Number Of Chronic Comorbidities Research Articles

Haematological sequelae in the post-acute phase of symptomatic SARS-CoV-2 infection.

Many patients surviving SARS-CoV-2 infection suffer from long-term symptoms (long COVID or post COVID) such as shortness of breath, fatigue, loss of taste or smell and cognitive deterioration. However, few data are available concerning blood cell counts and haematological parameters during the post-COVID period. We analysed haematological data from 83 patients previously admitted to the internal medicine unit of our institution because of symptomatic SARS-CoV-2 infection; all data were obtained within 1-12months from disease onset. A control group of 70 apparently healthy, age- and sex-matched COVID-19 negative individuals was assessed for comparison. Blood cell counts improved in the post-COVID period, but 81% of patients had persistent abnormalities, compared with 50% in the control group, p < 0.001. Most common haematological findings included anaemia (40%), reduced lymphocyte (43%) or eosinophil counts (38%) and low IgM memory B cells and correlated with advanced age, number of chronic comorbidities, female gender, altered renal function, reduced baseline Hb and procalcitonin concentrations and increased RDW. Data on lymphocytes and IgM memory B cells show that impaired immune responses may persist for up to one year in the post-COVID period, possibly contributing to long-term symptoms, especially in female patients.

Barriers and Facilitators to Exercise Compliance for Community Elders with COPD: A Cross-Sectional Study.

Exercise compliance was known as important to improve long-term health conditions for Chronic obstructive pulmonary disease (COPD) patients, however, little was known about the determinants which affect their exercise compliance. This study aimed to investigate factors related to exercise compliance of COPD elderly patients. This cross-sectional study included elderly patients with stable COPD participants. Random cluster sampling and a survey, including the Exercise Compliance Scale, mMRC Dyspnea Index Scale, Social Support Scale, Anxiety Self-Assessment Scale, and Self-rating Depression Scale, were used. Data were analyzed using Spearman correlation and backward logistic regression. 124 participants (45.90%) had poor exercise compliance while 146 had good compliance (54.10%). The backward logistic regression showed household monthly income (¥501-¥1500: OR=21.54, P<0.05; ¥3001-¥5000: OR=32.76, P<0.05), two chronic comorbidities (OR=17.13, P<0.05), and the moderate dyspnea (OR=16.87, P<0.05) might help to improve exercise compliance. While female COPD patients (OR=0.11, P<0.01) who had server dyspnea (OR=0.02, P<0.05) and depression (OR=0.84, P<0.05) might have more difficulties adhering to exercise. Low exercise compliance in community-dwelling elderly COPD patients could be affected by sex, monthly income level, number of chronic comorbidities, dyspnea, and depression.

Real-world risk factors of confirmed or probable COVID-19 in Americans with diabetes: A prospective, community-based study (iNPHORM).

IntroductionAmericans with diabetes are clinically vulnerable to worse COVID‐19 outcomes; thus, insight into how to prevent infection is imperative. Using longitudinal, prospective data from the real‐world iNPHORM study, we identify the intrinsic and extrinsic risk factors of confirmed or probable COVID‐19 in people with type 1 or 2 diabetes.MethodsThe iNPHORM study recruited 1206 Americans (18–90 years) with insulin‐ and/or secretagogue‐treated type 1 or 2 diabetes from a probability‐based internet panel. Online questionnaires (screener, baseline and 12 monthly follow‐ups) assessed COVID‐19 incidence and various plausible intrinsic and extrinsic factors. Multivariable Cox regression was used to model the rate of COVID‐19 (confirmed or probable). Risk factors were selected using a repeated backwards‐selection ‘voting’ procedure.ResultsA sub‐sample of 817 iNPHORM participants (type 1 diabetes: 16.9%; age: 52.1 [SD: 14.2] years; female: 50.2%) was analysed between May 2020 and March 2021. During this period, 13.7% reported confirmed or probable COVID‐19. Age, body mass index, number of chronic comorbidities, most recent A1C, past severe hypoglycaemia, and employment status were selected in our final model. Body mass index ≥30 kg/m2 versus <30 kg/m2 (HR 1.63 [1.05; 2.52]95% CI), and increased number of comorbidities (HR 1.16 [1.05; 1.27]95% CI) independently predicted COVID‐19 incidence. Marginally significant effects were observed for overall A1C (p = .06) and employment status (p = .07).ConclusionsThis is the first US‐based epidemiologic investigation to characterize community‐based COVID‐19 susceptibility in diabetes. Our results reveal specific and promising avenues to prevent COVID‐19 in this at‐risk population. ClinicalTrials.gov Identifier: NCT04219514.

Artificial Intelligence Predicts Cost After Ambulatory Anterior Cruciate Ligament Reconstruction

PurposeTo develop and internally validate a machine-learning algorithm to reliably predict cost after anterior cruciate ligament reconstruction (ACLR).MethodsA retrospective review of the New York State Ambulatory Surgery and Services database was performed to identify patients who underwent elective ACLR from 2015 to 2016. Features included in initial models consisted of patient characteristics (age, sex, insurance status, income, medical comorbidities as classified by the Clinical Classifications Software diagnosis code) as well as intraoperative variables (type of anesthesia and procedure-specific factors). Models were generated to predict total charges using 4 algorithms: random forest, extreme gradient boost, elastic net penalized regression, and support vector machines with radial kernels. Training was performed with 10-fold cross-validation followed by internal validation via 0.632 bootstrapping. Model discriminative performance was assessed by area under the receiver operating characteristic curve, calibration, and the Brier score. Decision curve analysis was performed to demonstrate the net benefit of using the final model in practice.ResultsIn total, 7,311 patients undergoing ambulatory ACLR were included. The random forest model demonstrated the best performance assessed via internal validation (area under the curve = 0.85), calibration, and the Brier score (0.208). Cost incurred was influenced by anesthesia type, operating room time, and number of chronic comorbidities. Decision curve analysis revealed a net benefit for use of the random forest model and the model was integrated into a web-based open-access application.ConclusionsThe random forest model predicted cost after ambulatory ACLR using a large, statewide database with good performance. The top variables found to predict increased charges were general anesthesia, operating room time, meniscal repair, self-pay insurance, patient neighborhood characteristics, and number of chronic conditions.Level of EvidenceIII, retrospective cohort study.

Abstract 11579: In-Hospital Characteristics and Outcomes Among Patients Who Received an Off-Label Tricuspid Clip

Intro: Tricuspid regurgitation has high morbidity &amp; mortality, leading to recurrent hospitalization preventing surgery. Tricuspid valve transcatheter edge-to-edge repair with an off-label clip (TVc) are becoming more common, but data are limited. We examined the National Inpatient Sample (NIS) database to describe demographics &amp; in-hospital outcomes among TVc patients. Methods: The NIS database was queried from 2016-2018 to identify patients that received TVc using ICD-10 codes. Weights were applied to obtain national estimates. Results: All P values were &lt;.05. A total of 485 patients received TVc, 94% at large academic medical centers as elective procedures (73%). Patients were older (78±9 Vs 58±20 yrs) with an equal proportion of males &amp; females (45% vs 55%). They were more likely to have comorbidities, like congestive heart failure (88.6% vs 15%), chronic kidney disease (45.3% Vs 16%), hypertension (72.1% vs 52%), atrial fibrillation (85.5% vs 13%) &amp; pulmonary hypertension (47.4% vs 3%). Concomitant mitral regurgitation was the most common valve disorder (7.2% vs. 0.1%). The most common complication was acute kidney injury (32.9% vs 13%), followed by pericardiocentesis (4% vs 0.06%) &amp; cardiac arrest (1% vs 0.01%). Hospital costs rose by six-fold ($303,222 vs $53.5270) &amp; length of stay (LOS) was longer by 3.5 days in those with a TVc. Half of patients were discharged home (54.6%) but 23% required home health &amp; 19% a skilled nursing facility. Conclusions: TVc patients are more likely to be white, older, with an even division in gender &amp; a significant number of chronic comorbidities. Overall mortality is low &amp; complications are rare. Both hospitalization costs &amp; LOS were higher.

Care need and dry mouth as risk indicators for impaired taste and smell

To identify whether reduced saliva secretion or xerostomia symptoms are risk indicators for impaired taste and smell, depending on age and care needs. This cross-sectional study evaluated taste and smell in patients categorized into different age groups (<65> years) and different care need, with and without dry mouth. Of the 185 patients included, 119 were classified as “dry mouth” and 66 as “without dry mouth”. Overall, 103 (55.7%) were female and 37 (20%) needed care. There was no difference between “dry mouth” and “without dry mouth” regarding identification of odors or tastes, but a difference in the number of correctly identified odors and tastes in favor of “without care need” patients (p < 0.05). The ability to identify smells and tastes was negatively influenced by age, number of medications, and number of comorbidities, but subjective dry mouth had no impact. According to our results, subjective dry mouth is not a risk factor for an impaired ability to recognize smells and tastes. However, care need representing age, the number of medications taken, and the number of chronic comorbidities is a risk indicator.

Development of a model for predicting the 4-year risk of symptomatic knee osteoarthritis in China: a longitudinal cohort study

ObjectivesWe aimed to develop a model for predicting the 4-year risk of knee osteoarthritis (KOA) based on survey data obtained via a random, nationwide sample of Chinese individuals.MethodsData was analyzed from 8193 middle-aged and older adults included in the China Health and Retirement Longitudinal Study (CHARLS). The incident of symptomatic KOA was defined as participants who were free of symptomatic KOA at baseline (CHARLS2011) and diagnosed with symptomatic KOA at the 4-year follow-up (CHARLS2015). The effects of potential predictors on the incident of KOA were estimated using logistic regression models and the final model was internally validated using the bootstrapping technique. Model performance was assessed based on discrimination—area under the receiver operating characteristic curve (AUC)—and calibration.ResultsA total of 815 incidents of KOA were identified at the 4-year follow-up, resulting in a cumulative incidence of approximately 9.95%. The final multivariable model included age, sex, waist circumference, residential area, difficulty with activities of daily living (ADLs)/instrumental activities of daily living (IADLs), history of hip fracture, depressive symptoms, number of chronic comorbidities, self-rated health status, and level of moderate physical activity (MPA). The risk model showed good discrimination with AUC = 0.719 (95% confidence interval [CI] 0.700–0.737) and optimism-corrected AUC = 0.712 after bootstrap validation. A satisfactory agreement was observed between the observed and predicted probability of incident symptomatic KOA. And a simple clinical score model was developed for quantifying the risk of KOA.ConclusionOur prediction model may aid the early identification of individuals at the greatest risk of developing KOA within 4 years.

445 - The factors associated with the presence of psychotic symptoms in the HELIAD Greek community study of older adults

ABSTRACTBackground:The prevalence and associated factors related to psychotic symptoms in older adults are understudied. The objectives were to assess the prevalence, incidence and factors associated with psychotic symptoms in a representative Greek sample of community living older adults.Methods:This study includes older adults aged ≥ 65 years participating in the Hellenic Longitudinal Investigation of Aging and Diet. The analysis is based on n=1,904 participants with available data at baseline and n=947 participants at the 3-year follow-up. The presence of delusions and hallucinations in the past month was assessed on the grounds of the 17 symptoms of the Columbia University Scale for Psychopathology in Alzheimer's Disease and of the 14 symptoms of the Neuropsychiatric Inventory Questionnaire. An affirmative answer to any of these 31 symptoms defined the presence of psychotic symptoms. A comprehensive neuropsychological assessment for probable diagnosis of dementia and physical comorbidity was carried out by neurologists. Study factors included age, education, marital status, widowed in the past year, occupation, hearing impairment and number of chronic comorbidities. Penalized logistic regression analyses were carried out to assess the socio-demographic and clinical factors associated with the prevalence and incidence of psychotic symptoms.Results:The past-month prevalence of any psychotic symptom was 1.9% and 1.0% when excluding cases of dementia. The prevalence of any delusion and hallucination was 1.5% and 0.7%, and 0.8% and 0.3% when excluding cases with dementia. Paranoid delusions were the most prevalent. The incidence at the follow-up of any psychotic symptom was 2.1% and 1.3% when excluding dementia. Individuals not married had twice the odds and, farmers/breeders had three times the odds than public servants/teachers/executives of experiencing psychotic symptoms. Hearing impairment and the number of comorbidities increased the odds of the presence of psychotic symptoms. In addition to age and recent widowhood, these factors remained significantly associated with the presence of psychotic symptoms in cases without dementia.Conclusion:Dementia was not related to over half of the cases observed with psychotic symptoms. Paranoid delusions were the most prevalent. Socio-economic and health status factors are significant predictors of psychotic symptoms.

Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013.

OBJECTIVETo examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM).RESEARCH DESIGN AND METHODSUsing claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1) age- and sex-standardized proportion of patients who filled each class of agents; 2) age-, sex-, race-, and region-standardized proportion with hemoglobin A1c (HbA1c) <6%, 6 to <7%, 7 to <8%, 8 to <9%, ≥9%; and 3) age- and sex-standardized rate of severe hypoglycemia among those using medications. Proportions were calculated overall and stratified by age-group (18–44, 45–64, 65–74, and ≥75 years) and number of chronic comorbidities (zero, one, and two or more).RESULTSFrom 2006 to 2013, use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P < 0.001). The proportion of patients with HbA1c <7% declined (from 56.4 to 54.2%; P < 0.001) and with HbA1c ≥9% increased (9.9 to 12.2%; P < 0.001). Glycemic control varied by age and was poor among 23.3% of the youngest and 6.3% of the oldest patients in 2013. The overall rate of severe hypoglycemia remained the same (1.3 per 100 person-years; P = 0.72), declined modestly among the oldest patients (from 2.9 to 2.3; P < 0.001), and remained high among those with two or more comorbidities (3.2 to 3.5; P = 0.36).CONCLUSIONSDuring the recent 8-year period, the use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged.

Abstract 19138: Thirty-day Readmission Following Transcatheter Aortic Valve Replacement is Common, Most Often Associated With Heart Failure and Infection, and Consumes Substantial Resources

Introduction: Readmission within 30 days of hospitalization (30dRA) is increasingly used as a metric for quality of care. Transcatheter aortic valve replacement (TAVR) is also increasing, but 30dRA following TAVR is not well-understood. Hypothesis: The purpose of this study is to define the incidence, etiology, and resource utilization of 30dRA following TAVR. Methods: We used the ICD-9-CM code for TAVR (35.05) to identify patients who underwent TAVR and survived to discharge in 2012, in the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project’s State Independent Databases for 4 geographically distinct states: Florida, Massachusetts, New York, and Washington. The patients were divided into 2 groups: those with and without a 30dRA. Patients with a 30dRA for rehabilitation on the day of discharge were excluded. Approximately 8% of 30dRA were not captured because they occurred in the following year. Results: The incidence of 30dRA following TAVR was 20.2% (244/1210). The most common principal diagnoses for readmission were heart failure (21%), infection (17%), bleeding (11%), and dysrhythmia (7%). A total of 4.2% of patients died during the 30dRA. More than 60% required skilled care following discharge, and only 20% had a routine discharge to home or self-care. The Centers for Medicare and Medicaid Services (CMS) were the primary payer for 93.4% of 30dRA following TAVR. The mean length of stay for a 30dRA was 7.0 +/- 6.6 days. The mean charges for a 30dRA were $61,657 +/- $73,000. On univariate analysis, the number of chronic comorbidities (9.9 +/- 2.8 vs. 9.3+/- 2.8; P=0.002), length of index hospitalization (10.3 +/- 7.4 vs. 8.9 +/- 6.9; P=0.01), and non-routine discharge (83.1% vs. 72.6% P&lt;0.001) were associated with 30dRA. There was no significant difference in the mean age (83 years), gender makeup (50% female), racial makeup (19% non-White), and primary payer between patients who did and did not have a 30dRA. Conclusions: More than one in five patients undergoing TAVR is readmitted within 30 days of the procedure, most commonly for heart failure and infection. Future research should be directed toward identifying patients at risk for post-TAVR heart failure and infection prior to discharge, to reduce 30dRA.

Lymphoma and venous thromboembolism: influence on mortality

The population-based incidence of acute venous thromboembolism (VTE) in adult patients diagnosed with non-Hodgkin's lymphoma has not been established, and the effect of VTE on survival is not clear. To determine the incidence of acute VTE in California residents diagnosed with lymphoma, and to determine the effect of acute VTE on survival. We used the California Cancer Registry coupled with the California Patient Discharge database to identify incident cases with lymphoma, 1991-1997, and the incidence of first-time VTE in these patients. Multivariable models were constructed to evaluate risk of developing acute VTE within 2 years, and a proportional hazard model was used to predict death within 2 years, using acute VTE as a time-dependent covariate. There were 16,755 patients diagnosed with non-Hodgkin's lymphoma; 29% had low-grade, 66% intermediate/aggressive grade and 5.6% had high-grade lymphoma. Acute VTE developed in 3.6% of the patients by year 1 and 4.0% by the end of year 2. Significant predictors of acute VTE included advanced stage lymphoma, number of chronic comorbidities and advancing age. Significant predictors of death within 2 years included diagnosis of acute VTE, advanced stage disease, increasing number of co-morbidities, age over 75 years and intermediate or high grade histopathology. The effect of acute VTE on death increased as the time between lymphoma diagnosis and VTE diagnosis increased (HR=1.7 95%CI:1.5-1.9 for VTEs <6 months; HR=6.5 95%CI:4.7-8.9 VTEs 12-24 months). Acute VTE developed frequently in patients with lymphoma, and VTE was a strong predictor of decreased survival.

Outcomes After Vena Cava Filter Placement In Cancer Patients Hospitalized For Acute Venous Thromboembolism

BackgroundEvidence supporting use of an inferior vena cava filter (VCF) to prevent death or recurrent venous thromboembolism (rVTE) in cancer patients who are hospitalized for acute VTE is limited. AimsTo determine the effectiveness of VCF placement on the 15-day and 30-day incidence of death and the 180-day incidence of rVTE manifested as pulmonary embolism (PE) or recurrent deep-vein thrombosis (DVT) alone among cancer patients hospitalized for acute-VTE. MethodsUsing a large retrospective observational study of discharge records in California, we analyzed outcomes after VCF placement in cancer patients hospitalized 2005-2009 for acute VTE using propensity-score methodology. We excluded all patients who had a history of a prior VCF placement (1991-2009). Outcomes were death <15-days and <30-days and rVTE (as PE or DVT alone) at 6 months. We used 3 analytic methods: 1) standard risk-adjusted multivariable analysis, 2) adjustment using propensity-score and inverse probability weighing (IPW) and 3) comparison based on matching (2:1) based on propensity score (caliper method). The multivariate model used to generate the propensity score included age, race/ethnicity, insurance coverage, expected bleeding risk, metastatic disease, bleeding present-on-admission, location of bleeding, recent or impending major surgery, use of thrombolytic agents, number of chronic co-morbidities, severity-of-illness (ascertained by 3M, APR-DRG grouper), index PE vs. DVT, and hospital characteristics. IPW of propensity score was applied to a risk-adjusted logistic model to predict death; IPW was applied to risk-adjusted Cox models predicting rVTE (as PE or DVT alone). In the model predicting death, risk-of-mortality on admission was used instead of severity-of-illness. ResultsAmong 14,000 cancer-associated acute-VTE cases, the overall crude 15-day mortality rate was 1396 (10%) and the 30-day mortality was 2247 (16.1%). For 11,253 no-VCF patients, the crude 15-day mortality was 1089 (9.7%) and at 30 days it was 1727 (15.3%). A VCF was placed in 2747 patients (19.6%). The crude mortality in VCF patients was 307 (11.2%) at 15-days, and 520 (18.9%) at 30-days. After accounting for propensity to insert a VCF (using IPW) in a risk-adjusted model, there was no significant reduction in the risk of death associated with VCF use at 15-days (OR=0.90, CI:0.8-1.1, p=0.26) or 30 days (OR=1.04, 95%CI:0.9-1.2, p=0.57); findings were the same using standard multivariable analysis and matching based on propensity score. The crude 180-day incidence of recurrent PE was 3.3%: 2.6% in VCF patients and 3.4% in the no-VCF patients. In the adjusted model using IPW the risk of rVTE manifested as PE, the risk was lower in VCF patients (HR=0.81 95%CI:0.6-1.1, p=0.14) but this did not reach statistical significance. The crude 180-day incidence of rVTE manifested as DVT alone was 4.2% overall: 5.4% in VCF patients and 3.9% in no-VCF patients. In the IPW propensity score model, the risk of rVTE manifested as DVT at 180 days was significantly higher in VCF patients (HR=1.55, 95%CI:1.3-1.9, p<0.001). Models for recurrent VTE manifested by PE or DVT gave similar results whether based on propensity-score matching or multivariable analysis. ConclusionsUse of a VCF in cancer patients hospitalized specifically for acute VTE was not associated with a significant reduction in the risk of death at 15 or 30 days, and the overall 30-day mortality was high. There was a 20% reduction in the risk of rVTE manifested as PE at 180-days but this did not reach the level of statistical significance (p>0.05). VCF use was associated with a 55% higher risk of rVTE manifested as DVT at 180 days. Further refinements in modeling incorporating competing outcomes (e.g., death) are underway. Disclosures:Ho:American Society of Hematology: ASH HONORS trainee research award Other.

PND4 - Frequency and economic impact of comorbid cardiac conditions among hospitalizations of patients with multiple sclerosis

To determine the frequency and economic impact of comorbid cardiac conditions among hospitalizations of patients with a diagnosis of multiple sclerosis (MS). A retrospective analysis was conducted using the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. All hospital discharges with an MS diagnosis (ICD-9 CM 340.xx) from 1/1/2009 to 12/31/2009 were identified. Two cohorts were defined based on the presence or absence of at least one cardiac condition using ICD-9-CM codes: myocardial infarction (410.xx), ischemic disease (411.xx), angina (413.xx), occlusion of cerebral arteries (434.xx), acute cardiovascular disease (436.xx), cerebral ischemia (435.xx), and heart failure (428.xx). Total mean charges were converted to costs using NIS 2009 cost-to-charge ratios. Total costs per discharge were compared between cohorts while controlling for demographics, number of chronic comorbidities, and length of stay (LOS). Descriptive statistics, t tests, and chi square tests were conducted where appropriate, and regression models were employed for cost comparisons. An incremental cost effectiveness ratio (ICER) was calculated for the cost per additional hospital day. A total of 27,463 discharges with a diagnosis of MS were identified, and 9.1% (n=2,522) had at least one cardiac comorbidity. The sample was 70% female with a mean age of 53.5 years. MS discharges with a cardiac condition were for patients with a significantly higher mean age (62.5 vs 50.5 years, P<0.0001), more chronic comorbidities (7.8 vs 4.7 conditions, P<0.0001), and a longer LOS (6.4 vs 5.2 days, P<0.0001). The cost of hospitalization was significantly higher for MS discharges with a cardiac comorbidity after controlling for confounders ($16,752 vs $10,549, P<0.0001). The incremental cost per hospital day was $5,375 for discharges with a cardiac condition. Cardiac comorbidities are prevalent among MS discharges and are associated with higher costs than discharges without a cardiac comorbidity.

Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival

AbstractA population-based cohort was used to determine the incidence and risk factors associated with development of venous thromboembolism (VTE) among Californians diagnosed with acute leukemia between 1993 to 1999. Principal outcomes were deep vein thrombosis in both the lower and upper extremities, pulmonary embolism, and mortality. Among 5394 cases with acute myelogenous leukemia (AML), the 2-year cumulative incidence of VTE was 281 (5.2%). Sixty-four percent of the VTE events occurred within 3 months of AML diagnosis. In AML patients, female sex, older age, number of chronic comorbidities, and presence of a catheter were significant predictors of development of VTE within 1 year. A diagnosis of VTE was not associated with reduced survival in AML patients. Among 2482 cases with acute lymphoblastic leukemia (ALL), the 2-year incidence of VTE in ALL was 4.5%. Risk factors for VTE were presence of a central venous catheter, older age, and number of chronic comorbidities. In the patients with ALL, development of VTE was associated with a 40% increase in the risk of dying within 1 year. The incidence of VTE in acute leukemia is appreciable, and is comparable with the incidence in many solid tumors.

Effect of Premium, Copayments, and Health Status on the Choice of Health Plans

Explore effects of comorbidity and prior health care utilization on choice of employee health plans with different levels of cost sharing. Mayo Clinic employees in Rochester, Minnesota (MCR) under age 65 in January 2004; N = 20,379. Assessment of a natural experiment where self-funded medical care benefit options were changed to contain costs within a large medical group practice. Before the change, most employees were enrolled in a plan with first dollar coverage, while 18% had a plan with copays and deductibles. In 2004, 3 existing plans were replaced by 2 new options, one with lower premiums and higher out-of-pocket costs and the other with higher premiums, a lower coinsurance rate, and lower out-of-pocket maximums. Data on employees were merged across insurance claims, medical records, eligibility files, and employment files for 2003 and 2004. As the number of chronic comorbidities among family members increased, the probability of choosing high-premium option also increased. Seventy-two percent of employees with at least 1 family member with comorbidity chose the high-cost option versus 54.7% of employees with no comorbidities. High-premium and low-premium plans seem to subdivide population into discrete risk categories, which may adversely affect the future stability of the insurance plan options. Various factors affect decision making of employees regarding the choice of plan with different levels of cost-sharing. In a natural experiment setting where all options were redesigned, the health status of employees and their dependents played a very significant role in plan choice.

Venous thromboembolism in 9,489 patients with glioma

1538 Background: Venous thromboembolic events (VTE) are a commonly reported complication of brain tumors. The objective of this study was to define the incidence, risk factors, and outcomes associated with VTE in a population-based cohort. Methods: This was a retrospective analysis of all glioma cases diagnosed in California between 1993–1995 and 1997–1999. Glioma cases in the California Cancer Registry were linked to the California Patient Discharge Database to identify incident VTE. Cox models were generated to analyze the association of pre-specified risk factors with VTE or death within one year of the cancer diagnosis. Results: There were 9489 cases: 76% were Caucasians and 56% were men. The 1-year cumulative incidence of VTE was 663 (7%) with an incidence rate during the first year of 11.1 events per 100 person-years. Sixty-six percent of all VTE diagnosed in the first year occurred within 3 months of the cancer diagnosis with a corresponding incidence rate of 21.6 events per 100 person-years. Of 663 first year VTE, 405 (61%) occurred &lt;2 months after an invasive neurosurgical procedure. Glioblastoma multiforme (GBM) was associated with an increased risk of VTE (HR=1.6, CI: 1.3–2.0) compared to other gliomas. The risk of VTE was strongly associated with the number of chronic co-morbidities (HR=4.0, CI: 3.1–5.0 for ≥3 chronic co-morbidities). Asian race was associated with significantly lower risk of VTE (HR=0.3, CI: 0.2–0.6) and female gender conferred a modestly lower risk (HR=0.8, CI: 0.7–0.9). A VTE in the first year was associated with slightly lower risk of death (HR = 0.8; CI: 0.8–0.9), whereas increasing age (HR=6.3, CI: 5.6–7.0 for age≥75), number of co-morbidities (HR=1.9, CI: 1.7–2.0 for ≥3 chronic co-morbidities), and GBM (HR=2.2, CI: 2.0–2.4) or anaplastic astrocytoma (HR=1.5, CI: 1.3–1.7) histology were associated with a higher risk of death within 1 year. Conclusions: In this large glioma cohort, the incidence of symptomatic VTE was very high. Two-thirds of all VTE occurred early after the diagnosis of glioma, and most of these occurred within 2 months of an invasive neurosurgical procedure. The presence of chronic medical co-morbidities and GBM histology were strong predictors of VTE. A diagnosis of VTE was not associated with an increased risk of death within 1 year. No significant financial relationships to disclose.