Hospital Discharge Data System Research Articles

Evaluating racial disparities in central-line–associated bloodstream infections for Tennessee hospitals, 2018–2021

Background: Central-line–associated bloodstream infections (CLABSIs) significantly burden the US population and healthcare system. Reporting facilities in Tennessee consistently omit race and ethnicity data in the NHSN despite having the option to enter. Racial and ethnic disparities are well documented across many health outcomes, including patient safety. CLABSIs were compared among 3 racial groups to better understand the impact of race on CLABSI incidence in Tennessee. Methods: CLABSI data from NHSN were linked with records from the TN Hospital Discharge Data System (HDDS) for 2018–2021. A multivariable linear regression model was used to determine relative risk (RR) between racial groups for contracting a CLABSI after controlling for confounding variables including Charlson comorbidity index (CCI) and social vulnerability index (SVI) scores. Statistical significance was set at P < .05. Data linkage and statistical analyses were performed in SAS version 9.4 software. Results: In Tennessee between 2018 and 2021, 342 (17.2%) of the 1,980 CLABSI events had race documented, and no ethnicity variables exist in the NHSN. The data linkage process yielded a 72% match (1,426 CLABSIs). The remaining 28% were excluded from the analysis. Per 1,000 central-line days (CL days) for all races, white patients had the highest CLABSI rate (17.5), followed by Black patients (1.36), and Native American or Alaskan Native patients (0.68). Per 1,000 admissions by race, Black patients had a higher CLABSI rate (1.26) than Native American/Alaskan Native patients (0.85) and white patients (0.75). The risk of contracting a CLABSI was 79% higher in Black patients than in white patients (RR, 1.79; 95% CI, 1.55–2.07; P < .0001) when controlling for CCI, age group, and SVI. Conclusions: These results suggest that racial disparities between Black and white patients are present in Tennessee hospitals regarding CLABSIs. Although most CLABSI events were linked to HDDS patients, there were limitations in the ability to match all cases and calculate CL days by race. This study highlights the need for complete race and ethnicity data in the NHSN. Further studies should examine infection types at the regional and facility levels to target interventions for reducing HAI inequities in Tennessee.Disclosures: None

Mortality rates among non-Hispanic Black and White persons in carbapenemase-producing Enterobacterales, Tennessee, 2015–2019

Background: Carbapenem-resistant Enterobacterales (CRE) are an urgent public health threat, particularly those that produce carbapenemase (CP-CRE). Certain risk factors associated with CRE acquisition have been well described, such as older age, indwelling devices, prior hospitalizations, and underlying conditions. However, data are limited regarding the association of CRE and health disparities, such as race and ethnicity. Published literature has consistently shown that minority groups, including but not limited to Non-Hispanic Black persons, have higher risks of developing adverse health outcomes. To better understand the impact of race and ethnicity in CP-CRE cases, we compared 1-year mortality rates among Non-Hispanic Blacks and Non-Hispanic Whites. Methods: CRE are reportable in Tennessee; isolates must be sent to the State Public Health Laboratory for carbapenemase detection and resistance mechanism testing. We linked 2015–2019 CP-CRE surveillance cases and laboratory data from our statewide surveillance system, the National Disease Surveillance System (NEDDS)-Base System, with the Tennessee Hospital Discharge Data System (HDDS) and vital records databases. Database linkage and data analyses were performed using SAS version 9.4 software. Results: Among 615 CP-CRE cases, the mean age was lower among non-Hispanic Blacks (59 years; SD, 16.6) compared to non-Hispanic Whites (mean, 65 years; SD, 15.7). Among 156 non-Hispanic Blacks with CP-CRE, 101 (64.7%) were nursing home residents, whereas 281 (71.1%) among the 395 non-Hispanic Whites were nursing home residents. Also, 64 Non-Hispanic Blacks (41%) died within 1 year of their first specimen collection date compared to 92 Non-Hispanic Whites (23.3%). Non-Hispanic Blacks with CP-CRE who died within 1 year had a mortality rate of 5.6 per 100,000 (95% CI, 4.21–6.94) Black population, which was 1.6 times higher than Non-Hispanic White persons at 3.5 per 100,000 (95% CI, 2.94–3.95; χ2P < .001) White population. Conclusions: Despite a lower mean age, non-Hispanic Black CP-CRE cases had a higher 1-year mortality rate than non-Hispanic Whites. Racial and ethnicity data often are missing or incomplete from surveillance data. Data linkages can be a valuable tool to gather additional clinical and demographic data that may be missing from public health surveillance data to improve our understanding of health disparities. Recognition of these health disparities among CRE can provide an opportunity for public health to create more targeted interventions and educational outreach.Funding: NoneDisclosures: None

Ensemble learning to predict opioid-related overdose using statewide prescription drug monitoring program and hospital discharge data in the state of Tennessee.

ObjectiveTo develop and validate algorithms for predicting 30-day fatal and nonfatal opioid-related overdose using statewide data sources including prescription drug monitoring program data, Hospital Discharge Data System data, and Tennessee (TN) vital records. Current overdose prevention efforts in TN rely on descriptive and retrospective analyses without prognostication.Materials and MethodsStudy data included 3 041 668 TN patients with 71 479 191 controlled substance prescriptions from 2012 to 2017. Statewide data and socioeconomic indicators were used to train, ensemble, and calibrate 10 nonparametric “weak learner” models. Validation was performed using area under the receiver operating curve (AUROC), area under the precision recall curve, risk concentration, and Spiegelhalter z-test statistic.ResultsWithin 30 days, 2574 fatal overdoses occurred after 4912 prescriptions (0.0069%) and 8455 nonfatal overdoses occurred after 19 460 prescriptions (0.027%). Discrimination and calibration improved after ensembling (AUROC: 0.79–0.83; Spiegelhalter P value: 0–.12). Risk concentration captured 47–52% of cases in the top quantiles of predicted probabilities.DiscussionPartitioning and ensembling enabled all study data to be used given computational limits and helped mediate case imbalance. Predicting risk at the prescription level can aggregate risk to the patient, provider, pharmacy, county, and regional levels. Implementing these models into Tennessee Department of Health systems might enable more granular risk quantification. Prospective validation with more recent data is needed.ConclusionPredicting opioid-related overdose risk at statewide scales remains difficult and models like these, which required a partnership between an academic institution and state health agency to develop, may complement traditional epidemiological methods of risk identification and inform public health decisions.

Urban versus rural setting as a predictor of injury type and severity among pediatric pedestrians: using a database derived from state-wide crash data and hospital discharge data in Illinois

We obtained and linked data from the Illinois Department of Transportation and the Illinois Hospital Discharge Data System 2008 − 2015. We evaluated differences in demographic characteristics, injury severity and type among cases and examined associations among injury type, severity, and crash location. There were 11,303 injured pedestrians under 19 years of age and 46% matched to hospital data. Demographic characteristics were similar to unlinked cases. Among linked cases, fractures, traumatic brain injury, open wound or amputation, and internal organ injuries occurred more often in rural areas (p < 0.001), as were more severe injuries (p < 0.001). Mild injury and soft tissue injuries occurred more often in urban areas (p < 0.001). These data can inform targeted interventions for injury reduction. Preliminary investigations found that more severe injuries and specific injury types are more likely to occur in rural versus urban settings. Our combined database approach may be extended to other databases.

Hospital Readmissions After Laboratory-Confirmed Influenza Hospitalization.

Influenza infection causes substantial morbidity and mortality. However, little is known about hospital readmissions after an influenza hospitalization. The aim of our study was to characterize frequency of hospital readmissions among patients hospitalized with laboratory-confirmed influenza. We conducted a retrospective study using Tennessee Emerging Infections Program Influenza Surveillance data from 2006 to 2016 and the concurrent Tennessee Hospital Discharge Data System. We analyzed demographic characteristics and outcomes to better understand frequency and factors associated with hospital readmissions. Of the 2897 patients with a laboratory-confirmed influenza hospitalization, 409 (14%) and 1364 (47%) had at least 1 hospital readmission within 30 days and 1 year of the influenza hospitalization, respectively. Multiple readmissions occurred in 739 patients (54%). The readmission group was older, female predominant, and had more comorbidities than patients not hospitalized. Pneumonia, acute chronic obstructive pulmonary disease/asthma exacerbation, septicemia, acute respiratory failure, and acute renal failure were the most common causes for readmission at 30 days. Underlying cardiovascular disease, lung disease, kidney disease, diabetes, immunosuppression, and liver disease were associated with increased risk of readmission during the subsequent year. After an admission with laboratory-confirmed influenza, there is a high likelihood of readmission within 30 days and 1 year adding to the morbidity of influenza.

Methicillin-Resistant Staphylococcus aureus Bloodstream Infections and Injection Drug Use, Tennessee, USA, 2015-2017.

Recently, Tennessee, USA, has seen an increase in the use of commonly injected drugs, such as heroin and fentanyl. Injection drug use (IDU) practices can lead to life-threatening methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and other serious diseases. We matched MRSA BSIs identified through the National Healthcare Safety Network to the Tennessee Hospital Discharge Data System to characterize the prevalence, demographics, and clinical characteristics associated with IDU in this disease population. Of the 7,646 MRSA BSIs identified during 2015-2017, we found that 1,839 (24.1%) were IDU-related. IDU-related BSIs increased by 118.9%; the greatest rise occurred among emergency department-onset infections (197.4%). IDU was more often associated with white, female, 18-49-year-old, and uninsured persons (p<0.001). We found >1 additional IDU-related diagnoses in 84.2% of IDU-related BSIs. Targeted harm reduction strategies for persons at high risk of IDU are necessary to reduce MRSA BSIs in acute care settings.

Prescribing patterns before and after a non-fatal drug overdose using Tennessee's controlled substance monitoring database linked to hospital discharge data

We performed a statewide evaluation of prescribing patterns of controlled substances (CS) before and after an overdose, using Tennessee's Hospital Discharge Data System and the Controlled Substance Monitoring Database (CSMD). Adults' first non-fatal overdose discharges either from the emergency department (ED) or inpatient (IP) stay occurring between 2013 and 2016 were linked to prescriptions in the CSMD. The difference in the proportion of patients filling a prescription before versus after an overdose was calculated. Included were 49,398 patients with an overdose and a prescription record; most (60.5%) were treated in the ED. Among any drug type overdose the percentage of patients who filled a CS prescription within a year of experiencing an overdose was as follows: opioid analgesics: 59.1%, benzodiazepines: 37.3%, stimulants: 5.0%, muscle relaxants: 3.4%, concurrent opioid-benzodiazepines: 24.0% with the percent difference from before to after similar in both settings. Among patients treated for an opioid overdose, this represented a decrease in opioid analgesics filled by 9.7% (95%CI: −11.2, −8.3) among those treated in the ED, and by 7.1% (95% CI: −8.3, −5.9) among treated inpatients. Among patients treated for a heroin overdose, 12.2% (95%CI: −15.2, −9.3) fewer of those treated in the ED and 8.8% (95%CI: −15.0, −2.7%) fewer of treated inpatients filled a CS prescription in that year. The most common opioid analgesics included hydrocodone and oxycodone. The number of patients filling buprenorphine for treatment increased in the year after overdoses associated with any drug or opioids but decreased among those treated for a heroin overdose.

Surveillance, Epidemiology, and Estimated Burden of Neonatal Abstinence Syndrome, Tennessee, 2013-2016.

Between 2003 and 2013, the rate of neonatal abstinence syndrome (NAS)-a postnatal drug withdrawal syndrome-in Tennessee increased approximately 10-fold. NAS surveillance is relatively new, and underestimation associated with surveillance has not been described. We compared data from the Tennessee NAS public health surveillance system (TNSS) with a second source of NAS data, hospital discharge data system (HDDS), and estimated the true number of infants with NAS using capture-recapture methods. We obtained NAS data on cases of NAS among Tennessee infants from TNSS and HDDS from January 1, 2013, through December 31, 2016. We matched cases of NAS identified in TNSS to cases identified in HDDS. We estimated the true number of infants with NAS by using the Lincoln-Peterson estimator capture-recapture methodology. During the study period, 4070 infants with NAS were reported to TNSS, and 5321 infants with NAS were identified in HDDS; 2757 were in both data sets. Using capture-recapture methods, the total estimated number of infants with NAS during the study period was 7855 (annual mean = 1972; estimated range = 1531-2427), which was 93% more than in TNSS and 48% more than in HDDS. Drugs used for the medication-assisted treatment of substance use disorder were the most commonly reported substances associated with NAS (n = 2389, 59%). TNSS underestimated the total burden of NAS based on the capture-recapture estimate. Case-based public health surveillance is important for monitoring the burden of and risk factors for NAS and helping guide public health interventions.

Using probabilistic matching to improve opioid drug overdose surveillance, New Jersey

Using probabilistic matching to improve opioid drug overdose surveillance, New Jersey

730. Hospital Readmissions Following Laboratory-Confirmed Influenza

BackgroundFurther understanding of hospital readmissions after influenza illness could reduce readmissions. The aim of our study was to characterize the morbidity associated with laboratory confirmed influenza hospitalizations.MethodsThis was a retrospective study using data from 2006 to 2016 from the Tennessee (TN) Emerging Infections Program Influenza Surveillance Network, which prospectively identifies laboratory-confirmed influenza hospitalizations in Nashville, TN and surrounding counties. Using the TN Hospital Discharge Data System, which collects information on all hospitalizations and discharges in TN, cases were linked to subsequent hospitalizations up to 1 year. The International Classification of Diseases was used to define the primary diagnosis associated with each hospitalization. Demographic characteristics and outcomes were compared by using χ2 tests for categorical variables. Multivariable logistic regression was used to compare study outcomes.ResultsOf the 2,897 patients with a laboratory-confirmed influenza hospitalization, 1,364 (47%) had a hospital readmission during the subsequent year (figure). Multiple readmissions occurred in 740 patients (54%). The readmission group was older, female predominant, and had more comorbidities than patients not re-hospitalized. Acute COPD/asthma exacerbation, pneumonia, septicemia, and acute renal failure were the most common causes for readmission. Underlying cardiovascular disease (OR 1.6), lung disease (OR 1.6), kidney disease (OR 1.7), diabetes (OR 1.3), immunosuppression (OR 1.6), and liver disease (OR 2.1) were associated with increased risk of readmission (table).ConclusionAn influenza hospitalization is associated with increased hospital readmissions. Approximately 47% of patients hospitalized with influenza are readmitted within 1 year. Patient comorbidities could be an important link to influenza readmissions.Table. Multivariable Analysis of Hospital ReadmissionOR P Age0.70.039Male0.80.012CVD1.6<0.001Stroke1.10.391Diabetes1.30.017Lung disease1.6<0.001Kidney disease1.7<0.001Immunosuppression1.6<0.001Dementia1.30.124Liver disease2.10.006Smoker1.00.947Figure. Flow chart of patient inclusionDisclosures W. Schaffner, Merck: Member, Data Safety Monitoring Board, Consulting fee. Pfizer: Member, Data Safety Monitoring Board, Consulting fee. Dynavax: Consultant, Consulting fee. Seqirus: Consultant, Consulting fee. SutroVax: Consultant, Consulting fee. Shionogi: Consultant, Consulting fee. H. K. Talbot, sanofi pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none.

Defining severe traumatic brain injury readmission rates and reasons in a rural state

BackgroundReadmissions after a traumatic brain injury (TBI) have significant impact on long-term patient outcomes through interruption of rehabilitation. This study examined readmissions in a rural population, hypothesizing that readmitted patients...

Abstract A69: Racial disparity in breast cancer hospital treatment costs: Examining the effect of depression

Abstract Objective: The effect of depression on hospital costs for breast cancer (BC) patients by race remains unknown. This presentation examines two issues by race: (i) hospitalized prevalence of BC and depression among discharged patients, and (ii) racial variation regarding the effect of depression on hospital costs of BC patients. Methods: For BC, available 2008 Tennessee Hospital Discharge Data System (HDDS) was examined. The BC sample (n=2,522) was mostly white (86%) with an average age of 63 years. We computed age-adjusted BC rates per CDC methodology, and determined racial disparity. We compared the hospital costs for BC patients with depression (BC+D) vs. without depression (BCND). Results: Age-adjusted BC rates (per 100K) were higher among white than black patients (43.3 vs. 9.2, p&amp;lt;.001). Further, 25% of BC patients were depressed (depression was higher among white than black patients [26% vs. 14%, p&amp;lt;.01]). Hospital costs for BC were 30% higher compared to non-BC patients. Further, the cost for depressed patients (BC+D) was 56% higher compared to nondepressed (BCND) patients ($64,439 vs. $41,344). Importantly, the higher costs for depressed patients (BC+D) were similarly higher among both black and white female patients compared to their nondepressed (BCND) peers. Conclusion: BC prevalence rate is higher among white females compared to black females. Depression increases hospital costs for both white and black patients. Since depression increased cost for both racial groups of patients, considerable cost savings might be attained by screening and treating depression among BC patients before their hospitalization. Citation Format: Baqar Husaini, Oscar Miller, Jessica Jones, Robert Levine. Racial disparity in breast cancer hospital treatment costs: Examining the effect of depression [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A69.

Abstract 4218: Racial similarities in the effects of depression on hospital cost of breast cancer

Abstract Objective: Breast cancer (BC) incidence is reported to have declined in the nation. However, the role of depression on hospital costs for BC by race remains unknown. In this presentation, we examine two issues: (i) prevalence of BC with comorbid depression among discharged hospital patients; (ii) racial variation in the effect of co-morbid depression on hospital costs of BC patients. Methods: We extracted data on depression and breast cancer from the 2008 Tennessee Hospital Discharge Data System (HDDS). The BC sample (n=2,523) patients were mostly white (86%) with an average age of 63 years. We computed age-adjusted BC prevalence rates per CDC methodology, and compared the hospital costs for BC patients with vs. without depression. Results: Age adjusted BC rates (per 100,000) were higher among white than black patients (92.2 vs. 43.3, p&amp;lt;.000). Nearly one-fourth (23%) of BC patients had depression (no racial differences: (25% white vs. 24% black BC patients). Hospital costs for BC patients were 17% higher compared to non-BC patients, and cost was 55% higher among BC patients with co-morbid depression compared to non-depressed BC patients ($64,439 vs. $41,344). The higher cost for depressed BC patients was similar across both white and black BC females. Conclusion: BC is higher among white females compared to black females. BC patients cost with depression tended to be significantly higher compared to non-depressed patients regardless of race. Since nearly one-fourth of BC patients were depressed with higher hospital cost, these results point to possible significant costs savings by treating depression before the need for hospitalization among BC patients. Citation Format: Baqar A. Husaini, Oscar Miller, Meggan Novotny, Robert Levine. Racial similarities in the effects of depression on hospital cost of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4218. doi:10.1158/1538-7445.AM2017-4218

Smoking, depression, and hospital costs of respiratory cancers: Examining race and sex variation.

The role of smoking and depression relative to hospital cost for lung cancer (LC) remains unknown. We extracted data on depression, smoking history, demographics, and hospital charges on patients with respiratory cancers (ICD-9 codes 161-163,165) from the 2008 Tennessee Hospital Discharge Data System. The sample (n=6,665) was mostly white (86%) and male (57). Age-adjusted rates were developed per CDC methodology, and hospital costs were compared for LC with vs. without depression and smoking. Three findings (p<.001) emerged: (i) LC rate was higher among blacks than whites, and higher among males than females; (ii) While 66% of LC smoked (more males than females without racial variation), 24% had depression (more females and whites were depressed); (iii) The LC hospital cost was 54% higher compared to non-LC, and this cost doubled for LC with depression and smoking vs. those without such characteristics. While LC is more prevalent among blacks and males, depression is higher among female and white patients. Since depression with higher costs existed among LC patients, our findings point to: (i) possibility of cost savings by diagnosing and treating depression among LC, and (ii) implementing proven smoking cessation programs to reduce LC morbidity and hospital costs.

Abstract 1796A: Race and gender differences in lung cancer: examining the effect of smoking history and depression on hospitalization costs

Abstract Objective: Incidence rates of lung cancer (LC) are reported to have declined in the nation. However, the role of depression and tobacco history relative to hospitalization cost for LC remains unknown. Tennessee, being a tobacco producing State, provides an opportunity to examine two issues: (i) Prevalence of LC, depression, and history of tobacco use among LC patients by race and gender; (ii) Effect of depression and smoking history on hospitalization costs by sub-groups of LC patients. Methods: We extracted data pertaining to depression, smoking history, and demographics on patients discharged with all lung cancer (adenocarcinoma, ICD-9 codes 160-165) from the 2008 Tennessee Hospital Discharge Data System (HDDS). The sample (n = 6,665) had patients that were mostly white (86%) and male (57%), with an average age of 67 years. We computed age-adjusted LC rates for race and gender (per CDC methodology), and compared the costs for LC patients with depression/ smoking history with LC patients without depression/smoking history. Results: LC rates (per 100K) were higher among blacks than whites (146.6 vs. 131.6, p&amp;lt;.000), and higher among male than female patients (174.9 vs. 118.0, p&amp;lt;.00). While nearly 40% of LC patients had a smoking history (more males than females had a history with no racial variation), 25% had depression (more females and whites were depressed). Further, the total hospitalization cost for 2008 was 50% higher for LC patients with depression plus smoking history compared to peers without depression/smoking history ($122,500 vs. 80,522, p&amp;lt;.000). Conclusion: LC rates are higher among blacks and males who also have more smoking history. Depression is higher among females and whites with LC. Further, both depression and smoking history adds significantly to the hospitalization costs. These results point to: (i) costs savings might be realized by treating depression first among the LC patients, and (ii) population-based smoking cessation programs need to be vigorously implemented to reduce lung cancer and associated co-morbidities. ___________________ This presentation at the Eight AACR annual Conference, New Orleans, April 16-20, 2016, was partially supported by grants from CDC #U58CCU422782, a sub-contract #ED-07-20811-09, and a NCI/NIH grant (5U54CA163066) to Tennessee State University, B. Husaini, PI. Citation Format: Baqar A. Husaini, Van A. Cain, Robert S. Levine. Race and gender differences in lung cancer: examining the effect of smoking history and depression on hospitalization costs. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1796A.

Depression and race affect hospitalization costs of heart failure patients

Objective Depression and anxiety are frequently observed in heart failure (HF) patients; however, the effect of such factors on hospitalization costs of HF patients, and whether such costs vary by race and gender remain poorly understood. This analysis delineated the prevalence of depression/anxiety among HF patients and estimated the effect of race and gender on hospitalization costs. Methods We examined the 2008 files of the Tennessee Hospital Discharge Data System (HDDS) on patients (≥20 years of age) with a primary diagnosis of HF (ICD-9 codes 402, 404, and 428) along with demographic data, depression/anxiety diagnoses, hospital costs, and comorbidities. Among the HF sample (n=16,889) 53% were female and 23% were black. Race and gender differences in hospital costs were evaluated for the following three groups: (1) HF patients with depression/anxiety (HF+D); (2) HF-only patients without depression/anxiety (HFO); and (3) HF patients with other mental diagnoses (HF+M). Results HF was significantly (p Conclusion Race and depression/anxiety are associated with increased hospitalization costs of HF patients. The higher costs among blacks reflect the higher burden of comorbidities, such as hypertension and diabetes, which calls for widespread dissemination, adoption, and implementation of proven interventions for the control of these comorbidities.

Impact of North Carolina’s Motorcycle Helmet Law on Hospital Admissions and Charges for Care of Traumatic Brain Injuries: TABLE 1.

BACKGROUND North Carolina requires motorcyclists of all ages to wear federally approved safety helmets. The purpose of this article is to estimate the impact of this state law in terms of hospital admissions for traumatic brain injury (TBI) and associated hospital charges. METHODS Hospital admissions of North Carolina motorcyclists with TBIs and associated hospital charges in 2011 were extracted from the North Carolina Hospital Discharge Data system. We estimated hospital admissions and charges for the same year under the counterfactual condition of North Carolina without a universal motorcycle helmet law by using various substitutes (Florida, Pennsylvania, and South Carolina residents treated in North Carolina). RESULTS North Carolina's universal helmet law prevented an estimated 190 to 226 hospital admissions of North Carolina motorcyclists with TBI in 2011. Averted hospital charges to taxpayer-funded sources (ie, government and public charges) were estimated to be between $9.5 million and $11.6 million for 2011, and total averted hospital charges for 2011 were estimated to be between $25.3 million and $31.0 million. LIMITATIONS Cost estimates are limited to inpatients during the initial period of hospital care. This study was unable to capture long-term health care costs and productivity losses incurred by North Carolina's TBI patients and their caregivers. CONCLUSIONS North Carolina's universal motorcycle helmet law generates health and economic benefits for the state and its taxpayers.

Abstract A90: Changes in lung cancer rate over four years in a tobacco producing state: Examining the effect of race and gender

Abstract Objective: According to a recent CDC report, lung cancer rates have declined in several states during 19975-2005. Tennessee, being a tobacco producing State, has received a large settlement from the tobacco industry and engaged in quit smoking program since 2006. Effective October 2007, the state also banned smoking in public places. However, the effect of this ban and smoking cessation program on lung cancer rates remains unknown. This presentation examines whether the lung cancer rates have changed over four years (2005-2008), and whether they vary by race and gender. Methods: We extracted relevant data pertaining to primary diagnosis of lung cancer (adenocarcinoma, ICD-9 codes of 160-165) and demographics from Tennessee Hospital Discharge Data system (HDDS) for 2005-2008. Data for each year pertained to 3,500 patients, mostly white (79%) and males (56.8%) with an average age of 66 years. To examine the effect of race and gender on cancer rate, we computed lung cancer prevalence rates per CDC procedures for age-adjusted rates (per 100,000 hospitalized patient population standardized to 2000 Census). Results: Our analyses show that the overall rates of lung cancer increased during four years by 26.3% (from 61.6/100K in 2005 to 77.8/100K in 2008). The increase was larger for blacks than whites (66.0% vs. 42.2%, p&amp;lt;.001). In general, in each year, rates were higher for blacks than whites (48.2 vs. 46.2 in 2005, 57.9 vs. 54.5 in 2006, 71.1 vs. 64.9 in 2007, and 80.0 vs. 65.7 in 2008). Similarly in each year, rates were higher for males than females (75.5 vs. 50.6 in 2005, 75.2 vs. 48.1 in 2006, 92.1 vs. 62.1 in 2007, and 93.8 vs. 65.3 in 2008). Further analyses revealed that (i) higher black rates were largely driven by higher rates among black males, and (ii) rates increased linearly from ages 45 through 74 years, and this was true for both black and white patients (both males and females). After age 84, rates dropped dramatically reflecting increasing mortality. Conclusion: Lung cancer rates have increased for both blacks and males. However, it is too early to tell if smoking cessation programs, banning asbestos use and smoking in public places will produce the desired decline in lung cancer rates. The results at present point to the need for more population-based intensive smoking cessation programs in Tennessee to lower lung cancer rates. Citation Format: Baqar A. Husaini, Van Cain, Mehhan Novotny, Zaheed Samad, Robert Levine. Changes in lung cancer rate over four years in a tobacco producing state: Examining the effect of race and gender. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A90. doi:10.1158/1538-7755.DISP13-A90

Short-term trends in heart failure-related hospitalizations in a high-risk state.

We sought to determine whether there are signs of improvement in the rates of heart failure (HF) hospitalizations given the recent reports of improvement in national trends. HF admissions data from the Tennessee Hospital Discharge Data System were analyzed. Hospitalization for primary diagnosis of HF (HFPD) in adults (aged 20 years old or older) decreased from 4.5% in 2006 to 4.2% in 2008. Similarly, age-adjusted HF hospitalization (per 10,000 population) declined by 19.1% (from 45.5 in 2006 to 36.8 in 2008). The age-adjusted rates remain higher among blacks than whites and higher among men than women. Notably, the rate ratio of black-to-white men ages 20 to 34 years admitted with HFPD increased from 8.5 in 2006 to 11.1 in 2008; similarly, the adjusted odds ratios for HFPD were 4.75 (95% confidence interval 3.29-6.86) and 5.61 (95% confidence interval 3.70-8.49), respectively. There was, however, a significant improvement in odds ratio for HF rates among young black women, as evidenced by a decrease from 4.60 to 3.97 (aged 20-34 years) and 4.21 to 3.12 (aged 35-44 years) between 2006 and 2008, respectively. Among patients aged 20 to 34 and 35 to 44 years, hypertension was the strongest independent predictor for HF. Diabetes and myocardial infarction emerged as predictors for HF among patients aged 35 years and older. The overall rate of HF hospitalization declined during the period surveyed, but the persistent disproportionate involvement of blacks with evidence of worsening among younger black men, requires close attention.

Depression Increases Stroke Hospitalization Cost: An Analysis of 17,010 Stroke Patients in 2008 by Race and Gender

Objective. This analysis focuses on the effect of depression on the cost of hospitalization of stroke patients. Methods. Data on 17,010 stroke patients (primary diagnosis) were extracted from 2008 Tennessee Hospital Discharge Data System. Three groups of patients were compared: (1) stroke only (SO, n = 7,850), (2) stroke + depression (S+D, n = 3,965), and (3) stroke + other mental health diagnoses (S+M, n = 5,195). Results. Of all adult patients, 4.3% were diagnosed with stroke. Stroke was more prevalent among blacks than whites (4.5% versus 4.2%, P < 0.001) and among males than females (5.1% versus 3.7%, P < 0.001). Nearly one-quarter of stroke patients (23.3%) were diagnosed with depression/anxiety. Hospital stroke cost was higher among depressed stroke patients (S+D) compared to stroke only (SO) patients ($77,864 versus $47,790, P < 0.001), and among S+D, cost was higher for black males compared to white depressed males ($97,196 versus $88,115, P < 0.001). Similar racial trends in cost emerged among S+D females. Conclusion. Depression in stroke patients is associated with increased hospitalization costs. Higher stroke cost among blacks may reflect the impact of comorbidities and the delay in care of serious health conditions. Attention to early detection of depression in stroke patients might reduce inpatient healthcare costs.