Antimicrobial resistance (AMR) has been increasing rapidly in the United States despite government efforts to contain its spread. Both under-utilization and overuse of prescribed antimicrobials contribute to rising resistance. The introduction of Medicare Part D in 2006 expanded prescription drug coverage for the elderly, including coverage for antimicrobial medications. If cost barriers had previously led to under-utilization of prescriptions, then Medicare Part D could have mitigated AMR by improving access to antimicrobials. However, if Medicare Part D also encouraged excessive antibiotic use, it may have inadvertently contributed to greater resistance. Using data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for January 2001 to September 2008, I estimate the causal impact of Medicare Part D on AMR-related hospital discharges using a difference-in-differences identification strategy. My findings suggest that Medicare Part D led to a slower increase in AMR-related inpatient discharges among the Medicare-eligible population.

Depression is one of the leading causes of disease burden worldwide, with profound effects on quality of life, productivity, and life expectancy. In the United States, its prevalence is particularly high, placing substantial strain on both public health systems and economic stability. Despite advances in treatment and growing awareness, depression remains underdiagnosed and undertreated, especially among low-income and vulnerable populations. As the burden of mental illness continues to rise, quantifying its long-term health and economic impacts is essential for guiding healthcare policy and resource allocation. This study projects the future burden of depression in the United States by estimating healthcare expenditures and mortality for 2023-2032, drawing on nationally representative datasets including the Behavioral Risk Factor Surveillance System (BRFSS), the National Survey on Drug Use and Health (NSDUH), and the Healthcare Cost and Utilization Project (HCUP). Using linear regression modeling, the analysis examines trends in prevalence, healthcare utilization, treatment costs, and mortality, highlighting both direct healthcare costs and indirect costs from lost productivity and premature death. While linear modeling offers a straightforward approach to trend estimation, it may not fully capture nonlinear dynamics in depression prevalence and outcomes, and results should be interpreted with this limitation in mind. By 2030, the annual economic burden of major depressive disorder is projected to exceed $540 billion, with nearly 3,000 depression-related deaths annually. These findings underscore the urgent need for early intervention, expanded access to care, and targeted policies to address treatment disparities, thereby reducing both the economic and human toll of depression.

While children's hospitals (CH) tend to be the locus of specialized hospital care, they also care for common conditions. There is no system to understand the distribution of hospital days within CHs and non-CHs (NCH) based on how ubiquitous conditions are across hospitals. We develop a method to classify conditions based on their commonality and consolidation within hospitals. We performed a retrospective study of the 2022 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database, excluding normal newborns. For the 441 conditions, the volume of hospital days and the distribution of days across hospitals using the Hospital Days Consolidation Index (HDCI) were determined. Conditions were categorized into four groups based on k-means clustering of hospital days and HDCI. There were 1.5 million hospitalizations from 123 CH and 3366 NCH. There were 54 conditions representing 85.7% of hospital days classified as Very High Days & Very Low Consolidation (i.e., commodity conditions); 47.2% of these hospital days were at a CH. At the other extreme, there were 50 conditions classified as Very Low Days & Very High Consolidation (e.g., chronic lymphocytic leukemia) representing <1% of hospital days; 75.3% at CH. Among all hospital days for commodity conditions, 52.8% were at NCH and 47.2% were at a CH. However, for the remaining condition groups, 27.3% of days were at an NCH and 72.7% at a CH. We identified commodity conditions but also conditions that are consolidated, typically within CH. Consolidation can be quantified, compared, and tracked using the HDCI.

Stroke has emerged as a major public health issue. Dysphagia affects more than half of stroke survivors and is frequently accompanied by malnutrition, particularly in elderly patients. This study investigated the prevalence and risk factors of malnutrition in elderly stroke patients with dysphagia using a large, nationally representative database. Data were extracted from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) for 2010–2019. Elderly patients (≥ 65 years) with a primary diagnosis of stroke and dysphagia were identified. Descriptive statistics and multivariate logistic regression were used to analyze the association between demographic factors, comorbidities, and malnutrition. The overall incidence of malnutrition in elderly stroke patients with dysphagia was 12.5%. Significant risk factors for malnutrition included fluid and electrolyte disorders and having three or more comorbidities. Malnourished patients had significantly higher mortality rates and longer hospital stays compared to those without malnutrition. Malnourished patients had significantly higher mortality rates (9.9% vs. 6.9%) and longer hospital stays (median 10 vs. 6 days). Malnutrition is prevalent in elderly stroke patients with dysphagia, with a 12.5% incidence. The findings highlight the critical need for early nutritional screening and intervention, particularly in patients with multiple comorbidities, Black race, and those admitted to urban hospitals. Addressing malnutrition in these high-risk patients is essential to improving clinical outcomes, reducing hospital stays, and lowering mortality rates.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-23448-3.

Background: Class III obesity (BMI ≥40 kg/m2) represents a growing public health challenge and is closely associated with cardiovascular disease (CVD). This study investigates clinical outcomes, healthcare disparities, and resource utilization in patients with morbid obesity and underlying CVD. Methods: We conducted a retrospective cohort study using data from the National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project (HCUP), covering hospitalizations between 2019 and 2020. Adults with class III obesity and a diagnosis of CVD—including hypertensive disease, ischemic heart disease, heart failure, and cerebrovascular disease—were identified using ICD-10 codes. The primary outcome was in-hospital mortality. Secondary outcomes included total hospitalization costs and length of stay (LOS). Multivariate logistic regression was used to identify predictors of mortality. Results: A total of 1,599,800 CVD-related hospitalizations in patients with class III obesity were identified. In-hospital mortality occurred in 2% of cases. The mean (±SD) patient age was 62 ± 13 years. White patients were significantly older than their Black and Hispanic counterparts (65 vs. 59 vs. 58 years; p&lt;0.001). In adjusted models, Black patients had lower odds of in-hospital mortality compared to White patients (OR 0.81; 95% CI, 0.72–0.91; p&lt;0.001). Female sex was also associated with reduced odds of mortality compared to males (OR 0.88; 95% CI, 0.80–0.97; p=0.008). Comorbid conditions such as diabetes mellitus (DM), human immunodeficiency virus (HIV), and chronic obstructive pulmonary disease (COPD) were independently associated with increased mortality. Racial and ethnic differences were also observed in LOS (White: 5.8 days, Black: 6.1 days, Hispanic: 5.7 days; p&lt;0.001) and total hospital charges. Conclusions: Among patients with class III obesity and CVD, Black race and female sex were associated with lower in-hospital mortality. In contrast, comorbidities such as DM, HIV, and COPD were linked to higher mortality risk. Notable disparities in LOS and healthcare expenditures across racial and ethnic groups underscore persistent inequities in care delivery and outcomes in this high-risk population.

Introduction: Heart failure with preserved ejection fraction (HFpEF) accounts for the majority of heart failure admissions in women; however, its impact during pregnancy is underexplored. With evolving cardiovascular risk profiles among reproductive-aged women, updated national data is essential. This study explored the prevalence, comorbidity burden, and pregnancy-related outcomes associated with HFpEF during pregnancy hospitalizations in the United States. Methods: We conducted a retrospective analysis of National Inpatient Sample (2020–2022) to identify pregnancy-related hospitalizations with and without HFpEF using ICD-10 codes. A 3:1 propensity score matching ( for demographics and comorbidities) and multivariable regression were used to assess adjusted odds ratios (aOR) with 95% confidence intervals (CI). We assessed in-hospital outcomes in the study population. In accordance with HCUP (Healthcare Cost and Utilization Project) data use guidelines, outcomes were excluded from reporting if the number of events in any subgroup was ≤10, to protect patient confidentiality and data integrity. Results: Among 2,257,352 pregnancy-related admissions, 1,565 (0.01%) involved HFpEF. Women with HFpEF were older (mean age 33.6 vs. 29.5 years, p &lt;0.0001), more frequently African American (55.2% vs. 16.1%), and from the lowest income quartile (42.2% vs. 27.7%, p&lt;0.0001). In an unmatched population, comorbidities such as hypertension (54% vs. 0.2%), obstructive sleep apnea (17.2% vs. 0.2%), renal disease (20.1% vs. 0.2%), cerebrovascular disease (24.3% vs. 7.0%), anemia, diabetes, hypothyroidism, and liver disease were significantly more prevalent (all p&lt;0.0001). After matching (n=1053), HFpEF was associated with higher odds of preeclampsia (aOR 2.69, p=&lt;0.0001) and lower odds of live birth (aOR 0.44, p&lt;0.0001). No significant differences were observed in AKI (aOR 1.31, p=0.277) or PPH (aOR 1). Fetal distress occurred less frequently in the HFpEF group (aOR 0.65). HFpEF was associated with a trend toward longer stay (+1.6 days, p=0.004) and higher costs (+$20,072, p=0.032). Conclusions: Though rare, HFpEF during pregnancy is linked with a high comorbidity burden and adverse obstetric outcomes. Early recognition, multidisciplinary care, and counseling regarding outcomes are essential, especially in women with overlapping cardiovascular risk factors.

The impact of extracorporeal membrane oxygenation on survival in critically ill adults with sickle cell acute chest syndrome: A national retrospective cohort study using inverse probability of treatment weighting

Characterizing palliative care utilization among patients with Acute Myeloid Leukemia (AML): Insights from analysis of AML hospitalizations in the United States.

Clinical outcomes in hospitalized sickle cell patients with palliative care consults

Outcomes of immune thrombocytopenia hospitalizations in patients with diabetes mellitus

Impact of obstructive sleep apnea on hospitalized patients with polycythemia vera

Understanding the burden and predictors of 90-day all-cause readmissions following hospitalization for diffuse large B-cell lymphoma: An analysis of the nationwide readmissions database

Real-World Effectiveness and Resource Utilization of Red Blood Cell Exchange in Adult Sickle Cell Disease: a Nationwide Robust Analysis from 2017-2022

Background: US federal and state governments are investing in comprehensive behavioral health crisis system reforms. These reforms aim to prevent suicide, limit police involvement in crises, and reduce reliance on hospitals and emergency departments. Arizona's reform is considered a model for other states. Aims: We evaluated whether Arizona's crisis system reform was associated with reductions in behavioral health-related hospitalizations. Method: We used a comparative interrupted time series design to assess Arizona's implementation of their crisis response system in 2015. We used 2011-2018 Healthcare Cost and Utilization Project (HCUP) State Inpatient Dataset (SID) data and selected Colorado, Kentucky, Michigan, New Jersey, New Mexico, and Washington as comparison states. Results: Arizona's annual behavioral health-related hospital discharge rate per 100,000 population decreased from 686.3 in 2011 to 673.7 in 2014 and increased from 759.3 in 2016 to 955.7 in 2019. The comparative interrupted time series analyses revealed that implementation of Arizona's crisis system was not associated with a change in the rate of behavioral health hospitalizations. Limitations: There may be some unmeasured, time-varying factors related to the rate of behavioral health-related hospitalizations between Arizona and our comparison states that we are not accounting for. Also, hospitals switched from using ICD-9 to ICD-10 codes in 2015, the same year as Arizona implemented their crisis system. Conclusions: More research is needed to confirm whether and how comprehensive crisis response systems impact behavioral health-related hospitalizations.

IntroductionCesarean sections are commonly performed in the United States, including among patients for whom vaginal delivery may be clinically feasible. This study aimed to evaluate rates and factors associated with cesarean section use and inpatient cost among low-risk deliveries in selected U.S. states.MethodsThis was a retrospective, cross-sectional analysis using Healthcare Cost and Utilization Project (HCUP) State Inpatient database for Maryland, Florida, and Wisconsin between January 1, 2017, and December 31, 2020. American Hospital Association (AHA) data and median household income quartiles based on the Agency for Healthcare Research and Quality’s (AHRQ) 2018 estimates were included in this study to assess hospital and patient neighborhood characteristics. AHA data was linked to HCUP data using the hospital identifier number. Median household income quartiles were linked to HCUP using ZIP codes. A multivariable generalized estimating equations regression model including a random intercept for hospitals was used to identify patient- and hospital-level characteristics associated with the use of cesarean section.Results245,383 women who underwent a delivery between 2017 and 2020 were included in the analysis. Of these women, 8.1% had cesarean section and 91.9% had vaginal delivery. Mean age was 26.9 (SD ± 4.41) years for cesarean section and 26.9 (SD± 4.37) years for vaginal delivery. An increasing rate of cesarean section was detected during the study period. Higher rates of cesarean section were found among Black and Hispanic women compared to White and Asian, and among women with lower income. Hospitals in Florida had the highest cesarean section rate of 9.4% among low-risk women while Maryland and Wisconsin had rates of 6.3% and 5.3%, respectively. Being Hispanic or Black, having private insurance, and giving birth in a for-profit hospital were associated with higher cesarean section utilization after controlling patient- and hospital-level factors. DiscussionA range of clinical and policy interventions have been implemented over the past decade to reduce cesarean sections among low-risk deliveries; however, we still identified an increasing rate of cesarean section among low-risk women between 2017 and 2020 in select U.S. states. There is an emergent need to revisit policies and interventions that impact cesarean section in these states. Women with low socioeconomic status were more vulnerable to have cesarean sections. Identifying variation in cesarean delivery rates among low-risk populations may inform future efforts to improve maternal care quality.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-08148-0.

The demand for surgical facial rejuvenation procedures, such as facelifts, has risen in recent decades. However, limited research has addressed the epidemiological and economic aspects of these procedures. This study examines trends in facelift surgeries using data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database. The HCUP-NIS database, which includes all-payer inpatient cases in the USA, was analyzed for facelift procedures identified through ICD-10 codes from 2016 to 2020. A total of 723 patients met the inclusion criteria. Patient demographics, hospitalization details, and procedural characteristics were evaluated using descriptive statistics. Exploratory comparisons were made across the three surgical technique subgroups, as allocated in ICD-10 procedural coding: open, percutaneous, and percutaneous endoscopic. The cohort included 723 patients, with a mean age of 56.7 ± 16.2 years, predominantly female (79.4%) and White (81%). Most patients were self-paying (63.2%) and of high-income status (50.8%). Higher-income individuals were more likely to undergo minimally invasive procedures. The average hospital stay was 1.7 ± 1.6 days, with total costs averaging $85,259.60 ± $63,152.80. The most common indication was plastic surgery due to cosmetic reasons. Facelift was also performed for gender dysphoria indications in 12.3% of the cases. Hypertension (18.8%) and nicotine abuse (13.7%) were the most frequent comorbidities. The results highlight the complex epidemiological and economic environment of inpatient facelift surgery. Procedures are subject to significant regional and socioeconomic disparities. The growing role of facial feminization and heterogenous surgical access warrants further research on emerging trends in esthetic facial surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ABSTRACT Objectives This study aims to find the incidence of pulmonary embolism (PE) in traumatic brain injury (TBI) and the impact of comorbidities on the development of PE in the United States. Methods This is a retrospective study of inpatient subjects from 2016 to 2020 in the United Stateswith TBI collected from the Healthcare Cost and Utilization Project (HCUP). Patients were evaluated for demographics, types of TBI, comorbidities, and complications. Regression statistical analyses were conducted to find the odds of developing PE after TBI. Results 219,005 TBI cases were included, of which 1,367 developed PE (0.6%). The cohort was mostly white (71%), and males (60%), with a mean age of 61.75 y/o. The patients who developed PE were younger (60.36 vs. 61.76, p < 0.001), had longer hospital stays (18.6 vs. 6.8 days, p < 0.001), and had significantly higher mortality (14% vs. 8%, p < 0.001). In multivariate analysis, having lower DVT (OR 10.16 [9.07–11.39], p < 0.001), upper DVT (OR 2.78 [2.26–3.42], p < 0.001), pneumonia (OR 1.35 [1.21–1.51], p < 0.001), myocardial infarction (OR 1.28 [1.00–1.63], p = 0.049), and sepsis (OR 1.26 [1.08–1.48], p = 0.004), had the highest association with developing PE following TBI. Conclusions Our data show that the incidence of PE in TBI patients is low; however, it is lethal with longer hospital stay. The risk of PE is higher in those with comorbidities such as paralysis, AIDS/HIV, metastatic cancer, and fluid/electrolyte disorders.

Tick-borne diseases (TBDs) are a growing public health concern in the United States. This study analyzed 261,630 weighted hospitalizations from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database between 2002 and 2021 to evaluate trends, coinfections, demographic disparities, and financial impacts. Lyme disease was the most common cause, accounting for 65% of hospitalizations (171,328 admissions), followed by ehrlichiosis/anaplasmosis (46,446), babesiosis (18,057), rickettsial diseases (16,412), tularemia (2428), and other TBDs (19,435). Hospitalizations increased 2.5-fold over the study period, with the Northeast region bearing 52.9% of the burden and peaking in July. Males (53.9%), Caucasians (81.4%), and residents of higher-income zip codes were predominant, though rickettsial diseases showed elevated Hispanic representation (18.4%). Coinfections were common, with 35.8% of babesiosis and 15.6% of ehrlichiosis/anaplasmosis cases involving another TBD, suggesting that routine testing may be warranted. Median hospital charges rose from USD 9433 in 2002 to USD 35,161 in 2021, totaling USD 1.265 billion in 2021. In-hospital mortality was 1.1%, with the highest cause of mortality being babesiosis (2.06%). Future areas for research include characterizing the burden of disease in an outpatient setting, understanding the causes of racial disparities in hospitalizations, and testing strategies to identify coinfection.

There is a lack of consensus on the effects of prior colectomy on health outcomes, particularly those that involve orthopedic procedures. We sought to characterize the association between prior colectomy and outcomes following primary total knee arthroplasty (TKA). We hypothesized that compared with patients without, those with prior colectomy who undergo primary TKA have higher odds of same-admission postoperative complication and reoperation. We performed a retrospective cohort study using the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample (NIS) database to identify patients who underwent primary TKA. Patients with prior colectomy were propensity-score matched to patients without prior colectomy at a ratio of 1:50 by age, gender, race/ethnicity, Charlson-Deyo Comorbidity index, history of osteoporosis, history of smoking, insurance status, hospital size, hospital location and teaching status, and hospital ownership. Adjusted logistic regression analyses were used to determine the relationship between colectomy and the same-admission outcomes, postoperative complication, and reoperation. Overall, 894,911 patients underwent primary TKA during the study period. After propensity score matching (PSM), 2,625 (1.96%) patients were assigned to the cohort with prior colectomy, while 131,250 (98.04%) patients were assigned to the cohort without prior colectomy. Compared with patients without prior colectomy, those with prior colectomy who underwent primary TKA had no significantly higher odds of same-admission postoperative complication; however, they had 2.12 times higher odds (95% confidence interval: 1.04-4.31; p = 0.038) of same-admission reoperation. Compared with patients with no prior colectomy, those with prior colectomy who underwent primary TKA had no higher odds of postoperative complication but had over twice the odds of reoperation during the same admission for surgery. Further studies examining the role of the colon and microbiota may help to better understand outcomes associated with the history of prior colectomy in the setting of primary TKA. This study is a level III retrospective cohort study.

e13557 Background: Hospice and home health care play significant roles in improving the quality of life and comfort for terminally ill patients. This analysis aims to identify modifiable factors that can improve hospice utilization among patients diagnosed with some of the most fatal malignancies. Methods: The National Inpatient Sample (NIS) database from the Healthcare Cost and Utilization Project (HCUP) for the year 2022 was used to identify all patients admitted with a primary diagnosis of lung, colorectal, pancreatic, or breast malignancy. Patients were divided into three subpopulations based on their primary payer: Medicare/Medicaid, private insurance, and self-pay. The primary outcome measured was hospice discharge versus other dispositions. Logistic and linear regression models were applied to evaluate statistically significant differences based on age, race, hospital-bed size, teaching status, income, gender, type of admission, and hospital region. Results: A total of 275,794 patients with a principal diagnosis of malignancy were included in the analysis, divided into the following payer subgroup: Medicare/Medicaid: 186,180 Private insurance: 75,624 Self-pay: 6,244 Of these, 67,975 (24.64%) were discharged to hospice Key Findings by Subpopulation: Medicare/Medicaid: Elective admissions had an OR of 1.58 (p &lt; 0.001) Female patients had an OR of 0.87 (p &lt; 0.001) Urban non-teaching hospitals (OR 0.80, p = 0.002) and urban teaching hospitals (OR 0.84, p = 0.007) were associated with lower hospice discharge rates compared to rural hospitals Private nonprofit hospitals (OR 0.83, p = 0.013) and private investor-owned hospitals (OR 0.79, p = 0.008) showed lower hospice discharge rates compared to government federal hospitals Median household income for Quartiles 2, 3, and 4 showed increased odds of hospice discharge OR of 1.09 (p = 0.007), 1.12 (p = 0.001), and 1.15 (p = 0.001) respectively Private Insurance Weekend admissions had less hospice discharges with OR of 0.85 (p = 0.027) Urban non-teaching hospitals (OR 0.71, p = 0.017) and urban teaching hospitals (OR 0.67, p = 0.002) were associated with lower hospice discharge rates compared to rural hospitals Self-Pay Only median household income for Quartile 2 compared to Quartile 1 showed significant and high hospice discharges with OR 1.77 and p (0.024). Conclusions: This analysis highlights the deficiencies in hospice utilization, with fewer than 25% of patients discharged to hospice care. These findings emphasize the need to address systemic factors influencing end-of-life care. By identifying barriers, clinicians can guide patient counseling and better allocate resources toward hospice, ultimately improving patient outcomes. Mean age, length of stay (LOS) in days, and total charges by payer subgroup. Mean Age LOS Total Charges in Dollars Medicare/Medicaid 73 7.44 114928 Private insurance 59 7.18 131513 Self pay 61 7.06 103635