1.59) and OOP costs (1.27, 95% CI 1.19, 1.35). The adjusted mean total and OOP cost difference for pregnancy per patient for any CHD, severe CHD, and nonsevere CHD was significantly higher than controls (Figure). Total expenditure and OOP cost of CHD pregnancies during the study period were $162.5 and $15.7 million dollars respectively. Conclusions: We provide novel estimates of economic burden of pregnancy among privately insured CHD patients for clinical and financial counseling and planning for patients, payors and policymakers.

Abstract 13969: Etiology-Specific Prevalence of Heart Failure: A Systematic Analysis of the Global Burden of Disease Study 2021

Background: While heart failure (HF) is a common disease worldwide with high health care costs and disease burden, the underlying causes vary widely by location. Estimates of how etiologies of HF vary globally will support clinical and public health practice, research, and related capacity building. Research Question and Goals: To provide, current, consistent and comparable estimates of etiology-specific HF prevalence as part of the Global Burden of Disease (GBD) Study 2021. Methods: We included all available population-representative data on prevalence, incidence, and mortality to estimate HF prevalence using DisMod-MR, a Bayesian geospatial model. We then estimated the proportion of HF due to each of 27 underlying etiologies using cause-specific mortality estimates, individual-level vital registration records with multiple cause of death information, and linked hospital-mortality data. These proportions were then multiplied by the estimates of HF prevalence to generate estimates of etiology-specific HF burden for all countries. Results: HF etiologies varied widely across the the seven GBD super-regions. Ischemic heart disease (IHD) was the most common underlying cause in all super regions except for Sub-Saharan Africa where hypertensive heart disease was the most common (Figure). Age-standardized prevalence of HF due to IHD ranged from 77.51 to 306.25 per 100,000 (Table). Conclusion: While IHD was the most common underlying cause of HF for most locations in 2021, there was substantial variability by location. Improved understanding of HF etiologies could guide tailored clinical and public health practice and research.

Abstract 13982: Ischemic Heart Disease Burden in the United States: Prevalence, Mortality, and Regional Differences From 1990-2019

Background: Understanding the burden of IHD in the United States is crucial for informed decision-making and targeted interventions aimed at reducing morbidity and mortality. Aim: To understand the burden of IHD, identify gender disparities and risk factors, explore the relationship between socioeconomic growth and IHD, and analyze risk factor distribution across states. Method: utilizing data from the GBD Study 2019. The study assessed the relationship between IHD and socioeconomic development using SDI and measured the overall impact of IHD using DALYs, considering premature death and disability. Data analysis involved comparing prevalence, mortality, SDI, DALYs, attributable burden, and risk estimation among states. Results: Between 1990 and 2019, there was an improvement in socioeconomic development in all states. Age-standardized rates of disease burden for IHD decreased by 50% with the most significant decline observed in Minnesota. Males had higher burden rates than females in all states, and the southeast region had the highest mortality rates. The prevalence of IHD showed a declining trend with a 37.1% decrease in ASPR from 1990. Metabolic risks were the leading contributors to the disease burden, accounting for 50% of cases, with Mississippi having the highest attributable risk. Arkansas had the highest attributable risk for high cholesterol and smoking. Conversely, Minnesota had the lowest burden of IHD among all states. Conclusion: This study highlights variations in the burden of IHD across US states and emphasizes the need for tailored prevention programs to address specific risk factors and gender differences.

Global burden of neck pain in 204 countries from 1990-2019.

The estimation of global burden of neck pain is lacking. To estimate the trends and burden of neck pain by sex, age, region, and sociodemographic index (SDI). The incidence and disability-adjusted life years (DALY) data for neck pain were extracted from the Global Burden of Disease 2019 database. The estimated annual percent change (EAPC) and 95% confidence intervals (CIs) were used to assess the trends in age-standardized incidence and DALY rates from 1990 to 2019. From 1990 to 2019, the global age-standardized incidence rate and age-standardized DALY rate indicated downward trends, with EAPCs of -0.06 and -0.09, respectively. The EAPCs of the age-standardized incidence rate and age-standardized DALY rate were negatively correlated with the SDI in 2019, respectively. The age-standardized incidence rates and age-standardized DALY rates in regions with a high SDI indicated a downward trend, including in high-income North America, Australia, and New Zealand. In 2019, the Philippines and high-income North America had the highest age-standardized incidence and age-standardized DALY rates. From 1990 to 2019, the areas which increased most rapidly in the age-standardized incidence rate and age-standardized DALY rate were in tropical Latin America (EAPCs of 0.53 and 0.60, respectively). Brazil had the most rapid increase in the age-standardized incidence rate and age-standardized DALY rate (EAPCs of 0.55 and 0.61, respectively). The age-standardized incidence rate and age-standardized DALY rate of neck pain decreased globally from 1990 to 2019. However, there were significant differences concerning sex, age, and regional distributions. Therefore, targeted prevention interventions and risk factor control measures should be reasonably allocated.