Standardized Hospitalization Ratios Research Articles

Risk of Renal or Urinary Related Hospitalization in Survivors of Childhood Cancer: Results from the French Childhood Cancer Survivor Study.

Hospitalization rates can be used as an indirect indicator of the burden and severity of adverse health outcomes in childhood cancer survivors (CCS). We aimed to determine the long-term risks of hospitalization related to renal and urinary diseases among 5-year CCS. The French Childhood Cancer Survivor Study cohort was linked with data from the French National Healthcare System database, which enabled the identification of hospitalizations related to renal or urinary diseases. Clinical and detailed treatment data were collected from medical records. Dose-volume histograms were estimated for all patients treated with radiotherapy. Standardized Hospitalization Ratios and absolute excess risks (AER) were calculated. Relative risks were estimated using Poisson regression. A total of 5,498 survivors were followed for 42,118 person-years (PY). Survivors experience 2.9 times more renal hospitalizations than expected in the general population, with an AER of 21.2/10,000 PY. Exposing more than 10% of the kidneys' volume to at least 20 Gray increases the risk of being hospitalized for renal causes by 2.2 (95% confidence interval, 1.3-3.6). Nephrectomized survivors treated with high doses of ifosfamide (>60 g/m²) have an extremely high risk of hospitalization for renal causes. Patients with comorbidities have about a 3-fold higher risk, and nephrectomized patients a 2-fold higher risk of being hospitalized for renal causes compared with other subjects. In the case of hospitalization for urinary causes, treatment by anthracycline administration was found to be associated with an almost 2-fold higher risk of hospitalization compared with the general population. These results support the need for careful monitoring of long-term renal diseases in survivors who have undergone nephrectomy, those treated with high doses of radiation (≥20 Gy) even to small volumes of the kidneys, and those with predisposing risk factors. This study provides new evidence with potential impact on surveillance guidelines related to dose-volume indicators associated with renal toxicity.

Multisource and temporal variability in Portuguese hospital administrative datasets: Data quality implications

BackgroundUnexpected variability across healthcare datasets may indicate data quality issues and thereby affect the credibility of these data for reutilization. No gold-standard reference dataset or methods for variability assessment are usually available for these datasets. In this study, we aim to describe the process of discovering data quality implications by applying a set of methods for assessing variability between sources and over time in a large hospital database. MethodsWe described and applied a set of multisource and temporal variability assessment methods in a large Portuguese hospitalization database, in which variation in condition-specific hospitalization ratios derived from clinically coded data were assessed between hospitals (sources) and over time. We identified condition-specific admissions using the Clinical Classification Software (CCS), developed by the Agency of Health Care Research and Quality. A Statistical Process Control (SPC) approach based on funnel plots of condition-specific standardized hospitalization ratios (SHR) was used to assess multisource variability, whereas temporal heat maps and Information-Geometric Temporal (IGT) plots were used to assess temporal variability by displaying temporal abrupt changes in data distributions. Results were presented for the 15 most common inpatient conditions (CCS) in Portugal. Main findingsFunnel plot assessment allowed the detection of several outlying hospitals whose SHRs were much lower or higher than expected. Adjusting SHR for hospital characteristics, beyond age and sex, considerably affected the degree of multisource variability for most diseases. Overall, probability distributions changed over time for most diseases, although heterogeneously. Abrupt temporal changes in data distributions for acute myocardial infarction and congestive heart failure coincided with the periods comprising the transition to the International Classification of Diseases, 10th revision, Clinical Modification, whereas changes in the Diagnosis-Related Groups software seem to have driven changes in data distributions for both acute myocardial infarction and liveborn admissions. The analysis of heat maps also allowed the detection of several discontinuities at hospital level over time, in some cases also coinciding with the aforementioned factors. ConclusionsThis paper described the successful application of a set of reproducible, generalizable and systematic methods for variability assessment, including visualization tools that can be useful for detecting abnormal patterns in healthcare data, also addressing some limitations of common approaches. The presented method for multisource variability assessment is based on SPC, which is an advantage considering the lack of gold standard for such process. Properly controlling for hospital characteristics and differences in case-mix for estimating SHR is critical for isolating data quality-related variability among data sources. The use of IGT plots provides an advantage over common methods for temporal variability assessment due its suitability for multitype and multimodal data, which are common characteristics of healthcare data. The novelty of this work is the use of a set of methods to discover new data quality insights in healthcare data.

Evaluating national trends in outcomes after implementation of a star rating system: Results from dialysis facility compare.

To examine which factors are driving improvement in the Dialysis Facility Compare (DFC) star ratings and to test whether nonclinical facility characteristics are associated with observed longitudinal changes in the star ratings. Data were collected from eligible patients in over 6,000 Medicare-certified dialysis facilities from three annual star rating and individual measure updates, publicly released on DFC in October 2015, October 2016, and April 2018. Changes in the star rating and individual quality measures were investigated across three public data releases. Year-to-year changes in the star ratings were linked to facility characteristics, adjusting for baseline differences in quality measure performance. Data from publicly reported quality measures, including standardized mortality, hospitalization, and transfusion ratios, dialysis adequacy, type of vascular access for dialysis, and management of mineral and bone disease, were extracted from annual DFC data releases. The proportion of four- and five-star facilities increased from 30.0% to 53.4% between October 2015 and April 2018. Quality improvement was driven by the domain of care containing the dialysis adequacy and hypercalcemia measures. Additionally, independently owned facilities and facilities belonging to smaller dialysis organizations had significantly lower odds of year-to-year improvement than facilities belonging to either of the two large dialysis organizations (Odds Ratio [OR]: 0.736, 95% Confidence Interval [CI]: 0.631-0.856 and OR: 0.797, 95% CI: 0.723-0.879, respectively). The percentage of four- and five-star facilities has increased markedly over a three-year time period. These changes were driven by improvement in the specific quality measures that may be most directly under the control of the dialysis facility.

Risk of cerebrovascular disease among 13 457 five-year survivors of childhood cancer: A population-based cohort study.

Survivors of childhood cancer treated with cranial irradiation are at risk of cerebrovascular disease (CVD), but the risks beyond age 50 are unknown. In all, 13457 survivors of childhood cancer included in the population-based British Childhood Cancer Survivor Study cohort were linked to Hospital Episode Statistics data for England. Risk of CVD related hospitalisation was quantified by standardised hospitalisation ratios (SHRs), absolute excess risks and cumulative incidence. Overall, 315 (2.3%) survivors had been hospitalised at least once for CVD with a 4-fold risk compared to that expected (95% confidence interval [CI]: 3.7-4.3). Survivors of a central nervous system (CNS) tumour and leukaemia treated with cranial irradiation were at greatest risk of CVD (SHR = 15.6, 95% CI: 14.0-17.4; SHR = 5.4; 95% CI: 4.5-6.5, respectively). Beyond age 60, on average, 3.1% of CNS tumour survivors treated with cranial irradiation were hospitalised annually for CVD (0.4% general population). Cumulative incidence of CVD increased from 16.0% at age 50 to 26.0% at age 65 (general population: 1.4-4.2%). In conclusion, among CNS tumour survivors treated with cranial irradiation, the risk of CVD continues to increase substantially beyond age 50 up to at least age 65. Such survivors should be: counselled regarding this risk; regularly monitored for hypertension, dyslipidaemia and diabetes; advised on life-style risk behaviours. Future research should include the recall for counselling and brain MRI to identify subgroups that could benefit from pharmacological or surgical intervention and establishment of a case-control study to comprehensively determine risk-factors for CVD.

Policy and Pandemic: The Changing Practice of Nephrology During the Coronavirus Disease-2019 Outbreak.

The coronavirus (coronavirus disease-2019) pandemic has changed care delivery for patients with end-stage kidney disease. We explore the US healthcare system as it pertains to dialysis care, including existing policies, modifications implemented in response to the coronavirus disease-2019 crisis, and possible next steps for policy makers and nephrologists. This includes policies related to resource management, use of telemedicine, prioritization of dialysis access procedures, expansion of home dialysis modalities, administrative duties, and quality assessment. The government has already established policies that have instated some flexibilities to help providers focus their response to the crisis. However, future policy during and after the coronavirus disease-2019 pandemic can bolster our ability to optimize care for patients with end-stage kidney disease. Key themes in this perspective are the importance of policy flexibility, clear strategies for emergency preparedness, and robust health systems that maximize accessibility and patient autonomy.

SENTIERI: Epidemiological Study of Residents in National Priority Contaminated Sites. Fifth Report

SENTIERI: Epidemiological Study of Residents in National Priority Contaminated Sites. Fifth Report

Mediterranean spotted fever rickettsiosis in Italy, 2001–2015: Spatio-temporal distribution based on hospitalization records

The Mediterranean spotted fever (MSF) rickettsiosis is the predominant rickettsial disease among the spotted fever group (SFG) rickettsiae in the Mediterranean countries and North Africa. Its causative agent is Rickettsia conorii, although, SFG rickettsiosis - cases due to Rickettsia monacensis, Rickettsia massiliae and Rickettsia aeschlimannii were also described. A retrospective study based on hospital discharge records with a diagnosis of SFG rickettsiosis was carried out to describe the spatial pattern, the trend of the disease, and the epidemiological characteristics of persons hospitalized in the period 2001–2015. Standardized hospitalization ratios were calculated at municipal level using the European population. Smoothed maps were produced using a localised smoothing Poisson model. The mean annual standardized hospitalization rate was 1.36/100,000 person years (95%CI: 1.34; 1.39). Rates showed strong summer seasonality and tended to decrease over time. During the study period, 28.89% of municipalities had smoothed standardized hospitalization ratios greater than 1 and 14.01% above 20. Higher standardized hospitalization ratios were found in areas along the Tyrrhenian coast, especially in the south of Calabria and in the islands of Sardinia and Sicily, where the disease is of public health relevance.

Spatial distribution of kidney disease in the contaminated site of Taranto (Italy).

Exposure to heavy metals has been associated with kidney disease. We investigated the spatial distribution of kidney disease in the industrially contaminated site of Taranto. Cases were subjects with a first hospital discharge diagnosis of kidney disease. Cases affected by specific comorbidities were excluded. Standardized Hospitalization Ratios (SHRs) were computed for low/high exposure area and for modeled spatial distribution of cadmium and fine particulate matter. Using the high/low exposure approach, in subjects aged 20-59 years residing in the high exposure area a significant excess of hospitalization was observed in males and a non-significant excess in females. No excesses were observed in subjects aged 60 years and over. The analysis by the modeling approach did not show a significant association with the greatest pollution impact area. Due to the excesses of hospitalization observed in the high/low exposure approach, a continuing epidemiological surveillance of residents and occupational groups is warranted.

Risk of Cerebrovascular Events in 178 962 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The TYACSS (Teenage and Young Adult Cancer Survivor Study).

Survivors of teenage and young adult cancer are at risk of cerebrovascular events, but the magnitude of and extent to which this risk varies by cancer type, decade of diagnosis, age at diagnosis, and attained age remains uncertain. This is the largest-ever cohort study to evaluate the risks of hospitalization for a cerebrovascular event among long-term survivors of teenage and young adult cancer. The population-based TYACSS (Teenage and Young Adult Cancer Survivor Study) (N=178,962) was linked to Hospital Episode Statistics data for England to investigate the risks of hospitalization for a cerebrovascular event among 5-year survivors of cancer diagnosed when 15 to 39 years of age. Observed numbers of first hospitalizations for cerebrovascular events were compared with that expected from the general population using standardized hospitalization ratios (SHRs) and absolute excess risks per 10 000 person-years. Cumulative incidence was calculated with death considered a competing risk. Overall, 2782 cancer survivors were hospitalized for a cerebrovascular event-40% higher than expected (SHR=1.4, 95% confidence interval, 1.3-1.4). Survivors of central nervous system (CNS) tumors (SHR=4.6, 95% confidence interval, 4.3-5.0), head and neck tumors (SHR=2.6, 95% confidence interval, 2.2-3.1), and leukemia (SHR=2.5, 95% confidence interval, 1.9-3.1) were at greatest risk. Males had significantly higher absolute excess risks than females (absolute excess risks =7 versus 3), especially among head and neck tumor survivors (absolute excess risks =30 versus 11). By 60 years of age, 9%, 6%, and 5% of CNS tumor, head and neck tumor, and leukemia survivors, respectively, had been hospitalized for a cerebrovascular event. Beyond 60 years of age, every year, 0.4% of CNS tumor survivors were hospitalized for a cerebral infarction (versus 0.1% expected), whereas at any age, every year, 0.2% of head and neck tumor survivors were hospitalized for a cerebral infarction (versus 0.06% expected). Survivors of a CNS tumor, head and neck tumor, and leukemia are particularly at risk of hospitalization for a cerebrovascular event. The excess risk of cerebral infarction among CNS tumor survivors increases with attained age. For head and neck tumor survivors, this excess risk remains high across all ages. These groups of survivors, particularly males, should be considered for surveillance of cerebrovascular risk factors and potential pharmacological interventions for cerebral infarction prevention.

Ethnic inequalities in acute myocardial infarction hospitalization rates among young and middle-aged adults in Northern Italy: high risk for South Asians.

The knowledge of ethnic-specific health needs is now essential to design effective health services and population-based prevention strategies. However, data on migrant populations living in Southern Europe are limited. The study is designed to investigate ethnic inequalities in hospitalization for acute myocardial infarction (AMI) in the Veneto region (Italy). Hospital admissions for AMI in Veneto for the whole resident population aged 20-59years during 2008-2013 were studied. Age and gender-specific AMI hospitalization rates for immigrant groups (classified by country of origin according to the United Nations geoscheme) and Italians were calculated. The indirect standardization method was used to estimate standardized hospitalization ratios (SHR) for each immigrant group, with rates of Italian residents as a reference. Overall, 8200 AMI events were retrieved, 648 among immigrants. The highest risk of AMI is seen in South Asians males (SHR 4.2, 95% CI 3.6-4.9) and females (SHR 2.5, 95% CI 1.4-4.5). AMI rates in South Asian males sharply increase in the 30-39years age class. Other immigrant subgroups (Eastern Europe, North Africa, Sub-Saharan Africa, other Asian countries, Central-South America, high-income countries) displayed age- and gender-adjusted hospitalization rates similar to the native population. Present findings stress the urgent need for implementation of ethnic-specific health policies in Italy. The awareness about the high cardiovascular risk in subjects from South Asia must be increased among general practitioners and immigrant communities.

Large variations in stroke hospitalization rates across immigrant groups in Italy.

A high mortality from cerebrovascular diseases has been reported among immigrants in Europe; however, data on stroke incidence in immigrants are sparse. Aim of the study is to assess hospitalization rates for stroke across different immigrant groups in the Veneto Region (Italy). The study population was represented by all residents aged 20-64 years. Admissions for stroke in 2008-2013 were extracted from hospital discharge records based on diagnosis codes. We computed age and gender specific rates separately for Italian and foreign residents. For each area of origin (Eastern Europe, North Africa, Sub-Saharan Africa, South Asia, other Asian countries, Central-South America, and industrialized countries) we calculated standardized hospitalization ratios (SHR) by means of indirect standardization, with rates observed in Italian residents as a reference. We identified 9740 hospitalization for stroke, 8.0% of which occurred in immigrants. Overall stroke rates were higher in immigrants males (SHR 1.45, 95% confidence interval 1.32-1.59) and females (SHR 1.21, 1.08-1.36) with respect to the Italian population. The highest risk was observed in Sub-Saharan Africans, in both genders (males SHR 3.15, 2.62-3.76; females SHR 3.15, 2.22-4.34), followed by immigrants from South Asia and other Asian countries. Our findings confirm the increased risk of stroke in immigrants, with wide variations by country of origin. Further studies are warranted to investigate associated risk factors in order to shape effective preventive strategies.

Hospitalization in a Cohort Seeking Treatment for Illicit Drug Use in Finland

Illicit drug use is associated with various health problems that result in inpatient hospital admissions. The primary objective of this study was to examine all-cause and cause-specific hospitalizations by gender. The cohort comprised 4817 drug users (3365 males and 1452 females) who sought treatment in Helsinki between 1997 and 2008. Data on hospitalizations that occurred among these clients were extracted from the National Hospital Discharge Register. Crude hospitalization rates (CHRs) and standardized hospitalization ratios (SHRs) with 95% confidence intervals (CIs) were calculated, and Kaplan–Meier analysis with Log-Rank test was used to compare survival in terms of time to hospitalization between males and females. At the end of the follow-up period, 84.5% of females and 73.3% of male clients were hospitalized at least once. Female clients had higher CHR (607.6/1000 person–years, 95%CI: 594.1–621.4) than males (511.0/1000, 95% CI: 502.9–519.3), and had significantly poorer survival than males (Log-Rank test, P<0.001). However, male clients stayed longer on admission than females (mean length of stay 70.2days versus 60.7days respectively, P<0.001). Compared to the national rates, excess hospitalizations were noted in both males (SHR=6.3, 95% CI: 6.2–6.4) and female clients (SHR=4.3, 95% CI: 4.2–4.4). Based upon primary discharge diagnosis, the leading causes of hospitalizations included psychosis (n=622), schizophrenia (n=604), depression (n=497), cardiovascular diseases (n=223), hepatitis C (n=116), HIV (n=81), and other types of hepatitis (n=45). Female clients were more likely than males to be admitted for hepatitis C infection (P<0.001) and depression (P<0.001). Male clients were more likely than females to be diagnosed with other types of hepatitis infections (P=0.032) and psychosis (P=0.035). Excess hospitalizations signify excessive utilization of health resources. Effective drug abuse treatment, gender-sensitive approaches, and regular health checks can help to reduce morbidity. Appropriate measures are needed to address psychiatric problems in this population.

Joint spatial modeling to identify shared patterns among chronic related potentially preventable hospitalizations.

BackgroundRates of Potentially Preventable Hospitalizations (PPH) are used to evaluate access of territorially delimited populations to high quality ambulatory care. A common geographic pattern of several PPH would reflect the performance of healthcare providers. This study is aimed at modeling jointly the geographical variation in six chronic PPH conditions in one Spanish Autonomous Community for describing common and discrepant patterns, and to assess the relative weight of the common pattern on each condition.MethodsData on the 39,970 PPH hospital admissions for diabetes short term complications, chronic obstructive pulmonary disease (COPD), congestive heart failure, dehydration, angina admission and adult asthma, between 2007 and 2009 were extracted from the Hospital Discharge Administrative Databases and assigned to one of the 240 Basic Health Zones. Rates and Standardized Hospitalization Ratios per geographic unit were estimated. The spatial analysis was carried out jointly for PPH conditions using Shared Component Models (SCM).ResultsThe component shared by the six PPH conditions explained about the 36% of the variability of each PPH condition, ranging from the 25.9 for dehydration to 58.7 for COPD. The geographical pattern found in the latent common component identifies territorial clusters with particularly high risk. The specific risk pattern that each isolated PPH does not share with the common pattern for all six conditions show many non-significant areas for most PPH, but with some exceptions.ConclusionsThe geographical distribution of the risk of the PPH conditions is captured in a 36% by a unique latent pattern. The SCM modeling may be useful to evaluate healthcare system performance.

Health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy): mortality and hospitalization from current data.

The objective of this chapter is to study the health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy), in terms of mortality and hospitalization. The diseases which international scientific literature indicates as associated with asbestos exposure were taken into consideration: mesothelioma of pleura, peritoneum, pericardium and tunica vaginalis testis, malignant neoplasm of larynx, malignant neoplasm of trachea, bronchus and lung, malignant neoplasm of ovary, pneumoconiosis; moreover, in order to describe the health profile of the study population, large groups of diseases were taken into consideration. Current data (available in the Data Bases of the Unit of Statistics of ISS) regarding mortality and hospitalization were analyzed. Standardized Mortality Ratios, Standardized Hospitalization Ratios and Age-standardized Death Rates were calculated. The demographic background of the population residing in Biancavilla was also outlined. Our findings support the etiologic role of fibres with fluoro-edenitic composition in the occurrence of the above mentioned diseases, already observed in other studies.

Chronic lower respiratory diseases among demolition and cement workers: a population-based register study

ObjectiveTo estimate standardised hospitalisation ratios (SHR) for chronic lower respiratory diseases among demolition and cement workers in Denmark, 1995–2009.DesignThis is a population-based register study on data from ‘the Occupational Hospitalisation...

Parkinson's disease and other neurodegenerative disorders among welders: A Danish cohort study

It has been hypothesized that welders are at increased risk for neurological disorders, including Parkinson's disease, but few well-designed cohort studies have been conducted. The risk for Parkinson's disease and other neurodegenerative disorders was examined in an updated follow-up study based on a previous cohort of 5867 Danish welders and 1735 nonwelding metal workers exposed to welding fume. Occupational history and information on smoking were obtained from questionnaires, supplemented by information from the compulsory Danish Supplementary Pension Fund. Hospital contacts, including outpatient data from 1994, for Parkinson's disease and other neurological disorders were ascertained from the Danish National Hospital Register. Based on first-time hospital contacts, standardized hospitalization ratios (SHRs) were calculated for the entire cohort and for welders, metal workers, and nonresponders separately and for the general Danish population in 1987-2008. In an internal analysis of welders, Cox proportional hazard models were used to estimate hospitalization rate ratios (HRRs) for Parkinson's disease associated with lifelong exposure to welding. Overall, 45 cohort members had a hospital contact for Parkinson's disease (SHR, 1.12; 95% confidence interval [CI], 0.82-1.50), of whom 25 were welders (standardized incidence rate ratio, 1.05; 95% CI, 0.68-1.55). When duration of welding was compared among 5736 welders, the HRR was 0.83 (95% CI, 0.59-1.16) per 10 years' welding, after adjustment for smoking. The results of this study do not support the hypothesis that welders are at increased risk for Parkinson's disease; these findings are consistent with those of our previously published analysis. © 2012 Movement Disorder Society.

Geospatial analyses to prioritize public health interventions: a case study of pedestrian and pedal cycle injuries in New South Wales, Australia

Pedestrian and pedal cycle injuries are important causes of child morbidity and mortality. The combination of Bayesian methods and geographical distribution maps may assist public health practitioners to identify communities at high risk of injury. Data were obtained on all hospitalizations of children from NSW (Australia), for pedestrian and pedal cycle injuries, from 2000-2001 to 2004-2005. Using Bayesian methods, posterior expected rate ratios (as an estimate of smoothed standardized hospitalization ratios for each injury mechanism) were mapped by local government area (LGA) across the state. There were over 7,000 hospitalizations for pedestrian and pedal cycle injuries. High risk LGAs accounted for more than one third of hospitalized pedestrian and pedal cycle injuries in NSW. LGAs at high risk for pedestrian injury tended to be urbanized metropolitan areas with a high population density, while high risk LGAs for pedal cycle injury tended to be either in urban regional areas, or on the margin of urbanized metropolitan areas. Geospatial analyses can assist policymakers and practitioners to identify high risk communities for which public health interventions can be prioritized.

Trends in all cause and viral liver disease-related hospitalizations in people with hepatitis B or C: a population-based linkage study

BackgroundPrevious studies have reported an excess burden of cancer and mortality in populations with chronic hepatitis B (HBV) or C (HCV), but there are limited data comparing hospitalization rates. In this study, we compared hospitalization rates for all causes and viral liver disease in people notified with HBV or HCV in New South Wales (NSW), Australia.MethodsHBV and HCV notifications were linked to their hospital (July 2000-June 2006), HIV and death records. Standardized hospitalization ratios (SHRs) were calculated using rates for the NSW population. Random effects Poisson regression was used to examine temporal trends.ResultsThe SHR for all causes and non alcoholic liver disease was two-fold higher in the HCV cohort compared with the HBV cohort (SHRs 1.4 (95%CI: 1.4-1.4) v 0.6 (95%CI: 0.6-0.6) and 14.0 (95%CI: 12.7-15.4) v 5.4 (95%CI: 4.5-6.4), respectively), whilst the opposite was seen for primary liver cancer (SHRs 16.2 (95%CI: 13.8-19.1) v 29.1 (95%CI: 24.7-34.2)). HIV co-infection doubled the SHR except for primary liver cancer in the HCV/HIV cohort. In HBV and HCV mono-infected cohorts, all cause hospitalization rates declined and primary liver cancer rates increased, whilst rates for non alcoholic liver disease increased by 9% in the HCV cohort but decreased by 14% in the HBV cohort (P < 0.001).ConclusionHospital-related morbidity overall and for non alcoholic liver disease was considerably higher for HCV than HBV. Improved treatment of advanced HBV-related liver disease may explain why HBV liver-related morbidity declined. In contrast, HCV liver-related morbidity increased and improved treatments, especially for advanced liver disease, and higher levels of treatment uptake are required to reverse this trend.

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Hospital-related morbidity in people notified with hepatitis C: A population-based record linkage study in New South Wales, Australia

Statistics are available about hepatitis C (HCV)-related transplants, mortality and cancer risk but little is known about morbidity in the earlier stages of infection. We examined condition specific (principal diagnosis) and overall hospitalization rates for the cohort of individuals notified with hepatitis C in New South Wales (NSW), Australia. HCV notifications in NSW were linked to their hospital records (available for July 2000 to June 2006), HIV and hepatitis B notifications, and death records. Cases co-infected with HIV or hepatitis B were excluded. Hospitalization rates by person-years of observation were calculated and compared with those expected using rates for the NSW population to calculate standardized hospitalization ratios (SHRs). Patterns of admission were generally similar to the NSW population, with the highest rates in the elderly. However, rates were 42% higher than expected overall and significantly increased in ages 15-64 years. The greatest was excess in 15-19 year olds (SHR 3.8, 95% CI 3.4-4.2), especially females (SHR 4.5, 95% CI 4.1-4.9). Lifestyle factors accounted for the highest absolute and relative rates in young adults while liver disease contributed the greatest burden in older adults. Illicit drug-related conditions accounted for 9% of admissions (SHR 16.1, 95% CI 15.7-16.6) while alcohol and liver-related conditions each accounted for 5% (SHRs 5.1, 95% CI 4.9-5.4 and 15.7, 95% CI 15.0-16.4, respectively). Our findings highlight the need for strategies to minimize lifestyle-related harms, including alcohol consumption, and to improve HCV treatment uptake, in order to reduce morbidity in people with HCV infection.