Nationwide Trends Research Articles

Nationwide trends in the use of ADHD medications in the period 2006–2022: a study from the Norwegian prescription database

BackgroundThe use of medication for Attention-Deficit/Hyperactivity Disorder (ADHD) increased globally throughout the early 2000s. This study examine trends in prevalences and incidences of medication use in Norway from 2006 to 2022.MethodsData from the Norwegian Prescription Database were used to present one-year-prevalence and incidence rates of ADHD medication (ATC-group N06BA and C02AC02) for the overall population (ages 6–64) and within sex and age subgroups of children (ages 6–17) and adults (ages 18–64). Incident use was defined as the dispensing of medication, with no recorded use in the previous two calendar years.ResultsThe overall prevalence of ADHD medication use in 6- to 64-year-olds increased from 5.2 to 19.4 per 1000 in the period, most pronounced from 2020 and onwards. While males experienced a nearly threefold increase in use (from 7.3 to 20.6 per 1000), the use among females increased almost sixfold during the study period (from 3.0 to 18.1 per 1000). Consequently, the male-to-female prevalence-ratio decreased from 2.4 to 1. Children exhibited a higher prevalence of use compared to adults throughout the period, although the largest relative increase was observed in adults, particularly in female adults. In children the male-to-female ratio decreased from 3.2 to 2.0, primarily due to an increasing use in 13–17-year-old females. Among adults, prevalences were similar across most age groups, with the highest rates observed among those aged 18–24, where female use exceeded male use by the end of the period. The male-to-female prevalence-ratio in adults decreased from 1.6 to 0.9 during the period. Parallel to prevalent use, overall incident use increased from 1.4 to 5.0 per 1000 during the period, with the most pronounced increase occurring from 2020 and onwards. From this point, incident use among females aged 13–17, 18–24, and 25–34, exceeded that of males. The male-to-female incidence-ratio decreased from 1.8 to 0.9. The overall incidence to prevalence ratio remained similar throughout the period, being 0.27 in 2006 and 0.25 in 2022.ConclusionA sustained increase in the prevalence of ADHD medication use was observed, with the most pronounced rise occurring among females and adults from 2020 and onwards. By 2022, the overall gender disparity in ADHD medication use had diminished, which should be considered in the context of a steep increase in incident use among adolescent and young adult females starting from 2020.

Nationwide trends in utilization and safety of ventricular arrythmia ablation in patients with hypertrophic cardiomyopathy

Abstract Background Catheter ablation for ventricular arrhythmias, including ventricular tachycardia (VT) and premature ventricular complexes (PVC) is increasingly utilized across the nation, while data on its safety in Hypertrophic Cardiomyopathy (HCM) patients is sparse. Purpose To analyze the nationwide trends in utilization and complications of inpatient ventricular arrhythmia ablations in patients with HCM. Methods This study is a retrospective analysis of hospitalizations, in HCM patients 18 years of age and older, who underwent an inpatient VA ablation in the U.S., between 2016 and 2020. We drew data from the National Inpatient Sample (NIS) database. Patients without HCM undergoing the CA for VA were used as controls. Baseline sociodemographic and clinical data, procedural complications, mortality and length of stay were analyzed. Multivariable analysis was performed to identify independent predictors of procedural complications. Results Among a weighted total of 2880 patients hospitalized between 2016 and 2020, who underwent VA ablations, the median age was 67 years (IQR 56-74), 60% were male, and 73% were white. The HCM group had similar age distribution but more women (64.5% vs 33.6%, p<0.001) and more African Americans (13.2% vs. 7.3%, p=0.03). The non-HCM cohort had significantly higher rates of prior myocardial infarction (22% vs 12.4%, p=0.026), ischemic cardiomyopathy (30.1% vs 0.8%, p<0.001), heart failure (70.5% vs 39.7%, p<0.001), and peripheral vascular disease (PVD, 42.9% vs 18.2%, p<0.001). This was reflected in higher Deyo Comorbidity Index in the non-HCM cohort (score of ≥ 2 in 66.6% vs 43%, p<0.001). Overall, the real-world peri-procedural complication rate in the entire cohort was 15.3%, including 6.4% hemorrhagic, 4.5% pericardial, and 2.3% vascular complications. There was a trend for lower complication rate in the HCM group (9.9% vs. 16.7%, p = 0.08). The in-hospital mortality didn’t defer (1.7% vs. 4.2%, p=0.28) and the length of stay was shorter in the HCM group (3.5 vs. 6.4 days, p < 0.001). Multivariable logistic regression analysis showed obesity (OR 2.06; 95%CI: 1.59 - 2.67; p<0.001) and PVD (OR 2.19; 95%CI: 1.34-3.53; p=0.001) to be independent predictors of complications while HCM was not (OR 0.76, 95% CI 0.51-1.14, p = 0.195). Conclusion Real-world data from a nationwide inpatient database shows comparable safety for VA ablation in HCM patients with similar mortality and lower length of stay, compared to non-HCM patients.

Nationwide trends in blood pressure control among those with and without diabetes in England over last 2 decades: Health Survey of England 2003-2019

Abstract Diabetes and hypertension are both risk factors for cardiovascular disease (CVD), and often co-exist. Over recent decades practice guidance and health policy efforts have been made to improve population wide blood pressure (BP) control, particularly amongst those with diabetes, to reduce CVD. However, the nationwide impact of these ongoing efforts is yet to be documented comprehensively in England. We used data from 11 serial nationally representative health surveys of England between 2003 and 2019 and compared BP control and presence of untreated hypertension amongst those with and without diabetes. These cross-sectional, randomly sampled surveys included 94,100 individuals cumulatively. We applied sample weights, accounting for oversampling and survey nonresponse, and transformations mitigating for survey equipment changes during this period. We used ‘period definitions’ to define those with diabetes and quantify BP control at the time of each coinciding survey, facilitating accurate comparison of trends over the sixteen-year period, while accounting for changes in understanding, variations in definitions, and shifts in medical practices. Python and STATA were used to conduct analyses and Join Point regression software was used to develop and compare trends. In England, from 2003-2019, the prevalence of hypertension amongst those with diabetes and without diabetes decreased from 74.4% to 66.5% and from 32.6% to 27.1% (7.9% vs. 5.5%), respectively. This corresponded to reductions in population-wide mean systolic (S) and diastolic (D) BPs: compared to those without diabetes, those with diabetes had greater reduction in both SBP (7.9mmHg vs. 4.8mmHg) and DBP (2.7mmHg vs. 1.9mmHg) (Figure1). Both groups showed similar temporal improvement in BP-control amongst those with diagnosed hypertension, with those with diabetes showing better improvement in BP control compared to those without diabetes (14% vs. 12%). There was a significant difference in proportions of those with undiagnosed (unaware) hypertension amongst those with and without diabetes (11.4% vs. 30.0% respectively) (Figure2). Notably, there was no change in proportion of those with hypertension unaware about the condition (i.e. detection rate for hypertension in either of the group did not show any improvement over time). These results suggest that we have been able to improve BP control over this period amongst those with and without diabetes, however, those without diabetes (more than 90% of population) have shown significantly poorer improvement. In addition, around one third of hypertensive patients amongst the no-diabetes group are unaware of the condition, and overall, the detection rates for hypertension in both groups have not improved in the last two decades. Lessons learnt from improving BP control amongst those with diabetes should be applied across the entire population, and newer strategies need to develop to improve detection of those with hypertension and are unaware.

Nationwide trends and incidence of blindness in patients with diabetic retinopathy identified using an age-period-cohort analysis.

To estimate the epidemiologic trends of blindness in patients with diabetic retinopathy (DR) and investigate the age-, period-, and cohort-specific effects on blindness. A total of 2.5 million patients with DR aged 20 years or older were included from the Korean National Health Claims database from 2005 to 2019. Non-proliferative DR/ proliferative DR (NPDR/PDR) cohorts were constructed separately. Participants were identified as having a blindness in at least one eye. The incidence of blindness were calculated using a log-linear Poisson age-period-cohort (APC) analysis model, each effect on blindness were estimated for each study group. The incidence of blindness was 1326.62 per 100,000 in the NPDR group and 3397.57 in the PDR group. The blindness rate sharply decreased after 2011, with annual decreases of 5.6% and 4.4% in the NPDR and the PDR groups, respectively. People born between 1920 and 1930 had the highest overall risk of blindness, with the risk decreasing rapidly after that. For those born after 1980, the risk started to increase in both sexes. Among the APC models, the combination model of age, period, and cohort effects showed the highest explanatory power (0.96). In this nationwide long-term study, blindness in DR was not due to a single epidemiologic cause but rather a combination of biological age, social determinants, and healthcare policies. The increased risk of blindness in individuals in their 20 s and 30 s may even increase in the future and should not be ignored. Therefore, vigilance of younger patients is recommended.

Nationwide trends in the suicide mortality among the disabled in Korea from 2006 to 2017

Abstract Aims The disabled are one of the priority populations at risk of suicide, but there has been no study of the factors influencing suicide mortality among the disabled in South Korea. Methods To analyze age-standardized suicide mortality (ICD-10 Codes, X60-84) for each year according to the presence, severity and type of disability, we linked three population datasets (National Health Insurance Claims Database, Disability Registry, and Deaths by Cause). Our dataset covers the entire population of South Korea, extended over a 12-year period from 2006 to 2017. The analyses were stratified by sex, and hazard ratios for suicide were determined by multivariate logistic regression after adjustment for socio-demographic and clinical variables. Results The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. The highest suicide rates were observed among intellectual or mental disabled, and severe disabled. In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female. Conclusions Although the disabled people’s suicide is often seen as an individual problem, it actually affects their families, communities and society. Therefore, government must strive to emphasize the broad view of the disabled population - not just the health of individuals, and track suicide trends and identifying risk and protective factors for suicidal behavior. From this information, suicide prevention strategies for the disabled people should be evaluated to identify the most effective interventions. Financial support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (No. 2022R1I1A3070074, and 2022R1I1A1A01068449), and a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health & Welfare, Republic of Korea (No. HC23C016500). Key messages • The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. • In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.

Nationwide trends in major cardiovascular risk factors in England in the last 2 decades: Health Survey of England 2003-2019

Abstract Cardiovascular disease (CVD) accounts for a quarter of deaths annually in the UK, with more than 7.6 million people living with the disease. Hypertension, diabetes, and obesity are among the most prevalent modifiable risk factors for CVD, and the strategies to reduce the incidence and prevalence of these CV risk factors are deemed the most effective to reduce this immense toll. In the UK, over the last few decades, several health policy decisions and pathways have been developed to reduce this toll. We used data from 11 nationally representative, cross-sectional surveys from the Health Survey of England between 2003 and 2019 to evaluate trends in the prevalence of these CV risk factors and whether there has been any population-wide improvement in them. These surveys have cumulative information on 94,100 adults, and we applied sample weights, accounting for oversampling and nonresponse. We used "period definitions and cut-offs" to define those with diabetes. For example, for undiagnosed diabetes, we used glycated haemoglobin cut-off equivalent of 7% or more for years before 2011 and the current diagnostic threshold of > 6.5% thereafter. This was done to facilitate and compare the trends after accounting for changes in medical practice and understanding across this period. Similarly, hypertension was defined as doctor-diagnosed hypertension or in its absence regular use of antihypertensive medications or blood pressure ≥ 140/90mmHg (period diagnostic threshold remains unchanged during). Python and STATA were used to conduct analyses, and Join Point regression software was used to develop and compare trends. In England, from 2003-2019, mean population BMI consistently increased over this period, rising by 0.8kg/m2 from 27.6 to 28.8 kg/m2. Obesity prevalence (BMI ≥30kg/m2) increased by 5.4% from 22.6% to 28.0%. Concurrently, mean glycated haemoglobin increased by 0.36% from 6.18% to 6.54%, surpassing the current diabetes diagnostic threshold. Diabetes period prevalence surged from 4.2% to 11.6%, a trend consistent when the current diagnostic threshold was alternatively applied across all periods. Conversely, doctor-diagnosed and total hypertension (including those who are unaware) prevalence exhibited a slight decrease (1.4% and 3%, respectively), mirrored by reductions in population-wide mean systolic and diastolic blood pressure by 4.6mmHg and 1.9mmHg. These results suggest that, with the total population in England standing at 56.3 million in 2019, an estimated 15.8 million adults were within the obese BMI range, 6.5 million had diabetes and 17.6 million had hypertension. The obesity epidemic is likely fuelling the increase in diabetes prevalence. These findings underscore the importance of prioritising obesity reduction in public health initiatives, aiming to subsequently curb diabetes prevalence. Hypertension still remains a major CV risk factor, affecting almost one third of the adult population.

Nationwide prevalence and trends in high-risk drinking among adult men the disabled and non-disabled

Abstract Background Excessive drinking is an important public issue that causes various levels of physical, psychological, behavioral problems. Especially for the disabled, it matters in that it could lead to poor health and secondary health conditions. Methods This study analyzed high-risk drinking (HRD) behaviors over a 9-year period in adult South Korean men according to disability presence, severity, type. We linked national disability registration data with the National Health Insurance claims data. Age-standardized prevalence of HRD were analyzed for each year and the odds of current HRD were determined by multivariate logistic regression after adjusting for income level, residence, insurance type, Charlson comorbidity index. Results The age-standardized HRD prevalence of the mildly disabled was higher than that among the non-disabled. Among the mildly disabled and physically disabled, younger aged group showed higher prevalence of HRD than that of non-disabled. In multivariate logistic regression analysis, the mildly (aOR=1.26, 95% CI = 1.24-1.29), physically (aOR=1.31, 95% CI = 1.28-1.33), communication disabled (aOR=1.12, 95% CI = 1.07-1.17) had higher prevalence of HRD than the non-disabled. Conclusions The prevalence of HRD was higher among the young mildly disabled than the non-disabled, this was more evident in young men physically disabled, communication disabled. This may be a result of the physical and social limitations of severely disabled and should be interpreted with caution. Social activities should be supported, and health policies on alcohol consumption should be implemented to prevent secondary conditions and reduce health disparities. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074) and by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165). Key messages • The prevalence of high-risk drinking was highest among the mild disabled, especially the mild, physical, communication disabled in younger aged men. • Health policies and efforts to improve health disparities aimed at reducing alcohol consumption among people with disabilities are needed.

Trends in hypertension prevalence and control in England over the last 3 decades: Health Survey of England 1994-2019

Abstract Globally, raised blood pressure (BP) contributes to more than 10.8 million avoidable deaths from cardiovascular (CV) and renal disease. Understanding national BP control trends amongst hypertensive patients will help inform the effectiveness and gaps in existing pathways and policies. We used data from 13 nationally representative health surveys in England between 1994-2019 to compare nationwide trends in BP control and hypertension awareness over 25 years. We used ‘period’ definitions to define hypertension and BP control (i.e. using existing guidance at the time of the survey) to account for changes in BP targets and definitions. Analyses were also conducted using ‘current definitions’ (i.e. definition of hypertension and BP control targets as per NICE 2023), applied across the entire duration. Sample weights, accounting for oversampling and survey nonresponse, and other relevant transformations were applied. Python and STATA 18 were used to conduct analyses and Join Point regression software was used to compare trends. In England, between 1994-2019, the prevalence of hypertension initially increased sharply by 8% from 23.3% when the BP cut off was lowered in 1999. Thereafter for the next 12 years it remained static at 32-34%, and since 2011 has plateaued at 31-32%, showing only marginal improvement of 1.5% over this 25-year period (Figure 1). This is consistent with population-wide mean systolic (S) and diastolic (D) BPs, and amongst those with and without hypertension. Population-wide there was a reduction in SBP (8.5mmHg) and DBP (3.8mmHg) over the period. There was significantly greater reduction in SBP (11.9 vs 9.5mmHg) and DBP (4.1 vs 2.5mmHg) amongst those with diagnosed hypertension as compared to those without. Using the current target of below 140/90mmHg when evaluating BP control over this period suggests that we have improved. However, when we use ‘period definitions’ of BP targets at that time, it seems that over last 25 years there has been ‘no change’ in the proportion of diagnosed hypertensives with uncontrolled BPs (Figure 2). Additionally, although appearing to increase over the period, there has been no significant change in proportions of those with hypertension who are unaware of this condition since BP cut-offs were lowered in 1999. These findings indicate that in England, over last 25 years, whilst there have been some improvements in population wide mean SBP and DBP with slight reduction in hypertension prevalence, the proportions of those with known hypertension with uncontrolled BPs have remained static. This is despite improvement in medications and practice. Furthermore, there has been little progress in detection of those hypertensive patients who are unaware about and untreated for their condition. Clearly, these call in question the effectiveness of the current policies and clinical practice pathways and provide huge opportunity to improve population wide CV riskSytolic and Diastolic BP trendsTrends in the prevalence of BP control

Trends in overall and abdominal obesity among Korean adults, 2007-2022: an Age-period-cohort analysis

Abstract Overall and abdominal obesity, often defined as having high body mass index (BMI) and waist circumference (WC), are associated with an increased risk of chronic disease. A comprehensive understanding of trends and contributing factors is necessary to reduce the disease burdens. This study investigated the nationwide trends and independent effects of age, period, and birth cohort on BMI and WC in Korean adults. We conducted hierarchical age-period-cohort (cross-classified random-effects models) analyses using measured BMI and WC data from 85,292 Korean adults (aged ≥19) in the Korea National Health and Nutrition Examination Survey 2007-2022. We also examined whether the age, period, and cohort effects varied by socioeconomic subgroups. In 2007-2022, the age-standardized mean BMI (23.6 to 24.2 kg/m2) and WC (81.7 to 83.5 cm) increased in the overall population. An upward trend was evident among men, while only a slight change was observed in women. The mean BMI was highest at age 47 (25.1 kg/m2) in men and age 60 (24.2 kg/m2) in women and it decreased at older ages. Controlling for age and period effects, mean BMI was lowest among the birth cohorts of 1960-1964 (24.15 kg/m2), with the highest mean BMI observed among the birth cohorts of 1919-1939 (24.97 kg/m2) and 1990-2003 (24.99 kg/m2). The mean WC was highest at age 55 (88.0 cm) in men and age 79 (83.4 cm) in women. Similar U-shaped birth cohort effect was observed with WC, with the lowest mean observed among the birth cohorts of 1960-1964 [82.92 (0.30)]. At most age, period, and birth cohorts, mean BMI and WC were consistently higher among adults at lower income and education. The overall period effect was consistently found in all socioeconomic subgroups, but the gap in BMI between income and education subgroups widened over time. Our findings suggest that BMI and WC slightly increased in overall Korean adults in 2007-2022, with some inequalities among age, sex, birth cohort, and socioeconomic subgroups. Key messages • The obesity indices increased from 2007 to 2022, but the cohort effect on BMI and WC showed a U-shaped pattern with the lowest mean among birth cohorts of 1960-1964. • The obesity prevalence is varied by socioeconomic status, suggesting that more intense interventions may be needed to target the susceptible groups.

Steps Toward Decreasing Maternal Alcohol Consumption in Israel: Nationwide Trends During a Decade.

Prenatal alcohol exposure poses a substantial risk to fetal development. Efforts were made in 2011-2020 to increase public awareness of and prevent alcohol consumption during pregnancy. We conducted a cross-sectional survey in Israel of pregnant women's alcohol consumption from January 2021 through June 2023 and compared our results with the results of a survey conducted during 2009-2010 to assess changes over time. We conducted cross-sectional surveys at 3 public hospitals in central and northern Israel. Surveyors visited hospitals twice weekly and used a questionnaire consistent with one used in 2009-2010 that focused on alcohol consumption 3 months before pregnancy and during pregnancy. We conducted a stratified analysis of the prevalence of alcohol consumption during pregnancy by demographic characteristics. We also used a multivariable logistic regression model to examine variables associated with receiving guidance on alcohol consumption during pregnancy. Of 1915 women in the 2021-2023 survey (mean [SD] age, 30.8 [5.6] y), 1204 (62.9%) reported never consuming alcohol before pregnancy and 1708 (89.2%) reported no alcohol consumption during pregnancy. During pregnancy, 157 (8.2%) women reported consuming alcohol weekly or less, 12 (0.6%) more frequently, and 52 (2.7%) binge drinking. We found a significant decrease in alcohol consumption during pregnancy in 2021-2023 as compared with 2009-2010 (odds ratio, 0.68; 95% CI, 0.52-0.88; P = .03). Predictors of alcohol consumption during pregnancy included alcohol consumption before pregnancy, parity, and smoking. Significantly more women in the 2021-2023 sample (n = 569; 29.7%) than in the 2009-2010 sample received guidance on alcohol consumption during pregnancy (P < .001). Educational efforts should continue to increase awareness of the risks of prenatal alcohol exposure in the general population and among health professionals.

What they live for: Adaptive strategies of Virginia’s small-scale commercial fishermen in a changing industry

Small-scale commercial fishing communities around the world are facing a number of social, ecological, and economic challenges that are likely to persist or increase in prevalence with ongoing environmental changes and competing uses of marine resources. This research uses semi-structured interviews to assess the impacts of varying economic, ecological and social changes on individual decision-making and resilience in Virginia’s small-scale commercial fishing industry. Similar to nationwide trends, Virginia’s small-scale commercial fishing industry has shifted in response to changes in management, species abundance, and participation with impacts on social identities and cultural norms, job satisfaction, resource dependence, and the future of the commercial fishing industry. As a means of coping with the inherent volatility of commercial fishing, fishermen have implemented adaptation strategies, including diversification within and outside of commercial fishing, that enable continued participation in the commercial fishing industry. Interviews reveal that Virginia’s small-scale commercial fisheries are deeply embedded within the social identities of fishermen and fishing communities in the state. Therefore, it is valuable to managers and researchers to consider the economic and societal consequences associated with declines in small-scale commercial fisheries and more importantly, to understand why these declines are occurring. Managers can expand on these results to create workforce development strategies that ensure the long-term sustainability of Virginia’s commercial fishing industry and preserve the commercial fishing livelihood for the future.

National Trend of Surgical Stabilization of Rib Fractures: Indications, Approaches, and Disparities

IntroductionRib fractures are among the most frequent injuries in trauma. This study aims to assess the current nationwide trends in operative rib fixation and identify predictors of surgical stabilization of rib fractures (SSRFs). MethodsA 5-y (2017-2021) retrospective analysis of the Trauma Quality Improvement Program database was performed. Adult trauma patients who had at least one rib fracture were included. We analyzed data regarding type of SSRF including open and thoracoscopic approaches and its trends. ResultsA total of 780,275 patients were identified, of which 15,339 patients (1.9%) were managed with SSRF. Trends of both open and endoscopic approaches were increasing during the study period. Patients with ≤2 rib fractures had a decreasing rate of SSRF. Flail chest (odds ratio = 13.42, P < 0.001) was the strongest predictor of SSRF. ConclusionsSSRF is gaining popularity in the management of chest trauma. The presence of a flail segment and multiplicity of rib fractures is among the predictors of SSRF.

Trends in Acute Kidney Injury Related Deaths in the US from 1999 to 2020

Background Acute kidney injury requiring dialysis is linked to long-term care demands, higher hospital mortality, and increased healthcare expenses. We aim to assess nationwide trends and regional variations in acute kidney injury-related mortality in the US. Materials and Methods We used death certificates from the CDC WONDER database (1999-2020) to calculate age-adjusted mortality rates (AAMRs) and annual percent change (APC). The data were stratified by year, gender, race/ethnicity, and geographic region. Results From 1999 to 2020, there were a total of 4,599,652 deaths attributed to acute kidney injury. The AAMR for acute kidney injury-related deaths surged from 11.4 in 1999 to 20.1 in 2020. Men consistently exhibited higher AAMRs than women throughout the study period (overall AAMR in men: 20.1; women: 13.2). When examining average AAMRs by race/ethnicity, Black/African Americans recorded the highest rates at 21.9, followed by American Indian or Alaskan Native (16.4), Whites (15.6), Hispanics (14.5), and Asian/Pacific Islander (10.7). Significant regional disparities were observed, with the southern region reporting the highest AAMR (17.2) and non-metropolitan areas having higher AAMRs than metropolitan areas (18.3 vs. 15.6). States in the top 90th percentile for acute kidney injury deaths included Indiana, Kentucky and South Carolina, which had nearly double the AAMR compared to states like New York, Utah, and Vermont. Conclusion In the last two decades, the United States has experienced a troubling increase in acute kidney injury-related deaths, emphasizing the urgent need for targeted and equitable healthcare interventions to address persistent disparities in gender, race, geography, and urbanization.

TCT-354 Contemporary Nationwide Trends in Utilization of Invasive Physiology and Intravascular Imaging During Percutaneous Coronary Intervention Among Older Patients

TCT-354 Contemporary Nationwide Trends in Utilization of Invasive Physiology and Intravascular Imaging During Percutaneous Coronary Intervention Among Older Patients

S274 Contemporary Nationwide Trends and Predictors of Venous Thromboembolism and Mortality in Elderly Asian American and Pacific Islander Patients Hospitalized With Colorectal Cancer: A Comprehensive Analysis (2016-2020)

S274 Contemporary Nationwide Trends and Predictors of Venous Thromboembolism and Mortality in Elderly Asian American and Pacific Islander Patients Hospitalized With Colorectal Cancer: A Comprehensive Analysis (2016-2020)

Contemporary nationwide trends in major adverse cardiovascular events in young cannabis users without concomitant tobacco, alcohol, cocaine use.

Cannabis use has increased among young individuals in recent years. Although dependent cannabis use disorder (CUD) has been associated with various cardiac events, its effects on young adults without concurrent substance use remain understudied. To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events (MACCE) in this cohort. We used the National Inpatient Sample (2016-2019) to identify hospitalized young individuals (18-44 years), excluding those with concurrent substance usage (tobacco, alcohol, and cocaine). They were divided into CUD+ and CUD-. Using International Classification of Diseases-10 codes, we examined the trends in MACCE hospitalizations, including all-cause mortality (ACM), acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS). Of 27.4 million hospitalizations among young adults without concurrent substance abuse, 4.2% (1.1 million) had co-existent CUD. In CUD+ group, hospitalization rates for MACCE (1.71% vs 1.35%), AMI (0.86% vs 0.54%), CA (0.27% vs 0.24%), and AIS (0.49% vs 0.35%) were higher than in CUD- group (P < 0.001). However, rate of ACM hospitalizations was lower in CUD+ group (0.30% vs 0.44%). From 2016 to 2019, CUD+ group experienced a relative rise of 5% in MACCE and 20% in AMI hospitalizations, compared to 22% and 36% increases in CUD- group (P < 0.05). The CUD+ group had a 13% relative decrease in ACM hospitalizations, compared to a 10% relative rise in CUD- group (P < 0.05). However, when adjusted for confounders, MACCE odds among CUD+ cohort remain comparable between 2016 and 2019. The CUD+ group had higher rates of MACCE, but the rising trends were more apparent in the CUD- group over time. Interestingly, the CUD+ group had lower ACM rates than the CUD- group.

Catheter-Directed Therapies for Deep Vein Thrombosis and Pulmonary Embolism: Nationwide Trends in Medicare Part B Patients from 2015 to 2021

Abstract Background Nationwide trends in the utilization of catheter-directed therapies for deep vein thrombosis and pulmonary embolism in the Medicare population are essential as they represent a major health care challenge. The annual incidence and mortality with venous thromboembolism are around 900,000 and 60,000 to 100,000 patients, respectively, in the United States. Methods Data were acquired from the Data.CMS.gov website on Physician/Supplier Procedure Summary with a list of Medicare Part B fee-for-service claims from 2015 to 2021. Current Procedural Terminology codes 37187 (percutaneous venous mechanical thrombectomy) and 37212 (thrombolytic venous therapy) were queried for deep vein thrombosis. Similarly, Current Procedural Terminology codes 37184 (percutaneous arterial mechanical thrombectomy) and 37211 (thrombolytic arterial therapy) were queried for pulmonary embolism. Annual procedure counts, site of service, and self-reported specialty of the operator were recorded. Results Overall, there was a trend toward increasing utilization of thrombectomy and decreasing utilization of thrombolysis procedures for both deep vein thrombosis and pulmonary embolism. Radiologists performed the majority of the catheter-directed therapy interventions for deep vein thrombosis, while radiologists and surgeons performed a similar number of catheter-directed therapy procedures for pulmonary embolism. Cardiologists were third in the catheter-directed therapy procedure count for both deep vein thrombosis and pulmonary embolism. Conclusion An analysis of nationwide trends from 2015 to 2021 suggests increasing utilization of thrombectomy starting in 2020 when compared to thrombolysis for catheter-directed therapies for both deep vein thrombosis and pulmonary embolism procedures. Newer thrombectomy technologies may be one of the drivers of this shift from thrombolysis to thrombectomy.

Epidemiology and natural history of chronic Hepatitis B in the Canadian province of Alberta from 2012 to 2021: A population-based study

Introduction and ObjectivesThere are limited recent data on the burden of chronic hepatitis B (CHB) in the North American general population. We aimed to identify the CHB burden from a Canadian population-based perspective. Patients and MethodsUsing a retrospective cohort design, we searched Alberta Analytics administrative databases including the Provincial Laboratory database, to describe CHB epidemiology and natural history in Alberta, Canada between fiscal years 2012-2020. We analyzed incidence and prevalence trends using a Poisson regression model and conducted Kaplan-Meier analyses to examine the incident cohort's survival. ResultsThe age/sex-adjusted incidence of CHB between 2015-2020 was 27.1/100,000 person/years (29.6/100,000 in males and 24.5/100,000 in females) and was highest among individuals aged 45-64 years. Despite a decrease in annual incidence of CHB from 36.4 to 13.4/100,000 between 2015-2020, prevalence increased from 98.9 to 210.3/100,000 in the same period. Of 6,860 incident cases, 2.1% died, and 0.2% underwent liver transplantation during a median follow-up of 3.6 years (interquartile range 2.0-4.9 years). CHB patients had significantly lower survival rates compared to age/sex-matched Canadians, with a standardized mortality ratio of 3.9 (95% confidence interval [CI] 3.3-4.6). Male sex (hazard ratio [HR] 1.7; 95% CI 1.2-2.5), older age at diagnosis (HR, 1.08; 95% CI 1.07-1.09) independently predicted mortality. ConclusionsCHB incidence decreased in Alberta, which is consistent with nationwide trends. Males and individuals aged 45-64 had higher CHB incidence and prevalence. CHB patients’ lower survival rates emphasize the need to address barriers to guideline recommended HBV care linkage.

Trends of ankle arthroscopy in Italy: Analysis of an official national database

ObjectivesAnkle arthroscopy has become increasingly popular as a less invasive surgical diagnostic and therapeutic procedure for a variety ankle disorder previously managed with open surgery. Despite literature reports encouraging outcomes and low complication rates, nationwide trends in ankle arthroscopy have been poorly investigated. To fully understand the burden of an emerging surgical approach as well as helping to create global standards for the diagnosis and treatment of ankle diseases, this study aimed to evaluate the incidence and demographics of patients undergoing ankle arthroscopy in Italy from 2001 to 2016. MethodsData were obtained from the National Hospital Discharge Records (SDO) provided by the Italian Ministry of Health. The patient's age, gender, length of hospital stays, primary diagnosis, and primary procedure are among the anonymized data. Population data were obtained from the National Institute for Statistics (ISTAT). According to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) ankle arthroscopy was defined by the following procedure code: 80.27. ResultsA total of 23,644 procedures were performed in Italy. The 25 to 29 and 30 to 34 age groups underwent this type of surgery at most. The majority of patients were males. The median length of hospital stay was 2.1 ​± ​2.3 days. Each year in Italy, this surgery costs an average of 2,133,401€ ± 342,143€. The main primary codified diagnoses were: “contracture of joint, ankle and foot” (13.4 ​%), “articular cartilage disorder, ankle and foot” (8.6 ​%), “late effect of sprain and strain without mention of tendon injury” (7.5 ​%) and “other joint derangement, not elsewhere classified, ankle and foot” (6.4 ​%). ConclusionsThe present study evaluated the burden of ankle arthroscopy on the national health care system and the distribution of the main diseases requiring this type of surgery. Surgeons and policy makers can allocate healthcare resources more effectively and provide patients with high-quality care by having a better understanding of national practice patterns. Level of EvidenceIII.

49843 Nationwide trends in procedural billing modifier (-25) use in dermatology in Medicare beneficiaries, 2010-2021

49843 Nationwide trends in procedural billing modifier (-25) use in dermatology in Medicare beneficiaries, 2010-2021