Median Household Income Quartile Research Articles

Demographic factors affecting patients with AML with myelodysplasia-related changes.

e19027 Background: Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is a rare and aggressive form of acute myeloid leukemia (AML) that makes up about 25-34% of its annual cases. The subtype includes a varied group of tumors with clinical, genetic, and morphological characteristics that confer poor outcomes. AML-MRC is commonly treated with intensive chemotherapy, but the median survival is only 9-12 months. Given the poor outcomes, gaining a better understanding of epidemiologic factors could reveal opportunities for earlier diagnosis and improved treatment planning. Demographic characteristics of AML-MRC patients were identified and examined using the National Cancer Database (NCDB). Methods: Individuals with a confirmed diagnosis of AML-MRC (N = 14,536) were identified using the NCDB for a retrospective analysis from 2004 to 2020. Patient sex, age at diagnosis, race, household income, insurance status, urban/rural residence, and Charlson-Deyo score were examined by descriptive statistics, and diagnostic trends by year were identified and calculated with regression analysis. Results: A total of 14,536 patients diagnosed with AML-MRC between 2004 – 2020 were identified in the NCDB. Within this timeframe, there was an increasing incidence of diagnosis per year (R2 = 0.9). AML-MRC was more common in males (61.1%) than females (38.9%), and the average age at diagnosis was 68.9 years (SD = 13.0, range = 0 – 90 years). The majority of patients (87.3%) were White. Patients were most likely to be a part of the highest median household income quartile (33.6%) and least likely to be a part of the bottom quartile (13.2%). A higher percentage of patients were insured by Medicare (63.0%) compared to private insurance (25.3%). Most patients lived in counties in metro areas of 1 million population or more (51.4%). Most individuals had Charlson-Deyo comorbidity scores of zero (68.1%). The most common type of treatment facility was academic/research programs (55.1%) followed by comprehensive community cancer programs (23.3%). Conclusions: AML-MRC is a common subtype of AML with a poor prognosis. Previous studies have found that most individuals with AML-MRC are older-aged, White males. Our study corroborated this finding and examined additional demographic factors. We found that these patients were more likely to hold insurance through Medicare, likely reflecting the older average age at diagnosis. Additionally, patients were most commonly in the highest household income quartile and living in a metropolitan area with the highest population density. This could suggest that better access to healthcare improves rates of diagnosis of AML-MRC. Especially given that more people are being diagnosed each year, further research should work to understand the effects of these, and other, socioeconomic factors on the diagnosis, treatment, and prognosis of patients with AML-MRC.

43 Home alone: Factors associated with discharge with Home Health

Abstract Introduction Burn patients are discharged home with ongoing wound care needs. Many obtain assistance at home with home health services. There are few published studies that review factors associated with obtaining these services upon discharge. As such, this study aims to identify patient-specific and hospital-specific factors that may contribute to being discharged under the care of home health services. Methods The National Inpatient Sample was queried for all patients with age ≥ 18 years with ICD-9 codes for total body surface area (TBSA) burn ≥ 20% and non-elective admissions. Patients were further selected for those discharge home (routine) and those discharged under care of organized home health service organization. Years included were 2013- third quarter of 2015. Age, race, percent TBSA burn, demographic data, hospital factors and mortality were recorded. Statistical analysis was done with Chi-Square testing. Discharge was then used to perform a binary logistic regression using the significant variables. Results There were 3245 weighted cases. Females accounted for 21.3% of the population. Of these encounters, 22.8% were discharged home with home health services. The average age of those without home health was 39.61 ± 13.59 years, versus 44.75 ± 15.92 years for those with home health (p< 0.001). Gender, percent TBSA burn, quartile of median household income of residents in the patient's ZIP Code, patient insurance, use of alcohol or drugs (p< 0.001), hospital bed size, hospital region, and hospital control/ownership (p< 0.001) were found to be statistically significant on univariate analysis. Discharge with home health services was then used to perform a multivariate analysis with the statistically significant factors. This found age (p< 0.001), and alcohol or drug use (p< 0.001) to be significant factors. The additional statistically significant factors are listed in Table 1. Those with home health services were less likely to have history of drug or alcohol use (OR 0.550 [IQR 0.424-0.713]) but more likely to be older, and to have Government insurance (OR 2.899 [IQR 2.096-4.009]) or Private insurance (OR 2.398 [IQR 1.713-3.356]), compared to self pay. There is also significant variability based on hospital region. Conclusions Multiple patient-specific and hospital-specific factors may influence the possibility of burn patient being discharged home with home health services. It appears that patients who may benefit from these services were in fact captured as higher rates of home health services were noted among those with government insurance and within the lowest quartile of income based on patient zip codes. However, there seems to be room for improved services across the nation as there is great variability based on region. Applicability of Research to Practice Discuss factors associated with patients being discharged home with home health services. Identify areas of possible improvement to maximize access to these services for all burn patients.

Epidemiology of Retinopathy of Prematurity in the US From 2003 to 2019

Retinopathy of prematurity (ROP) is a potentially blinding retinal disease with poorly defined epidemiology. Understanding of which infants are most at risk for developing ROP may foster targeted detection and prevention efforts. To identify changes in ROP incidence in the US from 2003 to 2019. This retrospective database cohort study used the Healthcare Cost and Utilization Project Kids' Inpatient Databases. These nationwide databases are produced every 3 years, include data from over 4000 hospitals, and are designed to generate national estimates of health care trends in the US. Participants included pediatric newborns at risk for ROP development between 2003 and 2019. Data were analyzed from September 30, 2021, to January 13, 2022. Premature or low-birth-weight infants with relevant International Classification of Diseases, Ninth Revision or Tenth Revision codes were considered ROP candidates. Infants with ROP were identified using relevant codes. ROP incidence in selected subpopulations (based on database-reported race and ethnicity, sex, location, income) was measured. To determine whether incidences varied across time or subpopulations, χ2 tests of independence were used. This study included 125 212 ROP discharges (64 715 male infants [51.7%]) from 23 187 683 births. The proportion of premature infants diagnosed with ROP increased from 4.4% (11 720 of 265 650) in 2003 to 8.1% (27 160 of 336 117) in 2019. Premature infants from the lowest median household income quartile had the greatest proportional increase of ROP diagnoses from 4.9% (3244 of 66 871) to 9.0% (9386 of 104 235; P < .001). Premature Black infants experienced the largest increase from 5.8% (2124 of 36 476) to 11.6% (7430 of 63 925; P < .001) relative to other groups (2.71%; 95% CI, 2.56%-2.87%; P < .001). Hispanic infants experienced the second largest increase from 4.6% (1796 of 39 106) to 8.2% (4675 of 57 298; P < .001) relative to other groups (-0.16%; 95% CI, -0.29% to -0.03%; P = .02). The Southern US experienced the greatest proportional growth of ROP diagnoses, increasing from 3.7% (3930 of 106 772) to 8.3% (11 952 of 144 013; P < .001) relative to other groups (1.61%; 95% CI, 1.51%-1.71%; P < .001). ROP diagnoses proportionally increased in urban areas and decreased in rural areas. This cohort study found that ROP incidence among premature infants increased from 2003 to 2019, especially among Black and Hispanic infants. Infants from the lowest-income areas persistently had the highest proportional incidence of ROP, and all regions experienced a significant increase in ROP incidence with the most drastic changes occurring in the South. These trends suggest that ROP is a growing problem in the US and may be disproportionately affecting historically marginalized groups.

Mental health and substance use disorders at delivery hospitalization and readmissions after delivery discharge

BackgroundThe objective was to assess mental health and substance use disorders (MSUD) at delivery hospitalization and readmissions after delivery discharge. MethodsThis is a population-based retrospective cohort study of persons who had a delivery hospitalization during January to September in the 2019 Nationwide Readmissions Database. We calculated 90-day readmission rates for MSUD and non-MSUD, overall and stratified by MSUD status at delivery. We used multivariable logistic regressions to assess the associations of MSUD type, patient, clinical, and hospital factors at delivery with 90-day MSUD readmissions. ResultsAn estimated 11.8% of the 2,697,605 weighted delivery hospitalizations recorded MSUD diagnoses. The 90-day MSUD and non-MSUD readmission rates were 0.41% and 2.9% among delivery discharges with MSUD diagnoses, compared to 0.047% and 1.9% among delivery discharges without MSUD diagnoses. In multivariable analysis, schizophrenia, bipolar disorder, stimulant-related disorders, depressive disorders, trauma- and stressor-related disorders, alcohol-related disorders, miscellaneous mental and behavioral disorders, and other specified substance-related disorders were significantly associated with increased odds of MSUD readmissions. Three or more co-occurring MSUDs (vs one MSUD), Medicare or Medicaid (vs private) as the primary expected payer, lowest (vs highest) quartile of median household income at residence zip code level, decreasing age, and longer length of stay at delivery were significantly associated with increased odds of MSUD readmissions. ConclusionCompared to persons without MSUD at delivery, those with MSUD had higher MSUD and non-MSUD 90-day readmission rates. Strategies to address MSUD readmissions can include improved postpartum MSUD follow-up management, expanded Medicaid postpartum coverage, and addressing social determinants of health.

Exposure to ultrafine particles and cognitive decline among older people in the United States

BackgroundSome studies suggest that ambient particulate air pollution is associated with cognitive decline. However, the findings are mixed, and there is no relevant research examining the influences of ultrafine particles (UFP), which may have more toxicity than larger particles. We therefore conducted this study to investigate whether residential UFP exposure is associated with cognitive decline using data from the Alzheimer's Disease Research Centers in the United States. MethodsThis is a longitudinal study of participants who were aged 65 years and older and had normal cognitive status at baseline. Residential UFP exposure, expressed as particle number concentrations (PNC), was assessed in 2016–2017 using a nationwide land use regression model, and was assigned to each participant using their 3-digit residential ZIP codes. Cognitive functions including memory, attention, language, executive function, and global function were assessed annually using 15 neuropsychological tests from March 2015 to February 2022. Linear mixed-effects models were used to examine the associations after adjustment for covariates including baseline age, sex, APOE ε4 status, race, education, smoking status, history of diabetes, quartiles of neighborhood median household income, and interaction terms of follow-up time with each covariate. ResultsThis study included 5646 participants (mean age 76 years, 65% female). On average, each participant had 4 annual visits. When PNC was treated as a continuous variable, there were no statistically or clinically significant changes in annual decline of each cognitive function in relation to an interquartile range elevation in PNC (4026 particles/cm3). Similarly, when PNC was treated as a categorical variable including five exposure groups, there were no linear exposure-response trends in annual decline of each cognitive function across the five exposure groups. ConclusionsThis study found no meaningful associations between residential UFP exposure and cognitive decline in global and domain-specific functions. There is a need for further research that assigns UFP exposure at a finer geographic scale.

Racial disparities in surgical treatment of type A acute aortic dissection

ObjectiveTo determine whether there are racial disparities associated with mortality, cost, and length of hospital stay after surgical repair of type A acute aortic dissection (TAAAD). MethodsPatient data from 2015 to 2018 were collected using the National Inpatient Sample. In-hospital mortality was the primary outcome. Multivariable logistical modeling was used to identify factors independently associated with mortality. ResultsAmong 3952 admissions, 2520 (63%) were White, 848 (21%) were Black/African American, 310 (8%) were Hispanic, 146 (4%) were Asian and Pacific Islander (API), and 128 (3%) were classified as Other. Black/African American and Hispanic admissions presented with TAAAD at a median age of 54 years and 55 years, respectively, whereas White and API admissions presented at a median age of 64 years and 63 years, respectively (P < .0001). Additionally, there were higher percentages of Black/African American (54%; n = 450) and Hispanic (32%; n = 94) admissions living in ZIP codes with the lowest median household income quartile. Despite these differences on presentation, when adjusting for age and comorbidity, there was no independent association between race and in-hospital mortality and no significant interactions between race and income on in-hospital mortality. ConclusionsBlack and Hispanic admissions present with TAAAD a decade earlier than White and API admissions. Additionally, Black and Hispanic TAAAD admissions are more likely to come from lower-income households. After adjusting for relevant cofactors, there was no independent association between race and in-hospital mortality after surgical treatment of TAAAD.

The Relationship Between Peripheral Arterial Disease Severity and Socioeconomic Status

Although socioeconomic disparities in outcomes of peripheral arterial disease (PAD) have been well studied, little is known about relationship between severity of PAD and socioeconomic status. The objective of this study was to examine this relationship. Patients who had operations for severe PAD (rest pain or tissue loss) were identified in the National Inpatient Sample, 2005 - 2014. They were stratified by the median household income (MHI) quartiles of their residential ZIP codes. Other characteristics such as race/ethnicity and insurance type were extracted. Factors associated with more severe disease (tissue loss) were evaluated using multivariable regression analyses. There were 765,175 patients identified; 34% in the 1st MHI quartile and 18% in the 4th MHI quartile. Compared to patients in the 1st quartile, those in the 4th quartile were more likely White (69% vs. 42%, P <0.001), more likely ≥65 years old (75% vs. 62%, P <0.001), and were less likely to undergo amputations (25% vs. 34%, P <0.001). After adjusting for patient characteristics, the 4th quartile was associated with more severe disease [Odds ratio: 1.19, 95% CI: 1.11 - 1.27] compared to the 1st quartile.. While higher MHI was associated with higher PAD severity, patients with high MHI were less likely to undergo amputations indicating a disparity in the choice of treatment for PAD. Increased efforts are necessary to reduce socioeconomic disparities in the treatment of severe PAD.

Invasive Management and In-Hospital Outcomes of Myocardial Infarction Patients in United States Safety-Net Hospitals

AimSafety-net hospitals (SNHs) look after a higher proportion of uninsured patients and are often located in deprived areas. This study aimed to determine whether there are differences in the clinical characteristics, treatments and outcomes of patients presenting with acute myocardial infarction (AMI) in SNHs versus non-SNHs (N-SNHs). MethodsAll hospitalizations with a principal diagnosis of AMI in the United States' National Inpatient Sample between 2016 and 2019 were stratified by safety-net hospital status. Multivariable logistic regression with adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) was conducted to investigate invasive management and clinical outcomes. ResultsA total of 2,544,009 weighted discharge records were analyzed, including 601,719 records from SNHs (23.7 %). Compared with N-SNHs, SNH AMI patients were younger (median 66 years vs. 67 years, p < 0.001), and had a higher proportion in the lowest quartile of median household income (37.3 % vs. 28.5 %, p < 0.001). Patients from SNHs were less likely to receive coronary angiography (aOR 0.92, 95 % CI 0.91–0.93, p < 0.001), percutaneous coronary intervention (aOR 0.94, 95 % CI 0.93–0.95, p < 0.001), and coronary artery bypass grafting (aOR 0.93, 95 % CI 0.92–0.94, p < 0.001). In addition, they had increased all-cause mortality (aOR 1.11, 95 % CI 1.09–1.12, p < 0.001), major adverse cardiovascular/cerebrovascular events (composite of mortality, stroke and reinfarction) (aOR 1.11, 95 % CI 1.09–1.12, p < 0.001), and stroke (aOR 1.11, 95 % CI 1.08–1.14, p < 0.001), while there was no difference in major bleeding (aOR 1.02, 95 % CI 1.00–1.04, p = 0.107). ConclusionAmong AMI patients, treatment in SNHs was associated with lower utilization of coronary angiography and revascularization and worse clinical outcomes.

Abstract 14034: 30-day Readmission Rates of Cardiogenic Shock: A Nationwide Analysis of Inpatient Demographics and Clinical Outcomes

Introduction Cardiogenic shock (CS) is a common medical emergency that causes significant morbidity and mortality. Our aim was to characterize patient demographics and analyze the factors that increase the likelihood for CS readmissions. Methods This was a retrospective cohort study using the 2019 Nationwide Readmissions Database (NRD) database to identify admissions in adults with principal diagnosis of CS. Results The index CS admission cohort was 62.2% males, mean age 66.9 years. Of 146,254 index admissions with CS, 19,238 (20.4%) were readmitted. 30-day mortality rate (MR) of index admission was 35.4%, with a MR of 9.7% in those readmitted. The most common cause for readmissions was acute heart failure (26.7%). Patients with the lowest median household income, Medicare, and Medicaid insurance were more likely to be readmitted (1.10 OR 95% CI 1.04 -1.16, p &lt;0.01, 1.17 OR 95% CI 1.11-1.24, p &lt;0.001 and 1.27 OR 95% CI 1.12-1.86, p &lt;0.001 respectively). Meanwhile, being in the highest median household income quartile (&gt;75 th ) or having private insurance were protective against readmission. Acute MI patients were less likely to be readmitted (0.83 OR 95% CI 0.79 -0.87, p &lt;0.001). Diastolic HF and CHF were associated with increased odds of readmission when adjusted for other comorbidities, age, and gender (2.52 OR 95% CI 1.09-5.83, p&lt;0.031 and 2.15 OR 95% CI 1.01-4.57, p&lt;0.046 respectively). Conclusion Readmission after CS is common, with high mortality. Risk factors for readmission include lower household income and Medicare/Medicaid insurance, and those that leave AMA after index cardiogenic shock admission have increased odds of readmission. Conversely, those with the highest median household income and with private insurance had a significantly lower rate of readmission. Additional research is needed to elucidate the contributing factors for this stark difference.

S1404 Outcomes and Complications of Hospitalized Cirrhosis Patients With H. pylori Infection

S1404 Outcomes and Complications of Hospitalized Cirrhosis Patients With H. pylori Infection

S992 Burden and Impact of Cannabis Use Disorder on IBD Flare-Up/Emergent Admissions: A National Population-Based Analysis

S992 Burden and Impact of Cannabis Use Disorder on IBD Flare-Up/Emergent Admissions: A National Population-Based Analysis

S1059 Burden and Impact of Cannabis Use Disorder on Outcomes of IBD Patients With Alcohol Abuse: A National Inpatient Sample Analysis 2019

Introduction: Alcohol use disorder can potentially trigger Inflammatory bowel disease (IBD) flare-ups. With increasing use of cannabis for symptomatic relief in IBD, the impact of its chronic/habitual use on IBD outcomes remains unclear. Therefore, in this study we aimed to assess the burden and impact of concomitant cannabis use disorder (CUD) on IBD patients with known alcohol abuse. Methods: The National Inpatient Sample (2019) with relevant ICD-10 codes were used to identify Alcoholic Inflammatory Bowel Disease (IBD) patients and Cannabis Use Disorder (CUD). We compared demographics, comorbidities, and outcomes of alcoholic IBD patients with vs. without CUD. Primary endpoints were hospital outcomes [MACCE:all-cause mortality, acute myocardial infarction (MI), cardiac arrest and stroke], intestinal obstruction, colorectal cancer, colectomy, acute kidney injury[AKI], and sepsis) compared between CUD and non-CUD cohort among alcoholic IBD patients. Multivariable regression analyses were performed adjusting for demographics, hospital-level characteristics and relevant comorbidities. Results: Of 11,140 hospitalizations with IBD and alcohol abuse, 1130 (10%) concomitantly had CUD. Majority of the CUD cohort was white, male and the median age at admission was 40 years (IQR 33- 51). Most of them were Medicaid enrollees (41.2%) and belonged to lower 2 median household income national quartiles (31.7, 31.2%) The CUD cohort had a lower rate of traditional cardiovascular risk factors and pulmonary comorbidities except higher rate of tobacco use disorder vs. non-CUD cohort. Rates of intestinal obstruction (aOR 1.80; 95%CI:O.75-4.29) (p=0.187) and colorectal cancer (aOR 1.42; 95% CI:0.37-5.54)(p=0.610) were high among the CUD cohort (Table). However, neither of them attained statistical significance. Conclusion: Despite a higher burden of cardiovascular disease risk factors, the CUD cohort had comparable outcomes/complications in alcoholic IBD patients vs. non CUD cohort. Future prospective studies are warranted to confirm and validate these findings focusing on mode, dose and duration of recreational/medicinal use of cannabis in IBD patients with rising prevalence of polysubstance use in the US. Table 1. - Multivariate odds of in-hospital outcomes in IBD-Alcohol Abuse Patients with vs. without Cannabis Use Disorder Odds ratio 95% CI P value Lower Upper MACCE 0.95 0.41 2.21 0.909 Intestinal obstruction 1.80 0.75 4.29 0.187 GIH 0.54 0.29 1.02 0.590 Colorectal cancer 1.42 0.37 5.54 0.610 Acute Kidney Injury 0.60 0.35 1.02 0.061 Sepsis 0.43 0.10 1.82 0.250 MACCE - Major Adverse Cardiovascular and Cerebrovascular Events - all cause mortality, acute MI, cardiac arrest, stroke. Multivariate regression models were adjusted for : Age, Sex, Race, Median household income quartile, payer status, type of admission, hospital bed size, location, teaching status, hypertension, diabetes, dyslipidemia, obesity, PVD, Prior MI, Prior PCI, Prior CABG, drug abuse, smoking, Prior TIA & Stroke, Prior VTE.

Cardiovascular disease risk factors and outcomes of acute myocardial infarction in young adults in two nationwide cohorts in the united states

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute myocardial infarction (AMI) can have considerable morbidity and devastating socioeconomic and psychological consequences in young adults. Previous studies reveal that the decline in mortality in AMI has mainly been in the older population while being comparatively less significant in younger patients. This study compares young adults (18 to 44 years) hospitalized with AMI across two nationwide cohorts, 2007 and 2017, in the United States (US). It examines the burden of AMI hospitalizations, the prevalence of comorbidities, and in-hospital outcomes in young adults a decade apart. It highlights the rise in AMI hospitalizations, lack of decrease in mortality, sex-based and racial disparities, the surge in post-MI complications, and the decline in reperfusion interventions in young AMI patients over a decade. Purpose Coronary heart disease prevalence is challenging to ascertain in younger adults because of limited data and frequent silent clinical presentations. AMI and its complications can cause considerable morbidity, psychological trauma, and socioeconomic burden in the young. Methods We identified hospitalizations for AMI in young adults in 2007 and 2017 using the weighted data from the National Inpatient Sample (NIS), which covers 20% of stratified data of all non-federal community hospitals in the US. We compared the following data between the two cohorts: admission rates, sociodemographic features, in-hospital morbidity, complications, mortality, rate of coronary interventions, and healthcare utilization between the two cohorts. We used Pearson’s Chi-square test and Mann-Whitney U test to compare categorical and continuous variables, respectively. We also applied multivariable regression analyses to assess and compare the risk of cardiovascular complications and in-hospital mortality while controlling for confounders, including age, sex, race, median household income quartile, primary insurance enrolment, and pre-existing comorbidities. Results AMI’s incidence was higher in males in both the cohorts, although with a decline (71.1% vs 66.1%), whereas it rose from 28.9% to 33.9% in females. Hypertension (47.8% vs 60.7%), smoking (49.7% vs 55.8%), obesity (14.8% vs 26.8%), and diabetes mellitus (22.0% vs 25.6%) increased in the 2017 cohort (Table 1). We found no significant difference in all-cause mortality (aOR = 1.01 (0.93-1.10), p=0.749). Post-AMI complications, cardiogenic shock (aOR = 1.16 (1.06-1.27), p=0.001), and fatal arrhythmias increased. Reperfusion interventions decreased in the 2017 cohort (PCI; aOR=0.95 (0.91-0.98), p&amp;lt;0.001; CABG; aOR=0.66 (0.61-0.71), p&amp;lt;0.001) (Table 2). Conclusion Our study highlights the rise in AMI hospitalizations, plateauing of mortality, gender disparity, the surge in post-MI complications, and a reassuring decline in the requirement of reperfusion interventions in young AMI patients over a decade.

What Factors Influence the Hospitalization of Self-Inflicted Craniomaxillofacial Gunshot Wounds?

The following retrospective cohort study was competed using data from the Nationwide Inpatient Sample a database from the Healthcare Cost and Utilization Project (HCUP). The objective of this retrospective cohort study is to compare the hospitalization outcomes of managing maxillofacial trauma attempted suicide among handguns, shotguns, and hunting rifles. The primary predictor variable was the type of firearm. The outcome variables were the hospital charges (U.S. dollars) and length of stay (days). We used SPSS version 25 for Mac (IBM Corp., Armonk, NY, USA) to conduct all statistical analyses. A final sample of 223 patients was statistically analyzed. Relative to patients within the Q2 median household income quartile, patients in the Q4 median household income quartile added +$ 172'609 (P < .05) in hospital charges. Relative to patients living in "central" counties of metro areas, patients in micropolitan counties added +13.18 days (P < .05) to the length of stay. Relative to patients in the Q2 median household income quartile, patients in Q3 added +9.54 days (P < .05) while patients in Q4 added +11.49 days (P < .05) to the length of stay. Being within the highest income quartile was associated with increased hospital charges. Patients living in micropolitan counties have prolonged hospitalization relative to patients in metropolitan counties. Relative to the second income quartile, length of stay was higher in the third income quartile and highest in the fourth income quartile. Increase income grants access to deadlier firearms.

Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization - United States, 2017-2019.

Hypertensive disorders in pregnancy (HDPs), defined as prepregnancy (chronic) or pregnancy-associated hypertension, are common pregnancy complications in the United States.* HDPs are strongly associated with severe maternal complications, such as heart attack and stroke (1), and are a leading cause of pregnancy-related death in the United States.† CDC analyzed nationally representative data from the National Inpatient Sample to calculate the annual prevalence of HDP among delivery hospitalizations and by maternal characteristics, and the percentage of in-hospital deaths with an HDP diagnosis code documented. During 2017-2019, the prevalence of HDP among delivery hospitalizations increased from 13.3% to 15.9%. The prevalence of pregnancy-associated hypertension increased from 10.8% in 2017 to 13.0% in 2019, while the prevalence of chronic hypertension increased from 2.0% to 2.3%. Prevalence of HDP was highest among delivery hospitalizations of non-Hispanic Black or African American (Black) women, non-Hispanic American Indian and Alaska Native (AI/AN) women, and women aged ≥35 years, residing in zip codes in the lowest median household income quartile, or delivering in hospitals in the South or the Midwest Census regions. Among deaths that occurred during delivery hospitalization, 31.6% had any HDP documented. Clinical guidance for reducing complications from HDP focuses on prompt identification and preventing progression to severe maternal complications through timely treatment (1). Recommendations for identifying and monitoring pregnant persons with hypertension include measuring blood pressure throughout pregnancy,§ including self-monitoring. Severe complications and mortality from HDP are preventable with equitable implementation of strategies to identify and monitor persons with HDP (1) and quality improvement initiatives to improve prompt treatment and increase awareness of urgent maternal warning signs (2).

Contemporary socioeconomic-based disparities in cardiac surgery: Are we closing the disparities gap?

ObjectiveFemale sex and lower income residence location are associated with worse health care outcomes. In this study we analyzed the national, contemporary status of socioeconomic disparities in cardiac surgery. MethodsAdult patients within the Nationwide Readmissions Database who underwent coronary artery bypass grafting (CABG), surgical aortic valve replacement (SAVR), mitral valve (MV) replacement, MV repair, or ascending aorta surgery from 2016 to 2018 were included. Sex and median household income quartile (MHIQ) were compared within each surgery group. Primary outcome was 30-day mortality. Multivariable analysis was adjusted for patient characteristics and hospital-level factors. ResultsA weighted total of 358,762 patients were included. Fewer women underwent CABG (22.3%), SAVR (32.2%), MV repair (37.5%), and ascending aorta surgery (29.7%). In adjusted analysis, female sex was independently associated with higher 30-day mortality rates after CABG (adjusted odds ratio [aOR], 1.6), SAVR (aOR, 1.4), MV repair (aOR, 1.8), and ascending aorta surgery (aOR, 1.2; all P < .03). The lowest MHIQ was independently associated with higher 30-day mortality rates after CABG (aOR, 1.4), SAVR (aOR, 1.5), MV replacement (aOR, 1.3), and ascending aorta surgery (aOR, 1.8; all P < .004) compared with the highest quartile. Women were less likely to receive care at urban and academic hospitals for CABG compared with men. Patients of lower MHIQ received less care at urban and academic institutions for all surgeries. ConclusionsDespite advances in the techniques and safety, women and patients of lower socioeconomic status continue to have worse outcomes after cardiac surgery. These persistent disparities warrant the need for root cause analysis.

Is Insurance Status Associated With Likelihood of Operative ACL Injury Treatment Compared With Nonoperative Treatment?

Background:While many factors inform the choice of operative versus nonoperative treatment of injuries to the anterior cruciate ligament (ACL) of the knee, socioeconomic status influences this decision, as has been reported with other procedures.Purpose:To identify any associations between insurance status and likelihood of operative treatment of ACL injuries.Study Design:Cross-sectional study; Level of evidence, 3.Methods:The Nationwide Inpatient Sample database was queried using International Classification of Diseases, 9th Revision codes for ACL injuries and reconstruction from 2001 to 2013. Chi-square analysis was performed to determine significant predictors of operative intervention. Binary logistic regression was used to account for demographic and significant predictor variables. Results were recorded as odds ratios (ORs) and 95% CIs. Significance was defined as P < .05.Results:A total of 32,541 patients with ACL injuries were included in the final analysis. Overall incidence of surgical reconstruction was 85.4% (n = 27,805). Multivariable regression revealed that nonprivate insurance types were associated with lower likelihoods of operative reconstruction compared with private insurance: the lowest likelihood of operation was seen in uninsured patients (OR, 0.31; P < .01), followed by Medicare (OR, 0.33; P < .01) and Medicaid (OR, 0.51; P < .01) patients. There was also a decreased likelihood of surgery for elderly (OR, 0.0 [for age ≥75 years]; P < .01) and Black patients (OR, 0.65; P < .01). An increased likelihood of surgery was seen with female patients (OR, 1.14; P < .01). Patients in the highest median household income quartile were more likely to undergo surgery than those in the lowest (OR, 1.36; P < .01).Conclusion:Compared with privately insured patients, patients with nonprivate insurance had lower likelihood of surgery. Furthermore, patients in higher income quartiles were more likely to undergo operative fixation. These findings may suggest a need for more precise treatment guidelines and studies that investigate causes of such differences.

Journal of Vascular Surgery – January 2022 Audiovisual Summary

Hi! I am Peter Gloviczki from Mayo Clinic, Editor-In-Chief of the Journal of Vascular Surgery (JVS). We hope you found peace and happiness during the Holidays and you and your family are healthy and safe. I am happy to introduce four excellent papers we published in the 2022 January issue of the JVS. They are freely available to read or full-text download for the next 2 months. Our first article is the Editors’ Choice and our CME article this month, entitled “The influence of socioeconomic status on outcomes of lower extremity arterial reconstruction,” by Dr Kakra Hughes and colleagues from Maryland and Washington, D.C.1Hughes K. Olufajo O.A. Wright K. Roby D.H. Fryer C.S. Wright J.L. et al.The influence of socioeconomic status on outcomes of lower extremity arterial reconstruction.J Vasc Surg. 2022; 75: 172-180Google Scholar In this multicenter retrospective study, outcomes of lower extremity revascularizations for peripheral artery disease in over 131,000 patients were determined using the Nationwide Readmissions Database. Compared to patients in the lowest quartile of median household income (MHI), those in the highest quartile had lower rates of amputation and less readmissions. However, subsequent revascularization and mortality rates were similar across the groups. The authors concluded that a lower socioeconomic status was associated with worse outcomes and that improving results of lower extremity arterial reconstructions may involve addressing socioeconomic disparities. The next article I would like to introduce is titled “A more proximal landing zone is preferred for thoracic endovascular repair of acute type B aortic dissections,” written by Dr Tomaz Mesar and colleagues from Norfolk, Virginia.2Mesar T. Alie-Cusson F.S. Rathore A. Dexter D.J. Stokes G.K. Panneton J.M. A more proximal landing zone is preferred for thoracic endovascular repair of acute type B aortic dissections.J Vasc Surg. 2022; 75: 40-48Google Scholar In this single-center retrospective study, 83 patients underwent thoracic endovascular aortic repair (TEVAR) for complicated acute type B aortic dissection. The proximal landing zone was zone 2 in 48 and zone 3 in 35 patients. At 36 months those with zone 3 TEVAR needed significantly more aortic reinterventions and this group also had significantly lower freedom from aortic related events. These data suggest that these patients may benefit from a more aggressive proximal landing zone even if left subclavian revascularization has to be performed. The third article you should all read is entitled “Outcomes of intramural hematoma involving the ascending aorta and extending into the descending thoracic aorta.”3Li J. Xia L. Ma M. Feng X. Wei X. Outcomes of intramural hematoma involving the ascending aorta and extending into the descending thoracic aorta.J Vasc Surg. 2022; 75: 58-66Google Scholar This paper was written by Dr Jiangtao Li and colleagues from Wuhan, China. Out of 135 patients with acute intramural hematoma of the ascending aorta that extended into the descending thoracic aorta, 104 patients underwent TEVAR of the descending thoracic aorta and 31 were treated with medical therapy (MT) alone. Those who had TEVAR had higher freedom from adverse aorta related events and they also had a significantly better survival rate than those who had medical therapy. In the MT group, patients with renal insufficiency had most adverse aorta related events. The final article this month is on “The natural history of large abdominal aortic aneurysms in patients without timely repair,” written by Dr Elizabeth Lancaster and co-authors from San Francisco, Oakland, Pasadena, and South San Francisco, California.4Lancaster E.M. Gologorsky R. Hull M.M. Okuhn S. Solomon M.D. Avins A.L. et al.The natural history of large abdominal aortic aneurysms in patients without timely repair.J Vasc Surg. 2022; 75: 113-121Google Scholar Of 3248 patients with large aneurysms, 2215 (68%) patients underwent repair and 1033 (32%) did not undergo repair. The 3-year cumulative incidence of rupture was 3.4% for initial AAA size 5.0 to 5.4 cm (women only), 2.2% for 5.5 to 6.0 cm, 6.0% for 6.1 to 7.0 cm, and 18.4% for >7.0 cm. Women with AAA size 6.1 to 7.0 cm had a 12.8% incidence of rupture, while it was only 4.5% for men. In this large cohort, annual rupture rates for large AAAs were lower than previously reported, with possible increased risk in women. These were just four of the many excellent papers we published in the January issue of the JVS. Please read our journals, follow us on social media and send us great manuscripts for publication. We wish you and your family a Happy New Year! Thank you for watching and see you next time for the highlights of the February issue of the Journal of Vascular Surgery. The video accompanying this article may be found online at www.jvascsurg.org. https://www.jvascsurg.org/cms/asset/3f089146-0e7e-4ffd-87a7-6ddf476c6fa6/mmc1.mp4Loading ... Download .mp4 (264.52 MB) Help with .mp4 files Video

Preoperative Deficiency Anemia in Digital Replantation: A Marker of Disparities, Increased Length of Stay, and Hospital Cost

Introduction The effects of preoperative anemia have been shown to be an independent risk factor associated with poor outcomes in both cardiac and noncardiac surgery. Socioeconomic status and race have also been linked to poor outcomes in a variety of conditions. This study was designed to study iron deficiency anemia as a marker of health disparities, length of stay and hospital cost in digital replantation.Materials and Methods Digit replantations performed between 2008 and 2014 were reviewed from the National Inpatient Sample (NIS) database using the ICD-9-CM procedure codes 84.21 and 84.22. Patients with more than one code or with an upper arm (83.24) or hand replantation (84.23) code were excluded. Extracted variables included age, race, comorbidities, hospital type, hospital region, insurance payer type, and median household income quartile. Digit replantations were separated into patients with and without deficiency anemia. Demographics, comorbidities, and access to care were compared between cohorts by chi-squared and t-tests. Multivariate regressions were utilized to assess the effects of anemia on total cost and length of stay. The regression controlled for demographics, region, income, insurance, hospital type, and comorbidities. Beta coefficient was calculated for length of stay and hospital cost. The regression controlled for significant age, race, region, and comorbidities in addition to the above variables.Results In the studied patient population of those without anemia, 59.5% were Caucasian, and in patients with anemia, 46.7% were Caucasian (p < 0.001). Whereas in the in the studied patient population of those without anemia, 6.7% were Black, and in patients with anemia, 15.7% were Black (p < 0.001). Median household income, payer information, length of stay and total cost of hospitalization had statistically significant differences. Using regression and β-coefficient, the effect of anemia on length of stay and cost was also significant (p < 0.001). Regression controlled for age, race, region and comorbidities, with the β-coefficient for effect on cost 37327.18 and on length of stay 3.96.Conclusion These data show that deficiency anemias are associated with a significant increase in length and total cost of stay in patients undergoing digital replantation. Additionally, a larger percentage of patients undergoing digital replantations and who have deficiency anemia belong to the lowest income quartile. Our findings present an important finding for public health prevention and resource allocation. Future studies could focus on clinical intervention with iron supplementation at the time of digital replantation.

The influence of socioeconomic status on outcomes of lower extremity arterial reconstruction

Although it has been shown that patient socioeconomic status (SES) is associated with the surgical treatments chosen for severe peripheral arterial disease (PAD), the association between SES and outcomes of arterial reconstruction have not been well-studied. The objective of this study was to determine if SES is associated with outcomes following lower extremity arterial reconstruction. Patients 40years and older who had surgical revascularization for severe lower extremity PAD were identified in the Nationwide Readmissions Database, 2010 to 2014. Measures of SES including median household income (MHI) quartiles of patients' residential ZIP codes were extracted. Factors associated with repeat revascularization, subsequent major amputations, hospital mortality, and 30-day all-cause readmission were evaluated using multivariable regression analyses. Of the 131,529 patients identified, the majority (61%) were male, and the average age was 69years. On unadjusted analyses, subsequent amputations were higher among patients in the lowest MHI quartile compared with patients in the highest MHI quartile (13% vs 10%; overall P< .001). On multivariable analyses, compared with patients in the lowest quartile, those in the highest quartile had lower amputation (adjusted odds ratio [aOR], 0.70; 95% confidence interval (CI), 0.63-0.77; overall P< .001) and readmission (aOR, 0.91; 95% CI, 0.84-0.99; overall P= .028) rates. However, subsequent revascularization (aOR, 1.04; 95% CI, 0.94-1.15) and mortality (aOR, 1.01; 95% CI, 0.79-1.28) rates were not different across the groups. Lower SES is associated with disproportionally worse outcomes following lower extremity arterial reconstruction for severe PAD. These data suggest that improving outcomes of lower extremity arterial reconstruction may involve addressing socioeconomic disparities.