International Classification Of Diseases, 9th Revision, Clinical Modification Research Articles

Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition.

Traumatic injury is a leading cause of death and disability among USworkers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9thRevision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations. Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition. Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition. Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015.

Maternal diabetes mellitus and birth defects in Taiwan: A 5-year nationwide population-based cohort study.

Birth defects (BDs) are the main causes of mortality and disability in infants and children. Associations between maternal diabetes mellitus (DM), including gestational DM (GDM) and pregestational DM (type 1 or type 2), and the risk of BDs have been reported. This study aims to determine the relationship between maternal DM and BDs and to investigate whether reducing the incidence of DM can decrease the incidence of BDs. We identified all births in Taiwan from the National Birth Defects Surveillance Program between January 1, 2010, and December 31, 2014. Information on the infants' characteristics (sex, gestational age, and birth weight) and mothers' characteristics (age, parity, and associated diseases, including DM) were obtained from the National Birth Registry and National Health Insurance Research Database (NHIRD) in Taiwan. BDs were coded according to the International Classification of Diseases, 9th Revision-Clinical Modification (ICD-9-CM) codes 740-759. Multiple logistic regression analysis with adjusted odds ratio (aOR) and 95% confidence interval (95% CI) for all BDs showed that the aOR (95% CI) was 1.002 (0.965-1.041), and the p -value was 0.9139 in the GDM group. In the type 1 DM group, the aOR (95% CI) was 1.748 (1.110-2.754), and the p -value was 0.016. In the type 2 DM group, the aOR (95%CI) was 1.175 (1.005-1.375), 1.331 (1.196-1.482), and 1.391 (1.216-1.592), and the p -value was 0.0437, <0.0001, and <0.0001 for the duration of mothers with type 2 DM <2, 2 to 5, >5 years, respectively. Mothers with pregestational DM (type 1 or type 2) increase the incidence of BD. Appropriate maternal glycemic control may achieve good pregnancy and perinatal outcomes.

Reducing Birth Defects by Decreasing the Prevalence of Maternal Chronic Diseases-Evaluated by Linked National Registration Dataset.

Birth defects (BDs) are an important cause of abortion, stillbirth, and infant mortality that may cause lifelong disability. The defects can be caused by genetics, environmental exposure, or maternal chronic diseases. We conducted a study to analyze the association between maternal chronic diseases and BDs and to evaluate the effect of decreasing the prevalence of maternal chronic diseases on reducing BDs. The data of newborns and their mothers were concatenated and analyzed from three national population databases: the National Health Insurance Research Database, the Birth Certificate Application, and the Birth Registration Database in Taiwan during the period of 2005 to 2014. Codes 740-759 of the International Classification of Diseases 9th Revision-Clinical Modification (ICD-9-CM) were used as the diagnosis of BDs. The prevalence of BDs was 2.72%. Mothers with cardiovascular diseases, hypertension, anemia, genitourinary tract infections, renal diseases, neurotic or psychotic disorders, gestational diabetes mellitus (DM), and pregestational type 1 or type 2 DM had a significantly higher prevalence of BDs. The population attributable risk percent (PAR%) of BDs was 1.63%, 0.55%, 0.18%, 1.06%, 0.45%, 0.22%, 0.48%, and 0.24% for maternal hypertension, cardiovascular disease, renal disease, genitourinary infection, anemia, neurotic and psychotic disorders, gestational DM, and pregestational type 1 or type 2 DM, respectively. The percentage change (-1%, -5%, and -10% of prevalence in 2034 compared with the prevalence in 2005-2014) of maternal disease and the predicted number of live births was used to estimate the decrease in the number of newly diagnosed BDs in 2034. By using the middle-estimated number of live births in 2034, we predicted that the number of BDs would decrease by 302, 102, 33, 196, 83, 41, 89, and 44 with a -5% prevalence of maternal hypertension, cardiovascular disease, renal disease, genitourinary infection, anemia, neurotic and psychotic disorders, gestational DM, and pregestational type 1 or type 2 DM, respectively. We conclude that mothers with chronic diseases, including cardiovascular diseases, hypertension, anemia, genitourinary tract infections, renal diseases, neurotic or psychotic disorders, gestational DM, and pregestational type 1 or type 2 DM, have a significantly higher (p &lt; 0.01) prevalence of having offspring with BDs. Mothers with chronic diseases are associated with BDs. It is very important to set up a policy to decrease the prevalence of these maternal chronic diseases; then, we can reduce the incidence of BDs.

361 Prevalence and Trends of Surgical Intervention for Trigeminal Neuralgia in the Inpatient Setting in the United States: Analyses from a National Database from 2002-2015

INTRODUCTION: Trigeminal neuralgia is a debilitating neurological condition characterized by sharp, stabbing pain in the distribution of the trigeminal nerve and its branches. For trigeminal neuralgia that is refractory to medical therapy, surgery is generally indicated. Herein, we sought to assess the prevalence of trigeminal neuralgia among inpatient admissions, utilization of surgical intervention, and trends of utilization of common surgical approaches for TN using a national database. METHODS: The National Inpatient Sample (NIS) was queried for all patients with trigeminal neuralgia using international classification of disease 9th revision clinical modification (ICD-9-CM) diagnosis code (350.1) between the 1st quarter of 2002 and the 3rd quarter of 2015. Cases were also classified into surgical groups using ICD-9 procedure codes which included MVD, percutaneous procedures and stereotactic radiosurgery. Using weighted discharge methodology, national estimates for prevalence, primary admissions, and utilization of each surgery type were computed. RESULTS: A total of 405,445 patients with trigeminal neuralgia were identified between the 1st quarter of 2002 and the 3rd quarter of 2015. The inpatient prevalence of trigeminal neuralgia in this 14 year cohort was found to be 63.8 per 100,000, and was found to increase from 54.9 per 100,000 in 2002 to 76 per 100,00 in 2015. A total of 67,768 patients had a primary diagnosis of trigeminal neuralgia. Of these, 41,473 (61.2%) underwent a surgical procedure; surgical utilization increased from 59.7% cases in 2002 to 69.1% in 2015. Of the cases undergoing a surgical intervention for trigeminal neuralgia, an MVD was performed for the majority of patients (87%, n=36,083) followed by percutaneous procedures (7.3%, n=3,036) and stereotactic radiosurgery (7.1%, n=2,940). Furthermore, the percent-utilization of MVD among patients undergoing surgical intervention increased form 67.3% in 2002 to 98% in 2015, the percent utilization of percutaneous procedures fell from 17.9% to 2%, and the percent utilization of stereotactic radiosurgery fell from 15.5% to 0.4%. CONCLUSION: The trends within surgical management of trigeminal neuralgia have been rapidly evolving over the past two decades with a steady trend towards MVD.

191 Clinical and Economic Outcomes of Patients Undergoing Surgical Intervention for Trigeminal Neuralgia: Analysis From a National Database

INTRODUCTION: The management of trigeminal neuralgia (TN) has evolved significantly in the past century. In the current manuscript, we compare clinical and economic outcomes of patients undergoing surgical intervention for TN between microvascular decompression (MVD), percutaneous procedures and stereotactic radiosurgery (SRS) using a national database. METHODS: The national inpatient sample (NIS) was queried for cases undergoing a surgical intervention for TN between 2002-2015 3rd quarter using the International Classification of Disease 9th Revision Clinical Modification (ICD-9-CM) and procedure codes (ICD-9-PCS). Outcomes assessed included length of stay (LOS), discharge disposition and cost. RESULTS: A total of 8,317 patients undergoing a surgical intervention for TN were identified between 2002 and 2015 3rd quarter, of which 7,202 (86.6%) underwent MVD, 548 (6.6%) underwent percutaneous procedures and 567 (6.8%) underwent SRS. Patients undergoing percutaneous and SRS procedures were more likely to be older compared to those undergoing MVD (&gt;65: 58.1% and 72.1% vs 32.2%, respectively; p &lt; 0.001). MVD was significantly more likely to be performed in an urban academic institution compared to percutaneous procedures and SRS (84.8% vs 75.1% and 75.8%; p &lt; 0.001). Patients undergoing SRS had the lowest LOS (1.34 days vs 3.2 days and 3.5 days; p &lt; 0.001) and lowest odds for a prolonged LOS (OR = 0.29; CI: 0.18-0.46; p &lt; 0.001) and non-routine discharge (OR = 0.44; CI: 0.28-0.71; p &lt; 0.001). Percutaneous procedures had the highest odds for a prolonged LOS (OR = 2.07; CI: 1.65-2.61; p &lt; 0.001). The total charges billed by the hospital were highest for patients undergoing MVD ($50,432.30) followed by those undergoing SRS ($38,450.90) and percutaneous procedures ($18,655.10) (p &lt; 0.001). The total reimbursed cost was highest for SRS ($18,265.70) followed by MVD ($17,590.20) and percutaneous procedures ($8,183.30). CONCLUSION: In the current era of value-based care, these analyses are important in helping physicians, hospitals and other stakeholders devise appropriate policies to ensure optimal patient outcomes, as well as optimal reimbursements.

General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma-endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin.

The current national burden of emergency general surgery (EGS) illnesses and the extent of surgeon involvement in the care of these patients remain largely unknown. To inform needs assessments, research, and education, we sought to: (1) translate previously developed International Classification of Diseases (ICD), 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes representing EGS conditions to ICD 10th Revision, CM (ICD-10-CM) codes and (2) determine the national burden of and assess surgeon involvement across EGS conditions. We converted ICD-9-CM codes to candidate ICD-10-CM codes using General Equivalence Mappings then iteratively refined the code list. We used National Inpatient Sample 2016 to 2017 data to develop a national estimate of the burden of EGS disease. To evaluate surgeon involvement, using Wisconsin Hospital Association discharge data (January 1, 2016 to June 30, 2018), we selected adult urgent/emergent encounters with an EGS condition as the principal diagnosis. Surgeon involvement was defined as a surgeon being either the attending provider or procedural physician. Four hundred and eighty-five ICD-9-CM codes mapped to 1,696 ICD-10-CM codes. The final list contained 985 ICD-10-CM codes. Nationally, there were 2,977,843 adult patient encounters with an ICD-10-CM EGS diagnosis. Of 94,903 EGS patients in the Wisconsin Hospital Association data set, most encounters were inpatient as compared with observation (75,878 [80.0%] vs. 19,025 [20.0%]). There were 57,780 patients (60.9%) that underwent any procedure. Among all Wisconsin EGS patients, most had no surgeon involvement (64.9% [n = 61,616]). Of the seven most common EGS diagnoses, surgeon involvement was highest for appendicitis (96.0%) and biliary tract disease (77.1%). For the other five most common conditions (skin/soft tissue infections, gastrointestinal hemorrhage, intestinal obstruction/ileus, pancreatitis, diverticular disease), surgeons were involved in roughly 20% of patient care episodes. Surgeon involvement for EGS conditions ranges from highly likely (appendicitis) to relatively unlikely (skin/soft tissue infections). The wide range in surgeon involvement underscores the importance of multidisciplinary collaboration in the care of EGS patients. Prognostic/epidemiological, Level III.

Vaccine-preventable diseases in hospitalized patients with heart failure: a nationwide cohort analysis

Abstract Introduction Infection related hospitalizations are common among patients with heart failure (HF), including those that could be prevented with appropriate vaccinations. Objective We aimed to determine the risk of vaccine preventable diseases (VPDs) in patients with HF. Methods We performed a population based retrospective cohort study using the United States- National Inpatient Sample (NIS) Database from 2010 to 2014. We identified patients who were admitted to the hospital with vaccine preventable diseases, namely influenza, varicella zoster infection (VZV), pneumococcal infection, meningococcal infection, diphtheria, pertussis, tetanus, hepatitis A (Hep A) and hepatitis B (Hep B) using international classification of diseases 9th revision clinical modification (ICD-9-CM) codes. In this cohort, we then identified patients with HF. Descriptive statistics were used to estimate the frequencies of various VPDs in patients with heart failure. A multivariate regression model adjusting for age, gender, race, immunosuppression (Diabetes, HIV, Organ transplantation, Malignancy) was employed to determine the risk of VPDs in patients with HF. Results Among a total of 11, 64,528 patients admitted with VPDs, HF was present in 1, 01,915 (8.8%).The most common VPD in patients with HF was VZV (30.7%), followed by influenza (28.2%), pneumococcal infection (20.9%) and Hep B (18.5%). Other VPDs were less common: Hep A (1.8%), diphtheria (0.4%), pertussis (0.2%), tetanus (10 patients) and meningococcal infection (0.1%). On multivariate analysis, patients with HF had increased risk of hospitalization due to influenza (aOR=1.20, 95% CI: 1.18–1.21; p&amp;lt;0.001) and pneumococcal infection (aOR=1.31, 95% CI: 1.29–1.33; p&amp;lt;0.001), but were at a lower risk of hospitalization due to VZV (aOR=0.81, 95% CI: 0.8–0.83; p&amp;lt;0.001), Hep B (aOR=0.78, 95% CI: 0.77- 0.8; p&amp;lt;0.001), Hep A (aOR=0.71, 95% CI: 0.67–0.74; p&amp;lt;0.001), Meningococcal infection (aOR=0.64, 95% CI: 0.52–0.78; p&amp;lt;0.001), diphtheria (aOR=0.79, 95% CI: 0.71–0.88; p&amp;lt;0.001) and tetanus (aOR=0.35, 95% CI: 0.19–0.65; p=0.001). No statistically significant association of HF was observed with pertussis (p=0.167). Conclusion In our study, patients with HF had a higher risk of hospital admissions secondary to influenza and pneumococcal infections and a lower risk of VZV, Hep B, Hep A, meningococcal infection, diphtheria, and tetanus related admissions when compared with non-HF patients. Funding Acknowledgement Type of funding source: None

Patient characteristics and in-hospital outcomes of Takotsubo Cardiomyopathy in pregnancy: a retrospective analysis

Abstract Introduction Takotsubo Cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction and predominantly affects post-menopausal women. However, it is rarely identified as a cause of acute heart failure in pregnancy. Objective We aimed to determine patient characteristics and in-hospital outcomes of TCM occurring in pregnancy. Methods We retrospectively analyzed the United States - National Inpatient Sample (NIS) Database from 2010–2014 to assess TCM in pregnant women ≥18 years using international classification of diseases 9th revision clinical modification (ICD-9-CM) codes. We compared patient demographics, co-morbidities and in-hospital outcomes between pregnant and non-pregnant women with TCM aged 18–49 years. Patients with a diagnosis of peripartum cardiomyopathy were excluded. Chi-square test and Student-t test or Mann- Whitney U test were used for categorical and continuous variables with normal and skewed distribution, respectively. Results TCM occurred at a younger age in pregnant women compared to non-pregnant women (Age [Mean ±SD]: 31.2±7.2 years vs. 41.8±7.1 years; p&amp;lt;0.001). Rates of TCM were higher during pregnancy in African American (19% vs. 11.5%; p=0.008), Hispanic (27.3% vs. 9.6%; p&amp;lt;0.001) and Asian women (11.3% vs. 2.6%; p&amp;lt;0.001) compared to non-pregnant women of similar race. However, among Caucasian women rates of TCM were higher in non-pregnant women (42.4% vs. 72.7%; p&amp;lt;0.001). There were no in-hospital deaths among pregnant women with TCM (0% vs. 5.2%; p=0.005), however they had higher rates of cardiogenic shock (13.8% vs. 5.8; p&amp;lt;0.001) and respiratory failure requiring mechanical ventilation (51.7% vs. 20.9%; p&amp;lt;0.001). The average length of hospitalization was also longer among pregnant women with TCM (Days [Mean±SD]: 5.8±4 vs. 5.5±7.5; p&amp;lt;0.001). Pregnant women had lower rates of diagnostic angiography (24.1% vs. 55.6%; p&amp;lt;0.001). Pregnant women with TCM had higher rates of ventricular fibrillation (6.9% vs. 2.9%; p=0.02), but had no atrial fibrillation (0% vs. 2.6%; p=0.05), atrial flutter (0% vs. 0.4%; p=0.43), paroxysmal supraventricular tachycardia (0% vs. 0.5%; p=0.4) and ventricular tachycardia (0% vs. 4.8%; p=0.07). Pregnant women with TCM had lower rates of psychiatric and certain medical co-morbidities: anxiety (6.9% vs. 20.4%; p&amp;lt;0.001), depression (0% vs. 2.6%; p=0.05), bipolar disorder (0% vs. 0.8%; p=0.3), hypertension (27.6% vs. 40.3%; p=0.002), hyperlipidemia (3.4% vs. 25.7%; p&amp;lt;0.001) and smoking (6.9% vs. 40.2%; p&amp;lt;0.001). The rates of diabetes (13.8% vs. 15.9%; p=0.5) and obesity (10.3% vs. 8.2%; p=0.37) were similar between the two groups. Conclusion There was no in-hospital mortality observed in pregnant women who developed TCM, however, they had increased rates of cardiogenic shock, mechanical ventilation, ventricular fibrillation and had longer hospitalizations. Funding Acknowledgement Type of funding source: None

Direct Costs of Opioid Abuse in an Insured Population in the United States.

To (a) describe the demographics of opioid abusers; (b) compare the prevalence rates of selected comorbidities and the medical and drug utilization patterns of opioid abusers with patients from a control group, for the period from 1998 to 2002; and (c) calculate the mean annual per-patient total health care costs (e.g., inpatient, outpatient, emergency room, drug, other) from the perspective of a private payer. An administrative database of medical and pharmacy claims from 1998 to 2002 of 16 self-insured employer health plans with approximately 2 million lives was used to identify "opioid abusers"-patients with claims associated with ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes for opioid abuse (304.0, 304.7, 305.5, and 965.0 [excluding 965.01]). A control group of nonabusers was selected using a matched sample (by age, gender, employment status, and census region) in a 3:1 ratio. Per-patient annual health care costs (mean total medical and drug costs) were measured in 2003 U.S. dollars. Multivariate regression techniques were also used to control for comorbidities and to compare costs with a benchmark of depressed patients. 740 patients were identified as opioid abusers, a prevalence of 8 in 10,000 persons aged 12 to 64 years continuously enrolled in health care plans for whom 12 months of data were available for calculating costs. Opioid abusers, compared with nonabusers, had significantly higher prevalence rates for a number of specific comorbidities, including nonopioid poisoning, hepatitis (A, B, or C), psychiatric illnesses, and pancreatitis, which were approximately 78, 36, 9, and 21 (P<0.01) times higher, respectively, compared with nonabusers. Opioid abusers also had higher levels of medical and prescription drug utilization. Almost 60% of opioid abusers had prescription drug claims for opioids compared with approximately 20% for nonabusers. Prevalence rates for hospital inpatient visits for opioid abusers were more than 12 times higher compared with nonabusers (P<0.01). Mean annual direct health care costs for opioid abusers were more than 8 times higher than for nonabusers ($15,884 versus $1,830, respectively, P < 0.01). Hospital inpatient and physician-outpatient costs accounted for 46% ($7,239) and 31% ($5,000) of opioid abusers' health care costs, compared with 17% ($310) and 50% ($906), respectively, for nonabusers. Mean drug costs for opioid abusers were more than 5 times higher than costs for nonabusers ($2,034 vs. $386, respectively, P<0.01), driven by higher drug utilization (including opioids) for opioid abusers. Even when controlling for comorbidities using a multivariate regression model of a matched control of depressed patients, the average health care costs of opioid abusers were 1.8 times higher than the average health care costs of depressed patients. The high costs of opioid abuse were driven primarily by high prevalence rates of costly comorbidites and high utilization rates of medical services and prescription drugs. Funding for this research was provided by an unrestricted grant from Janssen Medical Affairs, L.L.C. and was obtained by authors Susan Vallow and Jeff Schein, who are employed by Janssen Medical Affairs, L.L.C. Nathaniel Katz is a consultant to Janssen and numerous other pharmaceutical companies that manufacture branded opioid products and nonopioid analgesics; authors Alan G. White, Howard G. Birnbaum, Milena N. Mareva, and Maham Daher disclose no potential bias or conflict of interest relating to this article. White served as principal author of the study. Study concept and design were contributed primarily by White, Vallow, Schein, and Katz. Analysis and interpretation of data were contributed by all authors. Drafting of the manuscript was primarily the work of White, and its critical revision was the work of White and Vallow. Statistical expertise was contributed by White, Birnbaum, and Daher, and administrative, technical, and/or material support was provided by Analysis Group, Inc., Boston, MA.

Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study

ObjectivesTo identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness...

409 Risk Factors of Readmission to Hospital for Eosinophilic Esophagitis in United States: A National Readmission Database Analysis

INTRODUCTION: Eosinophilic esophagitis (EoE), once considered a rare entity, is becoming a commonly encountered gastroenterological condition. In addition to increased clinical recognition of EoE, rising EoE related hospitalization in the United States have been reported. Using the Healthcare Cost and Utilization Project (HCUP) National Readmission Database, we aimed to identify factors associated with readmissions in population with EoE. METHODS: We performed a retrospective cohort study using 2012-2014 data from the Nationwide Readmission Database (NRD). Using International Classification of Diseases-9th Revision, Clinical Modification (ICD-9-CM) codes, we identified patients with discharge diagnoses of EoE (530.13) and ascertained other related comorbidities (asthma (493.XX) and esophageal reflux (530.81)) during index admission. We evaluated patients with EoE related hospitalization, from January 2012 to November 2014, and analyzed readmissions over 90 days after discharge. Logistic regression analyses were used to examine the factors associated with risk of 90-day readmission. RESULTS: Among 6,877 hospitalizations of EoE patients, 407 (3%) were readmitted within 90 days of the index hospitalization resulting in average annual excess charge of roughly $4 million. The common reasons for readmission were foreign body in the esophagus (6%) and dysphagia (7%). Ninety-eight of readmitted EoE cases were ages 19 years or above, and common comorbidities associated with readmissions were GERD (25%) and asthma (26%). In multivariable analysis of patients with EoE, female compared to males (OR 1.94, 95%CI: 1.16–3.24) and having co-morbid asthma compared to no-asthma comorbidity (OR 1.39, 95%CI: 1.25–3.14) were associated with a significant increase in odds of readmission. There was no significant difference in risk of readmission by the type of insurance. CONCLUSION: In a national sample of inpatients with EoE, the risk of 90-day readmission was significantly associated with female and having asthma co-morbidity. These factors may represent targets for interventions to prevent frequent hospital readmission in this population.

Hospital and economic burden of influenza-like illness and lower respiratory tract infection in adults \u226550\u2009years-old

BackgroundInfluenza-like illnesses (ILIs) and lower respiratory tract infections (LRTIs) cause substantial morbidity and mortality worldwide.The study assessed the health and economic burden of ILI and LRTI according to age and comorbidities, since available evidence is limited and heterogeneous.MethodThe prevalence of comorbidities, the seasonal incidence rates and the mean and per capita direct costs of ED accesses for ILI/LRTI, whether followed by hospitalization or not, recorded in adults aged ≥50 years over the last 6 years, in the referral hospitals located in the Genoese metropolitan area (Liguria, Italy) where the syndromic surveillance system is active, were evaluated through a retrospective observational study. Comorbidities were estimated through the Chronic Condition Data Warehouse that integrates multiple Medicare data sources. A comparison with the administrative healthcare International Classification of Diseases-9th revision-Clinical Modification (ICD-9-CM)-based data was also conducted.ResultsThe prevalence of subjects with ≥1 comorbidity ranged from 23.49 to 59.92%. The most prevalent all-age comorbidities were cardiovascular diseases and cancer. The overall ILI/LRTI incidence rate was 6.73/1000 person-years, almost double the value derived from routine data, and increased with age. The highest rates were observed in patients with renal failure and bronchopneumopathies. The mean cost of ED accesses/hospitalization for ILI/LRTI was €3353 and was almost twice as high in the ≥85 years as in the youngest age-group. The highest mean costs were observed in patients with renal failure and cancer. The per capita costs increased from €4 to €71 with age, and were highest in patients with renal failure and bronchopneumopathy.ConclusionThe burden of ILIs/LRTIs in terms of ED accesses and hospitalizations in adults aged ≥50 years is heavy, and is related to increasing age and, especially, to specific comorbidities.These results could contribute to revising age- and risk-based anti-influenza and -pneumococcus immunization strategies.

Assessment of the Risk Factors of MDD Recurrence Based on Deep Learning Approaches

Objective: To explore the risk factors associated with of major depression disorder (MDD) recurrence using logistic regression, support vector machines (SVM) and a long-short term memory (LSTM) approaches based on two electronic health records (EHR) databases. Method: We extracted patients with MDD from two large, multi-center clinical datasets. The inpatient and outpatient datasets between Jan. 2010 and Dec. 2015 were collected. Eligible patients were 18-90 years-old and had a diagnosis of MDD. The major depression disorder (MDD) were identified based on the MDD-related International Classification of Diseases, 9th revision-Clinical Modification (ICD-9-CM) diagnosis codes (296.2x, 296.3x); and MDD-related ICD-10-CM diagnosis codes (F32.x, F33.x). The patients with less than three-time visits in a cohort during 5-year were followed up. Eventually, 140,497 patients were qualified for further analysis, including 69.2% female patients. Among of 140,497, 20, 078 patients (14.3%) had no complications. Logistic regression, SVM, and LSTM were employed to predict the key risk factors associated with MDD recurrence. Survival analysis was also conducted for analyzing the risk factors of MDD recurrence. Results: The MDD patients with married /life partners had a lower prevalence rate (9.2%) of MDD recurrence than the patients with single marital status (11.8%). The primary MDD patients had a higher MDD recurrence rate (11.7%) than secondary MDD patients (10.5%). Primary MDD was associated with MDD recurrence (OR 2.49, 95%CI 1.53-3.96) via logistic regression analysis. Insomnia, anxiety and single marital status were also top-ranked risk factors for the MDD recurrence. The prediction accuracy of logistic regression, SVM and LSTM were 0.736, 0.791 and 0.834, respectively. Conclusions: Building statistical models by mining existing EHR data can explore the risk factors associated with MDD recurrence. Our predictive results indicated that primary MDD, never married, anxiety symptoms, and insomnia were risk factors for MDD recurrence. The prediction accuracy of the LSTM model was higher than the other two approaches. Funding Statement: This work was support by UT SBMI. Declaration of Interests: The authors state that they have no potential conflict of interest. Ethics Approval Statement: This study was approved by the institutional review board (IRB).

PIH12 BURDEN OF ADVERSE DRUG EVENTS (ADE) DURING HOSPITALIZATION IN OLDER ADULTS- A CROSS SECTIONAL ANALYSIS USING NATIONWIDE READMISSION DATABASE

Adverse drug events (ADE) are a primary cause of significant morbidity in older adults and are associated with increased risk of mortality, length of stay, and substantial healthcare costs. This study was conducted to evaluate the clinical (readmission, in-hospital mortality, and length of stay (LOS)) and economic burden of ADE during hospitalization in older adults. Study was conducted in patients 65 years or older using Health Care Cost & Utilization Project’s Nationwide Readmission Database (NRD) 2014 dataset. Patients were selected based on 442 International Classification of Diseases 9th revision Clinical Modification (ICD-9-CM) & external causes of injury codes related to ADEs. Patients were categorized in ADE or non-ADE groups. A logistic regression model was used for multivariable analysis of readmission and in-hospital mortality. Generalized Poisson and inverse Gaussian models were used for LOS and cost multivariable analysis, respectively. 3,832,322 patients were included. Among these patients, 203,432 (5%) patients had at least one ADE during hospitalization. Majority of ADE were related to blood constituents (22%) and adverse effects of biological & medicinal substances in therapeutic use (23%). In adjusted models, older adults with ADE during hospitalization had 25% (p<0.0001) and 9% (p<0.0001) higher odds of readmission and in-hospital mortality, respectively, as compared to those without ADE. A 17% (p<0.0001) increase in LOS was estimated in ADE group and1% point estimate (p>0.05) rise in cost was observed in ADE group when compared with non-ADE group. ADE have substantial burden on in-patient care of older adults both clinically (increased readmission, in-hospital mortality, and LOS) & economically (increased cost). Targeted interventions can help to prevent ADE and, consequently, associated clinical and economic burden.

Abstract 179: Cardiac Resynchronization Therapy among Cancer Patients in the United States: Results from National Inpatient Sample

Background: Studies have shown that implantation of cardiac resynchronization therapy (CRT) devices could reduce morbidity and mortality in heart failure patients. Aims of this study are to examine the temporal trends and outcomes in CRT device implanted cancer survivors. Method: This study was a retrospective analysis of Nationwide Inpatient Sample during the period 2005-2014. Patients ≥18 years and who underwent CRT device implantation were included in the study. CCS codes 11-44 were used to identify cancer survivors. The International Classification of Diseases-9th Revision-Clinical Modification (ICD-9-CM) primary procedure codes 00.50 and 00.51 were used to identify patients with device implantation. Association between cancer diagnosis and in-hospital mortality and complications were determined using multivariable analyses. Result: During 2005 to 2014, a total of 392,758 inpatient CRT implantations were performed in the United States. Nearly 8.3% of these procedures were performed among patients with history of cancer. Number of procedures among cancer survivors decreased from 3127 in 2005 to 2115 in 2015. However, proportion of cancer patients undergoing CRT implantations increased from 6.8% in 2005 to 10.3% in 2014 (relative increase: 51.4%, P &lt;0.001). Overall in-hospital mortality was higher among cancer survivors (odds ratio (OR) 1.44, 95% confidence interval (95% CI) 1.01-2.10), compared to patients without a history of cancer. In addition, pericardial complications (OR 3.11, 95% CI 1.15-8.44), and vascular complications (OR 2.53, 95% CI 1.43-3.56) were observed more among cancer survivors. Discussion: Our study found that proportion of CRT implantations among cancer survivors increased from 6.8% to 10.3% during the study period. In addition, CRT implantations among cancer survivors were associated higher in-hospital complications. Strategies like prehabilitation and close collaboration between cardiologists and oncologists could improve outcome and general well-being of cancer survivors undergoing CRT implantations.

Tinnitus, Depression, Anxiety, and Suicide in Recent Veterans: A Retrospective Analysis

The purpose of this project was to investigate whether there is an association between tinnitus diagnosis and suicide and whether depression and anxiety strengthen that association. Given that tinnitus is the top service-connected disability among U.S. Veterans () and that suicide among Veterans has been occurring at a higher frequency as compared with community suicide rates (), the possible associations between tinnitus and suicide will be explored. Co-occurring physical conditions also will be examined to determine if they increase the risk of suicide in the context of tinnitus. Administrative health care data related to Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) were used to identify Veterans who accessed the Veterans Administration (VA) health care system from January 1, 2002, to December 31, 2011. Veterans who were deceased as of December 2011 were identified using the National Death Index (NDI) files. Tinnitus cases were followed until either they were deceased or to the end of the study period. The International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) codes were used to identify all conditions and diseases. As per mortality research standards, International Classification of Diseases 10th Revision (ICD-10) codes were used to identify cause of death. Of 769,934 OEF/OIF/OND Veterans receiving VA care January 2002 to December 2011, 15% (n =116,358) were diagnosed with tinnitus. Of these Veterans diagnosed with tinnitus, 21% were also diagnosed with depression, another 8% with anxiety, and another 17% with both depression and anxiety. Fifty-four percentage were identified as having tinnitus without depression or anxiety. Among individuals with tinnitus, 41.9% had co-occurring hearing loss. Suicide rates were lower among Veterans with tinnitus than Veterans without tinnitus. Co-occurring diagnoses of mental-health conditions did not significantly increase the risk of suicide. The study results do not confirm clinical and anecdotal reports that tinnitus could be related to suicide among Veterans. However, tenets from rehabilitation psychology suggest that the onset of chronic impairment or disability does not predict an individual's subsequent psychological states; other personal attributes may be more influential. Health care professionals, such as audiologists and psychologists, should be cognizant of the associations between tinnitus and mental health issues and be prepared to address the psychological needs of individuals who have tinnitus.

The prevalence of mental disorders in Taiwanese prisons: a nationwide population-based study.

In Taiwan, few studies explored the morbidity of mental disorders among prisoners. The purpose of this study is conducted to estimate the prevalence of mental disorders in Taiwanese prisoners. Based on Nationwide population-based databank, 82,650 prisons were studied for mental disorders. Mental disorders were assessed with the International Classification of Diseases 9th revision Clinical Modification (ICD-9-CM). The prevalence of mental disorders among prisoners was estimated 11.31%. Female prisons exhibited a higher prevalence than males (17.82% vs. 10.56%, p < 0.01). Among all cases that were diagnosed with the contents of mental disorder, anxiety, dissociative and somatoform disorders was the most frequent disease (total: 49.48%, female: 59.42%, male: 47.55%) followed by special symptoms or syndromes (total: 38.24%, female: 33.20%, male: 39.22%), drug dependence (total: 15.41%, female: 9.22%, male: 16.61%), episodic mood disorders (total: 13.56%, female: 26.15%, male: 11.12%), nondependent abuse of drugs (total: 11.23%, female: 2.77%, male: 12.87%) and depressive disorder (total: 11.23%, female: 11.66%, male: 11.14%). A substantial proportion of prisoners reported having mental disorders. The results suggests the necessity of comprehensive assessment and more treatment programs that offer alternatives to incarceration of mental health for the criminal justice system in Taiwan.

Assessing Disparities in the Rates of HCV Diagnoses Within American Indian or Alaska Native Populations Served by the U.S. Indian Health Service, 2005-2015.

Hepatitis C virus (HCV) disproportionately affects American Indians/Alaska Natives (AI/AN). The Indian Health Service (IHS), via federal and tribal health facilities provides medical services to an estimated 2.2million AI/AN people in the United States. HCV diagnoses, defined by International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) codes, were analyzed from 2005 to 2015. Results showed 29,803 patients with an HCV diagnosis; 53.4% were among persons born 1945-1965 and overall HCV burden was higher among males than females. These data will help inform local, regional, and national efforts to address, plan for and carry out a national strategy to provide treatment for HCV infected patients and programs to prevent new HCV infections.

Accuracy of lung cancer ICD-9-CM codes in Umbria, Napoli 3 Sud and Friuli Venezia Giulia administrative healthcare databases: a diagnostic accuracy study

ObjectivesTo assess the accuracy of International Classification of Diseases 9th Revision–Clinical Modification (ICD-9-CM) codes in identifying subjects with lung cancer.DesignA cross-sectional diagnostic accuracy study comparing ICD-9-CM 162.x code (index test)...

The short-term economic burden of gestational diabetes mellitus in Italy

BackgroundThe incidence of Gestational Diabetes Mellitus (GDM) is rising in all developed countries. This study aimed at assessing the short-term economic burden of GDM from the Italian healthcare system perspective.MethodsA model was built over the last pregnancy trimester (i.e., from the 28th gestational week until childbirth included). The National Hospital Discharge Database (2014) was accessed to estimate delivery outcome probabilities and inpatient costs in GDM and normal pregnancies (i.e., euglycemia). International Classification of Disease-9th Revision-Clinical Modification (ICD9-CM) diagnostic codes and Diagnosis-Related Group (DRG) codes were used to identify GDM cases and different types of delivery (i.e., vaginal or cesarean) within the database. Neonatal outcomes probabilities were estimated from the literature and included macrosomia, hypoglycemia, hyperbilirubinemia, shoulder dystocia, respiratory distress, and brachial plexus injury. Additional data sources such as regional documents, official price and tariff lists, national statistics and expert opinion were used to populate the model. The average cost per case was calculated at national level to estimate the annual economic burden of GDM. One-way sensitivity analyses and Monte Carlo simulations were performed to quantify the uncertainty around base case results.ResultsThe amount of pregnancies complicated by GDM in Italy was assessed at 54,783 in 2014 using a prevalence rate of 10.9%. The antenatal outpatient cost per case was estimated at €43.7 in normal pregnancies compared to €370.6 in GDM patients, which is equivalent to a weighted sum of insulin- (14%; €1034.6) and diet- (86%; €262.5) treated women’s costs. Inpatient delivery costs were assessed at €1601.6 and €1150.3 for euglycemic women and their infants, and at €1835.0 and €1407.7 for GDM women and their infants, respectively. Thus, the overall cost per case difference between GDM and normal pregnancies was equal to €817.8 (+ 29.2%), resulting in an economic burden of about €44.8 million in 2014 at national level. Probabilistic sensitivity analysis yielded a cost per case difference ranging between €464.9 and €1164.8 in 80% of simulations.ConclusionsThe economic burden of GDM in Italy is substantial even accounting for short-term medical costs only. Future research also addressing long-term consequences from a broader societal perspective is recommended.