Tennessee Hospital Research Articles

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.

Risk Factors and Hospitalization Costs of Dementia Patients: Examining Race and Gender Variations.

Aims:To examine the variation in risk factors and hospitalization costs among four elderly dementia cohorts by race and gender.Materials and Methods:The 2008 Tennessee Hospital Discharged database was examined. The prevalence, risk factors and cost of inpatient care of dementia were examined for individuals aged 65 years and above, across the four race gender cohorts - white males (WM), black males (BM), white females (WF), and black females (BF).Results:3.6% of patients hospitalized in 2008 had dementia. Dementia was higher among females than males, and higher among blacks than whites. Further, BF had higher prevalence of dementia than WF; similarly, BM had a higher prevalence of dementia than WM. Overall, six risk factors were associated with dementia for the entire sample including HTN, DM, CKD, CHF, COPD, and stroke. These risk factors varied slightly in predicting dementia by race and gender. Hospital costs were 14% higher among dementia patients compared to non-dementia patients.Conclusions:There exist significant race and gender disparities in prevalence of dementia. A greater degree of co-morbidity, increased duration of hospital stay, and more frequent hospitalizations, may result in a higher cost of inpatient dementia care. Aggressive management of risk factors may subsequently reduce stroke and cost of dementia care, especially in the black population. Race and gender dependent milestones for management of these risk factors should be considered.

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<.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

Age-Specific Influenza-Related Emergency Department Visits and Hospitalizations in 2010–2011 Compared With the Pandemic Year 2009–2010

Background During the 2009–2010 influenza A(H1N1)pdm09 pandemic, influenza-associated encounters had an unusual age distribution, with relative sparing of older adults. In postpandemic 2010–2011, influenza A(H3N2), A(H1N1)pdm09, and B cocirculated. Purpose To compare influenza-associated encounter rates in pandemic and postpandemic years. Methods We enrolled and tested patients with acute respiratory illness (ARI) at selected Middle Tennessee hospitals. Age-specific proportions of influenza-positive patients were multiplied by the number of ARI encounters during influenza season to estimate the numbers of influenza encounters. These were divided by the respective populations to estimate rates. Results In pandemic and postpandemic years, overall influenza-associated emergency department (ED) visits, 10.2 (95% confidence interval [CI], 7.6–14.0) and 10.3 (CI, 8.0–13.4) per 1000 residents, were similar. Overall hospitalizations increased from 0.9 (CI, 0.6–1.4) to 1.2 (CI, 0.8–1.6) per 1000 residents. For residents 0.5 to 17 years, influenza encounter rates declined, 13.2 (CI, 9.0–19.1) versus 11.9 (CI, 9.6–14.5) ED visits and 0.3 (CI, 0.2–0.5) versus 0.2 (CI, 0.1–0.3) hospitalizations. For residents 65 years or older influenza encounter rates increased, 1.6 (CI, 0.3–8.7) versus 6.7 (CI, 2.4–16.5) ED visits and 1.0 (CI, 0.3–2.7) versus 4.5 (CI, 3.1–6.5) hospitalizations. During 2010–2011, influenza A(H1N1)pdm09 accounted for 26%, 55%, and 13% of influenza-associated ARI in those aged 0.5 to 17, 18 to 64, and 65 years or older, respectively; influenza B accounted for 62%, 33%, and 54% and influenza A(H3N2) accounted for 12%, 12%, and 33%, respectively. Conclusions Overall influenza-associated ED rates were similar in both years, but hospitalizations increased modestly in the postpandemic year. Higher encounter rates in older adults in the postpandemic year were associated with the circulation of 2 nonpandemic influenza viruses.

Pharmacists, prescribers team up for collaborative practice in TN

Pharmacists, prescribers team up for collaborative practice in TN

Variation in risk factors of dementia among four elderly patient cohorts

AIM: To examine variation in risk factors that contributed to dementia among four elderly cohorts by race and gender. METHODS: We examined 2008 Tennessee Hospital Discharged database for vascular factors that play a role in both stroke and dementia. Risk factors for dementia were examined for black and white patients aged 65+. Four race-gender groups of patients-white males (WM), black males (BM), white females (WF), and black females (BF) were compared for prevalence of dementia and stroke. A logistic model predicting dementia in each group separately used several vascular factors affecting dementia directly or indirectly through stroke. RESULTS: 3.6% of patients hospitalized in 2008 had dementia and dementia was higher among females than males (3.9% vs 3.2%, P < 0.001), and higher among blacks than whites (4.2% vs 3.5%, P < 0.000). Further, BF had higher prevalence of dementia than WF (4.2% vs 3.8%, P < 0.001); similarly BM had more dementia than WM (4.1% vs 3.1%, P < 0.001). In logistic regression models, however, different patterns of risk factors were associated with dementia in four groups: among WF and WM, hypertension, diabetes, congestive heart failure, and stroke predicted dementia. Among BF and BM, only stroke and diabetes were related to dementia. CONCLUSION: Aggressive management of risk factors (hypertension and diabetes) may subsequently reduce stroke and dementia hospitalization. © 2014 Baishideng Publishing Group Inc. All rights reserved.

Stroke burden and risk factors during 1997-2008: Examining the effect of ethnicity and gender

Objective: Examine the effect of race and gender variation on the burden of stroke and associated risk factors among hospital-discharged patients. Materials and Methods: We examined Tennessee Hospital Discharge Database from 1997 to 2008 for patients (older than 20 years) discharged with a diagnosis of stroke. The number of stroke patients was 17,149 in 1997; 19,020 in 2003; and 17,010 in 2008. We also extracted data on cardiovascular risk factors for each patient. Age-adjusted prevalence of hospitalization for stroke per 100K for non-Hispanic white and black patient groups was developed per Center of Disease Control (CDC) procedures of at-risk population. Race- and gender-specific prevalence of stroke and associated cardiovascular risk factors among hospitalized patients were examined using multivariate logistic models. To examine consistency, we compared the two groups at three different points: 1997, 2003, and 2008 regarding the prevalence of stroke and their associated risk factors. Results: Our analyses revealed three major trends: (1) Age-adjusted stroke rate declined by 13.8% over a 12-year period (from 466.8 per 100,000 in 1997 to 402.2 per 100,000 in 2008). This decline occurred for both black and white patients. However, the white stroke rate declined by 19.8% (from 401.9 in 1997 to 322.2 in 2008), compared with only 13.7% among blacks (from 599.2 in 1997 to 517.3 in 2008). Additionally, throughout the 12-year period, although no significant gender differences were observed, the stroke rates among blacks remained consistently higher compared with whites (black:white rate ratios of 1.60 in 1997, 1.40 in 2003, and 1.60 in 2008). Logistic regression analysis revealed the four risk factors that consistently predicted stroke for both black and white patients in 1997, 2003, and 2008, namely, hypertension (HTN), diabetes mellitus (DM), high cholesterol, and cardiac arrhythmia. Conclusion : Aggressive management of two cardiovascular risk factors (HTN and DM) may subsequently reduce stroke health disparity and the burden of stroke hospitalization among blacks.

Decomposing Organizational Productivity Changes in Acute Care Hospitals in Tennessee, 2002-2006: A Malmquist Approach

After the passage of the Patient Protection and Affordable Care Act, the survival and the productivity of hospitals are a critical topic in health caremanagement. This study measured the productivity of acute care hospitals inTennessee, applying the DEA-Malmquist index, which can be decomposed intoa technical efficiency and technological change index in relation to factors suchas size, ownership, location, and network. This draws on utilization data andfinancial statements from 144 acute care hospitals in Tennessee from 2002through 2006. The analysis indicates that community hospitals in Tennesseewere generally inefficient. The community hospitals in Tennessee suffered bothwith respect to technological change and technical efficiency, with the latterplaying a relatively more important role. This study finds the bigger-sized, urban, public or nonprofit, strategically allied hospitals to be more productiverelatively speaking and suggests that community hospitals in Tennessee need toupsize their facilities or make other adjustments, such as changing their coststructure and the way they operate their facility or bringing in new managementto increase productivity. Government and health policy makers also need todevelop and enact health policies to ensure that hospitals are both able to maketechnical progress and improve efficiency and thereby increase productivity.

Efficiency Disparities among Community Hospitals in Tennessee: Do Size, Location, Ownership, and Network Matter?

This study examined the impact of ownership, size, location, and network on the relative technical efficiency of community hospitals in Tennessee for the 2002-2006 period, by applying data envelopment analysis (DEA) to measure technical efficiency (decomposed into scale efficiency and pure technical efficiency). Data envelopment analysis results indicate that medium-size hospitals (126-250 beds) are more efficient than their counterparts. Interestingly, public hospitals are significantly more efficient than private and nonprofit hospitals in Tennessee, and rural hospitals are more efficient than urban hospitals. This is the first study to investigate whether hospital networks with other health care providers affect hospital efficiency. Results indicate that community hospitals with networks are more efficient than non-network hospitals. From a management and policy perspective, this study suggests that public policies should induce hospitals to downsize or upsize into optional size, and private hospitals and nonprofit hospitals should change their organizational objectives from profit-driven to quality-driven.

Tennessee Emergency Hand Care Distributions and Disparities: Emergent Hand Care Disparities

Hand trauma is the most frequently treated injury in emergency departments, but presently there is a crisis of insufficient emergency coverage. This study evaluates the discrepancy of emergent and elective hand care trends based on socioeconomic factors in the state of Tennessee. We identified 119 hospitals in Tennessee that contained operating and emergency room facilities. Of these, 111 hospitals participated in a survey to determine the availability of elective and emergency hand surgery. Wilcoxon rank-sum test or permutation chi-square test and logistic regression were used to analyze reported measures. Our results revealed that hospitals in counties with the lowest per capita income and median household income are less likely to have hand specialists or offer hand call. There are also significantly fewer hospitals that have hand specialists and offer hand call that are located in medically underserved areas. In the state of TN, level 1 trauma facilities are required by the Tennessee Department of Health to have staffed hand specialists and 24/7 hand call. Our study revealed that while 7/8 (87.5%) level 1 trauma facilities have hand specialists, only 2/8 (25%) provide 24/7 hand specialist call. Our results strongly suggest the presence of a health care disparity for hand trauma in counties with a low income and in medically underserved areas.

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.

Value of pharmacy services to the healthcare system: an interdisciplinary assessment

The purpose of this project was to determine how pharmacists and physicians view the extending role of the hospital pharmacist in Tennessee, USA. An 18-question survey was sent via e-mail to five selected hospitals in Tennessee. The survey was comprised of questions related to the interaction of the pharmacist with other healthcare professionals and their role in the healthcare team. This survey achieved a 40.1% response rate. Ninety-one per cent of physicians and pharmacists in the sample are receptive to an extended role of the pharmacist and agree that pharmacists provide a benefit to patients and to the healthcare system. A minority of respondents, including pharmacists, do not consider the pharmacist a member of the healthcare team and suggest that barriers in the transition away from the traditional pharmacy role are time, staffing and reimbursement/funding. Results from this survey reveal that the majority of physicians and pharmacists in non-academic settings embrace an extended role of the pharmacist as part of the healthcare team and have an overall good perception of contemporary pharmacy practice. Clinical pharmacies are in place worldwide, making this topic applicable in many settings.

Lack of Emergency Hand Surgery

Wrist, hand, and finger trauma are the most common injuries presenting to emergency departments. Shortage of emergency hand care is an emerging problem, as on-call hand coverage declines. This study evaluates the availability of elective and emergency hand surgery services in Tennessee, with the use of telephone surveys administered to emergency department and operating facility management. One hundred eleven Tennessee hospitals completed the surveys (93% response rate). In all, 77% of hospitals offer elective hand surgery, 58% offer basic emergency hand services, 18% offer occasional hand specialist call coverage and only 7% of hospitals have 24/7 hand specialist call coverage. Hospitals with hand specialists have significantly more payer charges from commercial insurance than hospitals without hand specialists (26.1% vs. 16.1%, P < 0.001). Our results strongly support the need for increased emergency hand coverage. Solutions include creating multihospital coordinated call schedules, increasing incentives for call coverage, and training more hand specialists.

Estimating age-specific influenza-related hospitalization rates during the pandemic (H1N1) 2009 in Davidson Co, TN.

Please cite this paper as: Jules et al. (2012) Estimating age‐specific influenza‐related hospitalization rates during the pandemic (H1N1) 2009 in Davidson Co, TN. Influenza and Other Respiratory Viruses 6(3), e63–e71. Background In April 2009, a pandemic caused by a novel influenza strain, the A(H1N1)pdm09 virus, started. Few age‐specific estimates of hospitalizations associated with the first year of circulation of the pandemic virus are available. Objectives To estimate age‐specific hospitalization rates associated with laboratory‐confirmed A(H1N1)pdm09 virus in Davidson County, TN, from May 2009 to March 2010. Patients/methods Two separate strategies were applied: capture–recapture and surveillance‐sampling methods. For the capture–recapture estimates, we linked data collected via two independent prospective population‐based surveillance systems: The Influenza Vaccine Effectiveness Network (Flu‐VE) tested consenting county patients hospitalized with respiratory symptoms at selected hospitals using real‐time reverse transcriptase polymerase chain reaction (rRT‐PCR); the Emerging Infections Program identified county patients with positive influenza tests in all area hospitals. For the surveillance‐sampling estimates, we applied the age‐specific proportions of influenza‐positive patients (from Flu‐VE) to the number of acute respiratory illness hospitalizations obtained from the Tennessee Hospital Discharge Data system. Results With capture–recapture, we estimated 0·89 (95% CI, 0·72–1·49), 0·62 (0·42–1·11), 1·78 (0·99–3·63), and 0·76 (0·50–1·76) hospitalizations per 1000 residents aged <5, 5–17, 18–49, and ≥50 years, respectively. Surveillance‐sampling estimated rates were 0·78 (0·46–1·22), 0·32 (0·14–0·69), 0·99 (0·64–1·52), and 1·43 (0·80–2·48) hospitalizations per 1000 residents aged <5, 5–17, 18–49, and ≥50 years, respectively. In all age‐groups combined, we estimated approximately 1 influenza‐related hospitalization per 1000 residents. Conclusions Two independent methods provided consistent results on the burden of pandemic virus in Davidson County and suggested that the overall incidence of A(H1N1)pdm09‐associated hospitalization was 1 per 1000 county residents.

Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes

Led by the Tennessee Chapter of the American College of Surgeons, in May 2008 a 10-hospital collaborative was formed between the Tennessee Chapter of ACS, the Tennessee Hospital Association, and the BlueCross BlueShield of Tennessee Health Foundation. We hypothesized that by forming the Tennessee Surgical Quality Collaborative using the National Surgical Quality Improvement Program (NSQIP) system to share surgical process and outcomes data, overall patient surgical outcomes would improve. All NSQIP data from the 10-hospital collaborative for the time periods January to December 2009 (period 1) and January to December 2010 (period 2) were collected. Data on 20 categories of postoperative complications and 30-day mortality were compared between periods. Complication comparisons and hospital costs associated with complications were calculated per 10,000 procedures. Statistical analysis was performed by Z-test. There were 14,205 total surgical cases in period 1 and 14,901 surgical cases in period 2. Between periods (per 10,000 cases) there were significant improvements in superficial surgical site infections (-19%, p = 0.0005), on ventilator longer than 48 hours (-15%, p = 0.012), graft/prosthesis/flap failure (-60%, p < 0.0001), acute renal failure (-25%, p = 0.023), and wound disruption (-34%, p = 0.011). Although mortality (per 10,000) was higher in period 2 (237.6 vs 232.3), no statistical difference was noted. Net costs avoided between these periods were calculated as $2,197,543 per 10,000 general and vascular surgery cases. Data organization and scrutiny are the initial steps of process improvement. Participation in our regional surgical quality collaborative resulted in improved outcomes and reduced costs. Although the mechanisms for these changes are likely multifactorial, the collaborative establishes communication, process improvement, and frank discussion among the members as best practices are identified and shared and standardized processes are adopted.

Geographic Variations in Heart Failure Hospitalizations Among Medicare Beneficiaries in the Tennessee Catchment Area

IntroductionAlthough differences in heart failure (HF) hospitalization rates by race and sex are well documented, little is known about geographic variations in hospitalizations for HF, the most common discharge diagnosis for Medicare beneficiaries. MethodsUsing exploratory spatial data analysis techniques, the authors examined hospitalization rates for HF as the first-listed discharge diagnosis among Medicare beneficiaries in a 10-state Tennessee catchment area, based on the resident states reported by Tennessee hospitals from 2000 to 2004. ResultsThe age-adjusted HF hospitalization rate (per 1000) among Medicare beneficiaries was 23.3 [95% confidence interval (CI), 23.3–23.4] for the Tennessee catchment area, 21.4 (95% CI, 21.4–21.5) outside the catchment area and 21.9 (95% CI, 21.9–22.0) for the overall United States. The age-adjusted HF hospitalization rates were also significantly higher in the catchment area than outside the catchment area and overall, among men, women and whites, whereas rates among the blacks were higher outside the catchment area. Beneficiaries in the catchment area also had higher age-specific HF hospitalization rates. Among states in the catchment area, the highest mean county-level rates were in Mississippi (30.6±7.6) and Kentucky (29.2±11.5), and the lowest were in North Carolina (21.7±5.7) and Virginia (21.8±6.6). ConclusionsKnowledge of these geographic differences in HF hospitalization rates can be useful in identifying needs of healthcare providers, allocating resources, developing comprehensive HF outreach programs and formulating policies to reduce these differences.

General Surgery at Rural Tennessee Hospitals: A Survey of Rural Tennessee Hospital Administrators

Rural communities face an impending surgical workforce crisis. The purpose of this study is to describe perceptions of rural Tennessee hospital administrators regarding the importance of surgical services to their hospitals. In collaboration with the Tennessee Hospital Association, we developed and administered a 13-item survey based on a recently published national survey to 80 rural Tennessee hospitals in August 2008. A total of 29 responses were received for an overall 36.3 per cent response rate. Over 44 per cent of rural surgeons were older than 50 years of age, and 27.6 per cent of hospitals reported they would lose at least one surgeon in the next 2 years. The responding hospitals reported losing 10.4 per cent of their surgical workforce in the preceding 2 years. Over 53 per cent were actively recruiting a general surgeon with an average time to recruit a surgeon of 11.8 months. Ninety-seven per cent stated that having a surgical program was very important to their financial viability with the mean and median reported revenue generated by a single general surgeon being $1.8 million and $1.4 million, respectively. Almost 11 per cent of the hospitals stated they would have to close if they lost surgical services. Although rural Tennessee hospitals face similar difficulties to national rural hospitals with regard to retaining and hiring surgeons, slightly more Tennessee hospitals (54 vs 36%) were actively attempting to recruit a general surgeon. The shortage of general surgeons is a threat to the accessibility of comprehensive hospital-based care for rural Tennesseans.

MEET THE GUEST EDITOR

Bing Yan got his Ph.D. from Columbia University in 1990 and carried out postdoctoral research at University of Cambridge, U.K. and University of Texas Medical School in Houston from 1990 to 1993. From 1993 to 2005, he worked at Novartis in New Jersey, Discovery Partners International in South San Francisco, and Bristol-Myers Squibb in Connecticut. Now he is a Full Member at Department of Chemical Biology and Therapeutics, St. Jude Childrens Research Hospital in Memphis, Tennessee and Professor at Shandong University, China. He serves as Associate Editor for ACS Combinatorial Sciences (formerly Journal of Combinatorial Chemistry), published by American Chemical Society. He is also editor of book series “Critical Reviews in Combinatorial Chemistry” published by Francis & Taylor Group. He is engaged in research on the elucidation and regulation of nanoparticles biological activities.

Race, Sex, and Age Differences in Heart Failure-Related Hospitalizations in a Southern State

Background— Because heart failure (HF) is the final common pathway for most heart diseases, we examined its 10-year prevalence trend by race, sex, and age in Tennessee. Methods and Results— HF hospitalization data from the Tennessee Hospital Discharge Data System were analyzed by race, sex, and age. Rates were directly age-adjusted using the Year 2000 standard population. Adult (age 20+ years) inpatient hospitalization for primary diagnosis of HF (HFPD) increased from 4.2% in 1997 to 4.5% in 2006. Age-adjusted hospitalization for HF (per 10 000 population) rose by 11.3% (from 29.3 in 1997 to 32.6 in 2006). Parallel changes in secondary HF admissions were also noted. Age-adjusted rates were higher among blacks than whites and higher among men than women. The ratios of black to white by sex admitted with HFPD in 2006 were highest (9:1) among the youngest age categories (20 to 34 and 35 to 44 years). Furthermore, for each age category of black men below 65 years, there were higher HF admission rates than for white men in the immediate older age category. In 2006, the adjusted rate ratios for HFPD in black to white men ages 20 to 34 and 35 to 44 years were odds ratio, 4.75; 95% confidence interval, 3.29 to 6.86 and odds ratio, 5.10; 95% confidence interval, 4.15 to 6.25, respectively. Hypertension was the independent predictor of HF admissions in black men ages 20 to 34 years. Conclusions— The higher occurrence of HF among young adults in general, particularly among young black men, highlights the need for prevention by identifying modifiable biological and social determinants to reduce cardiovascular health disparities in this vulnerable group.