Multivariate Survey Logistic Regression Models Research Articles

Factors Associated With In-Hospital Death Among Pneumonia Patients in US Hospitals From 2016~2019.

Pneumonia is one of the leading causes of hospital admission in the United States with a global health burden of about 6.8 million hospitalizations and 1.1 million deaths in patients over 65 years old in 2015. This study aimed to identify possible patient and hospital-related risk factors for in-hospital pneumonia death across US hospitals. The National Inpatient Sample (NIS) was used to identify nationwide pneumonia patients (n=374 766, weighted n=1 873 828) from 2016 to 2019. We examined the characteristics of the study sample and their association with in-hospital death. Multivariate survey logistic regression models were used to identify risk factors. During the study periods, in-hospital death rates continuously decreased (2.45% in 2016 to 2.19% in 2019). Descriptive statistics showed that patient and hospital factors had varied in-hospital death rates. Survey logistic regression results suggested that male, very low income, non-Medicare, government hospitals, rural hospitals, and specific hospital regions were associated with higher in-hospital death rates than their reference groups. Socioeconomic factors, including income and insurance, are associated with pneumonia mortality. Census region, hospital ownership, and rural location are also related to in-hospital mortality. Such findings in underserved, impoverished, and rural areas to identify possible health disparities.

Is patients' rurality associated with in-hospital sepsis death in US hospitals?

The focus of this study was to explore the association of patients' rurality and other patient and hospital-related factors with in-hospital sepsis mortality to identify possible health disparities across United States hospitals. The National Inpatient Sample was used to identify nationwide sepsis patients (n = 1,977,537, weighted n = 9,887,682) from 2016 to 2019. We used multivariate survey logistic regression models to identify predictors for how patients' rurality is associated with in-hospital death. During the study periods, in-hospital death rates among sepsis inpatients continuously decreased (11.3% in 2016 to 9.9% in 2019) for all rurality levels. Rao-Schott Chi-Square tests demonstrated that certain patient and hospital factors had varied in-hospital death rates. Multivariate survey logistic regressions suggested that rural areas, minorities, females, older adults, low-income, and uninsured patients have higher odds of in-hospital mortality. Further, specific census divisions like New England, Middle Atlantic, and East North Central had greater in-hospital sepsis death odds. Rurality was associated with increased in-hospital sepsis death across multiple patient populations and locations. Further, rurality in New England, Middle Atlantic, and East North Central locations is exceptionally high odds. In addition, minority races in rural areas also have an increased odds of in-hospital death. Therefore, rural healthcare requires a more significant influx of resources and should also include assessing patient-related factors.

Trends and Factors Associated With Ventilator-Associated Pneumonia: A National Perspective.

Background: Ventilator-associated pneumonia (VAP) is a hospital-acquired pneumonia that occurs more than 48 hours after mechanical ventilation. Studies showing temporal trends, predictors, and outcomes of VAP are very limited.Objective: We used the National database to delineate the trends and predictors of VAP from 2009 to 2017.Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) for adult hospitalizations who received mechanical ventilation (MV) by using ICD-9/10-CM procedures codes. We excluded hospitalizations with length of stay (LOS) less than two days. VAP and other diagnoses of interest were identified by ICD-9/10-CM diagnosis codes. We then utilized the Cochran Armitage trend test and multivariate survey logistic regression models to analyze the data.Results: Out of a total of 5,155,068 hospitalizations who received mechanical ventilation, 93,432 (1.81%) developed VAP. Incidence of VAP decreased from 20/1000 in 2008 to 17/1000 in 2017 with a 5% decrease. Patients who developed VAP had lower mean age (59 vs 61; p<0.001) and higher LOS (25 days vs. 12 days; p<0.001). In multivariable regression analysis, we identified that males, African Americans, teaching hospitals and co-morbidities like neurological disorders, pulmonary circulation disorders and electrolyte disorders are associated with the increased odds of developing VAP. VAP was also associated with higher rates of discharge to facilities and increased LOS.Conclusion: Our study identified the trends along with the risk predictors of VAP in MV patients. Our goal is to lay the foundation for further in-depth analysis of this trend for better risk stratification and development of preventive strategies to reduce the incidence of VAP among MV patients.

OUTCOMES OF PATIENTS HOSPITALIZED DUE TO ACUTE EXACERBATION OF COPD AND REQUIRING VENTILATION SUPPORT

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) with respiratory failure has been associated with higher mortality and morbidities. Implementation of Non-invasive ventilation (NIV) in an early stage of AECOPD with acute respiratory failure has been found to reduce the intubation rate and improve the outcomes. IMV comes in use when the patient cannot tolerate NIV or has worsening respiratory failure despite NIV or has other comorbidities. We hypothesized to see trends and temporal changes in outcomes of AECOPD hospitalizations and factors associated with poor outcomes among those who received ventilation support. METHODS: We extracted data from the Nationwide Inpatient Sample (NIS) for the years 2007-2018 for adult hospitalizations due to AECOPD by using International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM) diagnosis codes and ventilation (IMV and NIV) by procedural codes. Primary objective is to study the trends of discharge disposition (in-hospital mortality and discharge to facilities) and predictors of poor outcomes among those who required ventilation. Cochran Armitage trend test and multivariate survey logistic regression models were used to analyze the data using SAS 9.4 software. RESULTS: We extracted a total of 5,673,467 hospitalizations due to acute exacerbation of COPD from 2007-2018, out of which 455,848 (8.0%) required either IMV or NIV. During the study period, overall, in-hospital mortality has reduced (1.8% in 2007 to 0.4% in 2018; ptrend<0.001) which was largely attributed to decline in in-hospital mortality among those who received NIV (6.3% in 2007 to 2.0% in 2018; ptrend<0.001) and IMV (26.6% in 2007 to 16.7% in 2018; ptrend<0.001). We observed similar declining trends for discharge to facilities. Additionally, among those who received NIV or IMV, age above 65, females (OR 1.1; 95%CI 1.1-1.1; p 0.03), Caucasian (OR 1.5; 95%CI 1.4-1.6; p<0.01), urban-non teaching hospitals (OR 1.2; 95%CI 1.1-1.2; p<0.01), IMV (OR 5.6; 95%CI 5.2-6.0; p<0.01), sepsis (OR 3.5,95%CI 3.3-3.9; p<0.01), pneumonia, CHF, renal failure were associated with higher odds of in-hospital mortality. CONCLUSIONS: Over the years, improved outcomes among AECOPD patients were attributed to significant decline in in-hospital mortality and discharge to facilities among those who received NIV and IMV. Additionally, we also identified several demographic and hospital level characteristics associated with poor outcomes among AECOPD patients requiring ventilatory support. CLINICAL IMPLICATIONS: Our study highlights the outcomes trends of AECOPD patients who required ventilatory support in the last decade. Although outcomes have been improved, still several modifiable factors are associated with higher mortality and morbidity which our study has highlighted. Better risk stratification and strategies are required to further improve the outcomes in these complex patient population. DISCLOSURES: No relevant relationships by Faizan Malik, source=Web Response No relevant relationships by MARIO MEKHAIL, source=Web Response No relevant relationships by Achint Patel, source=Web Response No relevant relationships by Kinjalben Patel, source=Web Response No relevant relationships by Aditi Patil, source=Web Response No relevant relationships by Abdur Raheem, source=Web Response No relevant relationships by Harshil Shah, source=Web Response No relevant relationships by Shiv Shah, source=Web Response No relevant relationships by FARAZ Siddiqui, source=Web Response No relevant relationships by vimala thambi, source=Web Response

Utilization Trends and Predictors of Non-invasive and Invasive Ventilation During Hospitalization Due to Community-Acquired Pneumonia.

Background: Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality. Non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) are most important interventions for patients with severe CAP associated with respiratory failure. We analysed utilization trends and predictors of non-invasive and invasive ventilation in patients hospitalized with CAP.Methods: Nationwide Inpatient Sample and Healthcare Cost and Utilization Project data for years 2008-2017 were analysed. Adult hospitalizations due to CAP were identified by previously validated International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. We then utilized the Cochran-Armitage trend test and multivariate survey logistic regression models to analyse temporal incidence trends, predictors, and outcomes. We used SAS 9.4 software (SAS Institute Inc., Cary, NC, USA) for analysing data.Results: Out of a total of 8,385,861 hospitalizations due to CAP, ventilation assistance was required in 552,395 (6.6%). The overall ventilation use increased slightly; however, IMV utilization decreased, while NIV utilization increased. In multivariable regression analysis, males, Asian/others and weekend admissions were associated with higher odds of any ventilation utilization. Concurrent diagnoses of septicemia, congestive heart failure, alcoholism, chronic lung diseases, pulmonary circulatory diseases, diabetes mellitus, obesity and cancer were associated with increased odds of requiring ventilation assistance. Ventilation requirement was associated with high odds of in-hospital mortality and discharge to facility.Conclusion: The use of NIV among CAP patients has increased while IMV use has decreased over the years. We observed numerous factors linked with a higher use of ventilation support. The requirement of ventilation support is also associated with very high chances of mortality and morbidity.

Chronic Periodontitis is Associated With Cerebral Atherosclerosis –A Nationwide Study

IntroductionChronic periodontitis and atherosclerosis share common risk factors and produce the same inflammatory markers. Many studies found a high prevalence of chronic periodontitis in patients with atherosclerosis but there is no strong evidence to support a specific association of chronic periodontitis with cerebral atherosclerosis. We aimed to study the concurrent prevalence and association of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases among the US population.MethodsWe performed a cross-sectional analysis of a Nationwide Inpatient Sample with adult hospitalizations to identify the primary diagnosis of cerebrovascular diseases [acute ischemic stroke (AIS), hemorrhagic stroke (HS), and transient ischemic attack (TIA)] with concurrent cerebral atherosclerosis and chronic periodontitis. Multivariate survey logistic regression models were fitted to evaluate the linkage of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases.ResultsOf total 56,499,788 hospitalizations, 0.01% had chronic periodontitis. Prevalence of chronic periodontitis was higher in 50-64 years (36.18% vs. 23.91%), males (59.19% vs. 41.06% in females), Afro-Americans (25.93% vs. 15.21%), and 0-25th percentile median-household-income-category (38.31% vs. 30.15%) compared to non-chronic periodontitis. There was significantly higher prevalence of cerebral atherosclerosis (0.71% vs. 0.41%; p<0.0001) with weak evidence of high prevalence of cerebrovascular diseases (AIS:2.21% vs. 1.97%; p=0.1563; HS:0.57% vs. 0.46%; p=0.1560) among chronic periodontitis compared to non-chronic periodontitis. In regression analysis, odds of having cerebral atherosclerosis were 2.48-folds higher in patients with chronic periodontitis compared to that without-chronic periodontitis, and cerebral atherosclerosis patients were associated with higher odds of TIA (aOR:2.40; p<0.0001), AIS (aOR:3.35; p<0.0001), and HS (aOR:1.51; p<0.0001) compared to without-cerebral atherosclerosis. No significant relationship between chronic periodontitis and cerebrovascular diseases was observed.ConclusionAlthough chronic periodontitis may not directly increase the risk of cerebrovascular diseases, it increases the burden of cerebrovascular diseases by evidently increasing the risk of cerebral atherosclerosis. Early identification of chronic periodontitis and atherosclerotic risk factors may help to mitigate the risk of cerebrovascular diseases.

TEMPORAL TRENDS AND PREDICTORS OF VENTILATOR-ASSOCIATED PNEUMONIA IN HOSPITALIZED PATIENTS: NATIONAL PERSPECTIVE

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Ventilator-associated pneumonia (VAP) is a hospital acquired pneumonia that occurs more than 48 hours after mechanical ventilation. Previous epidemiological studies reported temporal trends, predictors, and outcomes of VAP based on regional data or in specific subgroups of patients. In our study we used the National database to delineate the trends and predictors of VAP from 2009 to 2017. METHODS: We analyzed data from the Nationwide Inpatient Sample (NIS) for the years 2009-2017 for adult hospitalizations who received mechanical ventilation by using International Classification of Diseases (9th/10th Editions) Clinical Modification Procedural codes (ICD-9-CM/ICD-10-CM) procedures codes. We excluded hospitalizations with length of stay (LOS <2 days). VAP and other diagnosis of interests were identified by ICD-9-CM diagnosis codes and Elixhauser comorbidity software. We then utilized the Cochran Armitage trend test and multivariate survey logistic regression models to analyze temporal incidence trends, predictors. RESULTS: Out of a total 5,155,068 hospitalizations who received mechanical ventilation, 93432(1.81%) developed VAP. Incidence of VAP decreased from 20/1000 in 2008 to 17/1000 in 2017 with 5% decrease (OR 0.95; 95%CI 0.92-0.96; p<0.001). Patients who developed VAP had lower mean age (59 vs 61; p<0.001) and higher LOS (25d Vs. 12d; p<0.001). Furthermore, in multivariable regression analysis, predictors of VAP are males(OR 1.4; 95% CI 1.35-1.45; p<0.0001) and African Americans (OR 1.22; 95% CI 1.14-1.31;p<0.001), paralysis (OR 2.1; 95% CI 2.02-2.21; p<0.001) and congestive heart failure (OR 1.22; CI 1.17-1.27; p<0.0001). Also, age < 65, teaching hospital status and co-morbidities like neurological disorders, pulmonary circulation disorders, anemia and electrolyte disorders are associated with the increased odds of developing VAP. Amongst the patients who developed VAP, 62% were discharged to long term facilities and 19% died during the hospitalization. CONCLUSIONS: In this nationally representative study, we observed incidence of VAP has been decreasing in the last decade. We were also able to delineate several factors that were associated with development of VAP, which are potentially modifiable. CLINICAL IMPLICATIONS: There has been a paucity of nationwide data regarding VAP in the U.S.. Our study identified the trends along with the modifiable or non-modifiable risk predictors of VAP in MV patients. Our goal is to lay foundation for further in-depth analysis of this trend for better risk stratification and development of preventive strategies to further reduce the incidence of VAP among MV patients. DISCLOSURES: No relevant relationships by TANVEER DABRIA, source=Web Response No relevant relationships by Wonkyung Hur, source=Web Response no disclosure on file for Preetam Jolepalem; No relevant relationships by Faizan Malik, source=Web Response No relevant relationships by Uvesh Mansuri, source=Web Response No relevant relationships by Achint Patel, source=Web Response No relevant relationships by Hafsa Sabzposh, source=Web Response No relevant relationships by Harshil Shah, source=Web Response No relevant relationships by Chail Shah, source=Web Response

EPIDEMIOLOGY OF CRITICAL ILLNESS MYOPATHY AND POLYNEUROPATHY IN MECHANICALLY VENTILATED PATIENTS

SESSION TITLE: Advances in the Care of Mechanically-Ventilated Patients SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Critical-illness myopathy and polyneuropathy (CIMP) is a condition causing significant morbidity and mortality amongst patients admitted to the critical care units. CIMP can either be a single factor, or may be associated with concomitant risk factors. It can lead to failed weaning trials and longer duration of Mechanical Ventilation (MV). We aimed to estimate the temporal trends and predictors of CIMP in hospitalized patients receiving MV using a nationally representative database for the last decade. METHODS: Study cohort is derived from the Nationwide Inpatient Sample (NIS) for the years 2008-2017. Adult hospitalizations with length of stay (LOS) ≥7 days and who received mechanical ventilation were identified using International Classification of Diseases (9th/10th Editions) Clinical Modification (ICD-9/10-CM) procedures codes. CIMP and other diagnosis of interests were identified by either ICD-9/10-CM diagnosis codes or Elixhauser comorbidity software. We then utilized the Cochran Armitage trend test and multivariate survey logistic regression models to analyze temporal incidence trends, predictors, and outcomes. RESULTS: Out of a total 5,846,573 hospitalizations who had LOS ≥7 days and received mechanical ventilation, 71684(1.23%) developed CIMP. Incidence of CIMP increased from 5/1000 in 2008 to 19/1000 in 2017 with 13% yearly increase (OR 1.13; 95%CI 1.1-1.5; p<0.001). Patients who developed CIMP had lower mean age (61 vs 63; p<0.001) and higher LOS (31d Vs. 19d, p<0.001). Furthermore, in multivariable regression analysis, predictors of CIMP are female sex (OR 1.1; 95%CI 1.1-1.2; p<0.0001) and caucasian race (OR 1.5; 95%CI 1.4-1.6;p<0.001), on-Teaching Hospital (OR 1.2; 95%CI 1.1-1.3; p<0.005), MV ≥ 96 hours (OR 2.3; CI 2.1-2.4; p<0.0001), ventilator associated pneumonia (OR 1.6; 95%CI 1.5-1.8; p<0.0001), Septicemia (OR 1.5; 95%CI 1.5-1.6; p<0.0001), weight loss (OR 1.5; 95%CI 1.5-1.6; p<0.0001) and electrolyte imbalance (OR 1.4; 95%CI 1.3- 1.4; p<0.0001). Amongst the patients who developed CIMP, 69.47% were discharged to long term facilities and 14.7% died during the hospitalization. CONCLUSIONS: In this nationally representative study, we observed that the incidence of CIMP has been increasing. We identified several risk factors strongly associated with development of CIMP, some of which may be potentially modifiable. CLINICAL IMPLICATIONS: Our study highlights the need for early diagnosis, better risk stratification and need for complex long-term care in these vulnerable patients. Further studies are warranted to consider factoring some of the modifiable factors into account and to ameliorate the incidence and outcomes of CIMP. DISCLOSURES: No relevant relationships by Mohammed Abdulqader, source=Web Response No relevant relationships by Sohiel Deshpande, source=Web Response no disclosure on file for Preetam Jolepalem; No relevant relationships by Varshitha Kondapaneni, source=Web Response No relevant relationships by Faizan Malik, source=Web Response No relevant relationships by Uvesh Mansuri, source=Web Response No relevant relationships by Achint Patel, source=Web Response No relevant relationships by Harshil Shah, source=Web Response No relevant relationships by Venus Sharma, source=Web Response

TRENDS AND PREDICTORS OF DISSEMINATED INTRAVASCULAR COAGULATION AMONG HOSPITALIZATIONS DUE TO SEPTICEMIA: EVIDENCE FROM PAST DECADE

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Septicemia is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Disseminated Intravascular Coagulation (DIC) is a severe complication of sepsis associated with increased mortality and morbidity. We aim to analyze the trends and predictors of DIC in septicemia from a large national database to estimate current epidemiology and modifiable or non-modifiable risk predictors. METHODS: Study cohort is derived from the Nationwide Inpatient Sample (NIS) for the years 2008-2017. Adult Hospitalizations due to septicemia were identified using International Classification of Diseases (9th/10th Editions) Clinical Modification Procedural codes (ICD-9-CM/ICD-10-CM) procedures codes. We excluded patients with pregnancy related diagnoses. DIC and other diagnosis of interests were identified by ICD-9/10-CM diagnosis codes and Elixhauser comorbidity software. We then utilized the Cochran Armitage trend test and multivariate survey logistic regression models to analyze temporal incidence trends, and predictors. RESULTS: Out of a total 12,820,000 hospitalizations who had septicemia, 153,181(1.18%) was complicated by DIC. Proportion of DIC decreased from 1.6% in 2008 to 0.8% in 2017 with 6% decrease (OR 0.94; 95%CI 0.93-0.94; p<0.001) over the study years. Patients who developed DIC had lower mean age (63 vs 67; p<0.001) and were more likely to be females (53% vs 47%, p<0.001). In multivariable regression analysis, predictors of increased DIC are female sex (OR 1.20; 95%CI 1.17-1.23; p<0.0001), Asian/Other races (OR 1.08; 95%CI 1.02-1.11; p=0.008) and Uninsured/Self Pay (OR 1.19; 95%CI 1.13-1.25; p<0.001). Also, patients with concurrent diagnoses such as Pulmonary circulatory diseases (OR 1.23; 95%CI 1.16-1.29; p<0.001), Congestive Heart Failure, Hypertension, Diabetes Mellitus, Renal Failure, Liver Failure, Obesity and Anemia were at the increased odds of developing DIC. CONCLUSIONS: We observed that incidence of DIC in septicemia hospitalizations has decreased over the last decade. Multiple risk factors association have been identified with the development of DIC in septicemia, some of which are potentially modifiable. CLINICAL IMPLICATIONS: Our study advocates the need for early diagnosis and better risk stratification of patients with Septicemia who develop DIC during hospitalization. Further in-depth studies are warranted to understand the causality of some of the potentially modifiable risk factors which were identified in our study. Over the long term, this may help mitigate the incidence of DIC in septicemia hospitalizations even further. DISCLOSURES: No relevant relationships by Vaghdevi Bagam, source=Web Response No relevant relationships by Pawandeep Kaur, source=Web Response No relevant relationships by Hira Khan, source=Web Response No relevant relationships by Faizan Malik, source=Web Response No relevant relationships by Uvesh Mansuri, source=Web Response No relevant relationships by Safala Maskey, source=Web Response No relevant relationships by Achint Patel, source=Web Response No relevant relationships by Harshil Shah, source=Web Response No relevant relationships by jasvinder singh, source=Web Response No relevant relationships by Shreenivas Ashok Sreenivasan, source=Web Response

Sleep Latency in Men and Sleep Duration in Women Can Be Frailty Markers in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS).

To test whether sleep disturbances are associated with frailty in older men and women. Cross-sectional analysis of cohort study data. The participants were 1168 community-dwelling older adults aged 70 to 84 years who took part in the Korean Frailty and Aging Cohort Study and completed both self-reported sleep parameters and assessment of frailty. Univariate and multivariate survey logistic regression models were used to calculate odds ratios (OR) with 95% confidence intervals (CI) for frailty. Frailty was defined using the Fried's criteria. Frailty was associated with sleep latency in men. The odds ratio for this association was 3.39 (95% CI 1.31-8.76) after adjusting for age, body mass index (BMI), physical activity, and select comorbidities, and 2.16 (95% CI 0.75-6.23) after further adjusting for depression. Frailty was associated with long sleep duration of more than 8 hours a night in women. The odds ratio for this association was 3.95 (95% CI, 1.27-12.33) after adjusting for age, BMI, physical activity, select comorbidities, and the number of medications. Prolonged sleep latency (≥60 minutes) in men and long sleep duration (>8hr per night) in women were each independently associated with higher odds of frailty. Long sleep latency in elderly men and long sleep duration in elderly women may suggest they have a high chance of frailty.

Association between involuntary weight loss with low muscle mass and health-related quality of life in community-dwelling older adults: Nationwide surveys (KNHANES 2008–2011)

To investigate the relationship between involuntary weight loss with low muscle mass and health-related quality of life in a large representative sample of older adults. A nationwide cross-sectional study based on data from the Korea National Health and Nutritional Examination Survey, 2008 to 2011. Study participants included 2249 individuals aged ≥70 years. The participants reported an unintentional weight loss >3 kg in the past year. Appendicular lean mass was measured using dual-energy X-ray absorptiometry and calculated with the appendicular lean mass index. Health-related quality of life was measured using the EuroQol-5 dimension (EQ-5D) instrument. Univariate and multivariate survey logistic regression models were used to calculate odds ratios (OR) with 95% confidence intervals (95% CI) for the lowest quintile of the EQ-5D index. In total, 39.1% of participants were male and 60.9% were female. The weighted mean age was 75.6 years (95% CI; 75.3-75.9). Clinically significant weight loss is typically 5% of one's body weight; average, 2.8 kg (3.1 kg for men; 2.7 kg, women) for our participants. Compared with the normal reference group and after adjusting for potential confounders, the ORs for the lowest quintile of the EQ-5D indices were 1.39 (95% CI, 0.92-2.10), 2.56 (95% CI, 1.56-4.18), and 3.40 (95% CI, 2.05 to 5.63) for the low muscle mass, involuntary weight loss, involuntary weight loss with low muscle mass groups, respectively. Involuntary weight loss combined with low muscle mass was more closely associated with poor quality of life than involuntary weight loss alone in community-dwelling older adults.

Prevalence, comorbidities and mortality of toxic shock syndrome in children and adults in the USA.

Toxic Shock Syndrome (TSS), a superantigen-mediated illness, is characterized by rash, hypotension and multi-organ dysfunction. Predictors of TSS and related morbidity and mortality are poorly defined. In this study, data on 61,959,084 hospitalizations from the 2003-2012 Nationwide Inpatient Sample, a 20% stratified sample of US hospitalizations, were analyzed and ICD-9-CM coding used to identify 4491 hospitalizations with a diagnosis of TSS. Incidence, in-hospital mortality rate, comorbidities, length of stay and costs of care attributable to TSS were determined. In multivariate survey logistic regression models, TSS was associated with female sex (adjusted odds ratio [95% confidence interval], 1.54 [1.48-1.60]), younger age (0-17 years, 2.17 [2.06-2.29]; 40-59: 0.53 [0.50-0.56]; 60-79: 0.28 [0.26-0.30]; 80+: 0.13 [0.11-0.14] compared with 18-39) and race/ethnicity (black, 0.63 [0.59-0.67]; Hispanic: 0.60 [0.56-0.64]; Asian, 1.11 [1.00-1.11]; and other, 0.83 [0.75-0.92] compared with white). Patients with TSS had a three-fold greater cost of care (mean: $36,656 ± 942) and length of stay (LOS) (mean: 10.65 ± 0.23 days) than patients without TSS. Shared predictors of increased LOS and costs in patients with TSS were male sex; age 40-79 years; Black, Hispanic, Asian and other race/ethnicity; and more than one chronic condition. Predictors of in-hospital mortality included respiratory failure (13.66 [11.37-16.43]), liver disease/failure (3.36 [2.59-4.34]), chickenpox (91.26 [27.74-300.25]), coagulopathy (2.14 [1.85-2.48]), and higher age. In conclusion, there are significant racial/ethnic, socioeconomic, and comorbid disparities in the incidence and mortality of TSS in adults and children in the USA.

Cardiovascular comorbidities of pediatric psoriasis among hospitalized children in the United States

Psoriasis has been shown to be associated with cardiovascular disease in adults. Little is known about cardiovascular risk in pediatric psoriasis. To determine if there is an association between pediatric psoriasis and cardiovascular comorbidities. Data were analyzed from the 2002-2012 Nationwide Inpatient Sample, which included 4,884,448 hospitalized children aged 0-17years. Bivariate and multivariate survey logistic regression models were created to calculate the odds of psoriasis on cardiovascular comorbidities. In multivariate survey logistic regression models adjusting for age, sex, and race/ethnicity, pediatric psoriasis was significantly associated with 5 of 10 cardiovascular comorbidities (adjusted odds ratio [95% confidence interval]), including obesity (3.15 [2.46-4.05]), hypertension (2.63 [1.93-3.59]), diabetes (2.90 [1.90-4.42]), arrhythmia (1.39 [1.02-1.88]), and valvular heart disease (1.90 [1.07-3.37]). The highest odds of cardiovascular risk factors occurred in blacks and Hispanics and children ages 0-9years, but there were no sex differences. The study was limited to hospitalized children. We were unable to assess the impact of psoriasis treatment or family history on cardiovascular risk. Pediatric psoriasis is associated with higher odds of multiple cardiovascular comorbidities among hospitalized patients. Strategies for mitigating excess cardiovascular risk in pediatric psoriasis need to be determined.

Comorbidities and inpatient mortality for pemphigus in the U.S.A.

The morbidity and mortality associated with pemphigus and its treatments have not been fully described. Previous studies have found conflicting results about certain comorbidities and were limited by small sample sizes. To determine the morbidity and mortality from pemphigus and its treatments in the U.S.A. We examined a cross-sectional cohort of 87 039 711 hospitalized patients in the U.S.A. to determine the inpatient comorbidities and mortality of pemphigus. In multivariate survey logistic regression models adjusting for age, sex and race/ethnicity, pemphigus and its treatments were associated with 39 of 122 comorbidities examined. The disorders most strongly associated with pemphigus were Cushing syndrome [adjusted odds ratio (OR) 17·23, 95% confidence interval (CI) 2·41-122·90], adrenal insufficiency (4·08, 1·71-9·73), myasthenia gravis (6·92, 2·55-18·79), mucositis (17·19, 7·73-38·22), herpes infection (7·98, 3·62-17·62), fungal infections (4·03, 3·60-4·52), insomnia (18·02, 2·46-131·88) and hidradenitis (5·34, 1·33-21·43). Among malignancies, only leukaemia (OR 1·56, 95% CI 1·08-2·24) and non-Hodgkin lymphoma (1·52, 1·15-2·03) were associated with pemphigus, but not any solid organ malignancies. Patients with a secondary diagnosis of pemphigus had higher inpatient mortality (3·20%, 95% CI 2·71-3·69) than those with a primary (1·60%, 1·29-1·91) or no (1·78%, 1·78-1·78) diagnosis of pemphigus (P < 0·001). Pemphigus is associated with increased inpatient mortality, likely through its association with numerous comorbid health conditions. Patients with pemphigus require improved access to dermatological care and increased screening for the myriad of comorbidities.

Associations of Physical Activity and Sedentary Behavior with Atopic Disease in United States Children

To determine if eczema, asthma, and hay fever are associated with vigorous physical activity, television/video game usage, and sports participation and if sleep disturbance modifies such associations. Data were analyzed from 2 cross-sectional studies including 133 107 children age 6-17years enrolled in the 2003-2004 and 2007-2008 National Survey of Children's Health. Bivariate and multivariate survey logistic regression models were created to calculate the odds of atopic disease and atopic disease severity on vigorous physical activity, television/video game use, and sports participation. In multivariate logistic regression models controlling for sociodemographic factors, lifetime history ofasthma was associated with decreased odds of ≥1days of vigorous physical activity (aOR, 0.87; 95% CI, 0.77-0.99) and decreased odds of sports participation (0.91; 95% CI, 0.84-0.99). Atopic disease accompanied by sleep disturbance had significantly higher odds of screen time and lower odds of sports participation compared with children with either atopic disease or sleep disturbance alone. Severe eczema (aOR, 0.39; 95% CI, 0.19-0.78), asthma (aOR, 0.29; 95% CI, 0.14-0.61), and hay fever (aOR, 0.48; 95% CI, 0.24-0.97) were allassociated with decreased odds of ≥1days of vigorous physical activity. Moderate (aOR, 0.76; 95% CI,0.57-0.99) and severe eczema (aOR, 0.45; 95% CI, 0.28-0.73), severe asthma (aOR, 0.47; 95% CI, 0.25-0.89), and hay fever (aOR, 0.53; 95% CI, 0.36-0.61) were associated with decreased odds of sports participation in the past year. Children with severe atopic disease, accompanied by sleep disturbance, have higher risk of sedentary behaviors.

Eczema Is Associated with Childhood Speech Disorder: A Retrospective Analysis from the National Survey of Children's Health and the National Health Interview Survey

To determine if eczema is associated with an increased risk of a speech disorder. We analyzed data on 354,416 children and adolescents from 19 US population-based cohorts: the 2003-2004 and 2007-2008 National Survey of Children's Health and 1997-2013 National Health Interview Survey, each prospective, questionnaire-based cohorts. In multivariate survey logistic regression models adjusting for sociodemographics and comorbid allergic disease, eczema was significantly associated with higher odds of speech disorder in 12 of 19 cohorts (P < .05). The pooled prevalence of speech disorder in children with eczema was 4.7% (95% CI 4.5%-5.0%) compared with 2.2% (95% CI 2.2%-2.3%) in children without eczema. In pooled multivariate analysis, eczema was associated with increased odds of speech disorder (aOR [95% CI] 1.81 [1.57-2.05], P < .001). In a single study assessing eczema severity, mild (1.36 [1.02-1.81], P = .03) and severe eczema (3.56 [1.70-7.48], P < .001) were associated with higher odds of speech disorder. History of eczema was associated with moderate (2.35 [1.34-4.10], P = .003) and severe (2.28 [1.11-4.72], P = .03) speech disorder. Finally, significant interactions were found, such that children with both eczema and attention deficit disorder with or without hyperactivity or sleep disturbance had vastly increased risk of speech disorders than either by itself. Pediatric eczema may be associated with increased risk of speech disorder. Further, prospective studies are needed to characterize the exact nature of this association.

Hotspots of Malaria Transmission in the Peruvian Amazon: Rapid Assessment through a Parasitological and Serological Survey.

BackgroundWith low and markedly seasonal malaria transmission, increasingly sensitive tools for better stratifying the risk of infection and targeting control interventions are needed. A cross-sectional survey to characterize the current malaria transmission patterns, identify hotspots, and detect recent changes using parasitological and serological measures was conducted in three sites of the Peruvian Amazon.Material and MethodsAfter full census of the study population, 651 participants were interviewed, clinically examined and had a blood sample taken for the detection of malaria parasites (microscopy and PCR) and antibodies against P. vivax (PvMSP119, PvAMA1) and P. falciparum (PfGLURP, PfAMA1) antigens by ELISA. Risk factors for malaria infection (positive PCR) and malaria exposure (seropositivity) were assessed by multivariate survey logistic regression models. Age-specific seroprevalence was analyzed using a reversible catalytic conversion model based on maximum likelihood for generating seroconversion rates (SCR, λ). SaTScan was used to detect spatial clusters of serology-positive individuals within each site.ResultsThe overall parasite prevalence by PCR was low, i.e. 3.9% for P. vivax and 6.7% for P. falciparum, while the seroprevalence was substantially higher, 33.6% for P. vivax and 22.0% for P. falciparum, with major differences between study sites. Age and location (site) were significantly associated with P. vivax exposure; while location, age and outdoor occupation were associated with P. falciparum exposure. P. falciparum seroprevalence curves showed a stable transmission throughout time, while for P. vivax transmission was better described by a model with two SCRs. The spatial analysis identified well-defined clusters of P. falciparum seropositive individuals in two sites, while it detected only a very small cluster of P. vivax exposure.ConclusionThe use of a single parasitological and serological malaria survey has proven to be an efficient and accurate method to characterize the species specific heterogeneity in malaria transmission at micro-geographical level as well as to identify recent changes in transmission.

Association between eczema and stature in 9 US population-based studies.

Atopic dermatitis (eczema) is a chronic inflammatory disorder that is associated with other chronic diseases (eg, asthma), major quality-of-life impairment, sleep disturbance, and the use of potent topical and sometimes systemic corticosteroids, all of which might affect growth in childhood and adolescence. However, previous smaller-scale studies found conflicting results. To determine whether eczema is associated with short stature. We used data from 9 US population-based studies, including the National Survey of Children's Health (2003-2004 and 2007-2008), National Health Interview Survey (children's health, 2008-2012; adult health, 2010 and 2012), and National Health and Nutrition Examination Survey (2003-2004 and 2005-2006). Participants included 264 326 children and adolescents and 83 511 adults. History of eczema. Percentiles of height for age and sex in children and height in adults. We constructed multivariate survey linear or logistic regression models for individual studies with Box-Cox transformed or dichotomized height, respectively. Pooled analyses used generalized linear mixed models. Overall, eczema was not associated with significant differences of height (continuous or <5th or <25th percentiles) in any of the studies or in the pooled analyses. We found a significant interaction by age, such that eczema was associated with shorter stature at 12 to 13 but not 14 to 15 or 16 to 17 years of age or in adulthood. Moderate to severe eczema was associated with shorter stature (continuous and <25th percentile). In particular, short stature (<5th percentile) was associated with eczema only when accompanied by an indicator of insufficient sleep (ie, 0 to 3 nights of sufficient sleep per week) (1.3% of children with eczema) but was not associated with asthma, hay fever, or use of prescription medication. The interaction between eczema and insufficient sleep remained significant at 10 to 11 years of age (P = .003) but not at other ages (P > .08 for all). Eczema is not associated with short stature overall. However, a small subset of children and adolescents with severe eczema accompanied by prominent insufficient sleep may have potentially reversible vertical growth impairment.

Association between climate factors, pollen counts, and childhood hay fever prevalence in the United States

Climate factors and pollen counts may play a role in hay fever. We sought to determine the impact of specific climate factors and pollen counts on the US prevalence of hay fever and statewide variation in prevalence. We used a merged analysis of the 2007 National Survey of Children's Health from a representative sample of 91,642 children aged 0 to 17 years and the 2006-2007 National Climate Data Center and Weather Service measurements of relative humidity (%), indoor heating degree days, precipitation, Palmer Hydrological Drought Index, clear sky and issued ultraviolet indices, stratospheric ozone levels, and outdoor air temperature and National Allergy Bureau total pollen counts. Multivariate survey logistic regression models controlled for sex, race/ethnicity, age, household income, and birthplace. The US prevalence of hay fever in childhood was 18.0% (95% CI, 17.7% to 18.2%), with the highest prevalence in southeastern and southern states. Hay fever prevalence was significantly lower with second and third quartile mean annual relative humidity (logistic regression, P ≤ .01 for both), fourth quartile mean annual Palmer Hydrological Drought Index (P = .02), third and fourth quartile mean annual heating degree days (P < .0001 for both), and third and fourth quartile mean annual stratospheric ozone levels but increased with second, third, and fourth quartile mean annual temperature (P ≤ .02 for both), fourth quartile mean annual precipitation (P = .0007), mean total pollen counts (P = .01), and second, third, and fourth quartile issued ultraviolet index (P ≤ .0001 for all). Principal-component analysis was also used to determine the combined effects of correlated climate variables and pollen counts. This study provides evidence of the influence of climate on the US prevalence of childhood hay fever.

Associations of childhood eczema severity: a US population-based study.

Little is known about the predictors of eczema severity in the US population. We sought to determine the distribution and associations of childhood eczema severity in the United States. We analyzed the data from the 2007 National Survey of Children's Health, a prospective questionnaire-based study of a nationally representative sample of 91,642 children (range, 0-17 years). The prevalence of childhood eczema was 12.97% (95% confidence interval [95% CI], 12.42-13.53); 67.0% (95% CI, 64.8-69.2) had mild disease, 26.0% (95% CI, 23.9-28.1) had moderate disease, and 7.0% (95% CI, 5.8-8.3) had severe disease. There was significant statewide variation of the distribution of eczema severity (Rao-Scott χ, P = 0.004), with highest rates of severe disease in Mid-Atlantic and Midwestern states. In univariate models, eczema severity was increased with older age, African American and Hispanic race/ethnicity, lower household income, oldest child in the family, home with a single mother, lower paternal/maternal education level, maternal general health, maternal/paternal emotional health, dilapidated housing, and garbage on the streets. In multivariate survey logistic regression models using stepwise and backward selection, moderate-to-severe eczema was associated with older age, lower household income, and fair or poor maternal health but inversely associated with birthplace outside the United States. These data indicate that environmental and/or lifestyle factors play an important role in eczema severity.