Standardised Admission Ratios Research Articles

Ten-Year Trend in Emergency Department Visits for Sexually Transmitted Infections among Adolescents: A Retrospective Cross-Sectional Study in Italy.

to describe the last ten years of emergency department (ED) visits for STIs among adolescents. a retrospective cross-sectional observation was carried out in the Piedmont region in Italy. Data were retrieved through the Italian National Information System database. ED visits related to specific ICD-9-CM codes carried out on 11 to 19-year-old youths between 2011 and 2020 were investigated. Age-specific, crude, and standardized rates and admission ratios, with 95% confidence intervals (CIs), were calculated to estimate the STI trend. from a total of 1,219,075 ED visits, 339 were related to STIs, representing an increasing ratio of 28 per 100,000 visits, primarily in females. Most infections occurred in girls (83.5%) and among 17 to 19-year-olds (71.5%). A drop in both ED visits and STI cases was observed in 2020. Genital Herpes and Genital Warts were more frequent in girls while Gonorrhea was more frequent in boys. the increasing trend of ED visits for STIs, particularly in girls, represents an emerging relevant public health issue that needs to be urgently tackled.

Ethnicity and Risk of Death in Patients Hospitalised for COVID-19 Infection: An Observational Cohort Study in an Urban Catchment Area

Background: Studies during the COVID-19 pandemic have suggested patient characteristics with increased risk of death. Most studies have not included populations which reflect an urban UK demographic but emerging case reports have suggested poorer outcomes in certain ethnic groups. It was hypothesised that people from South Asian ethnic groups would be more susceptible to severe manifestations of COVID-19. Methods: Patients with confirmed SARS-CoV-2 infection by positive polymerase chain reaction testing and requiring admission to University Hospitals Birmingham NHS Foundation Trust in Birmingham UK between 10th March 2020 and 17th April 2020 were included. Demographics, ethnicity, baseline co-morbidities, social deprivation index and outcome (death within the censor date) were assessed and Cox regression analysis conducted. Using observed sex-specific age distributions of COVID-19 admissions/deaths and 2011 census data for Birmingham/Solihull, expected numbers of admissions and deaths were estimated and ratios of observed to expected numbers calculated, providing standardised admission ratios (SAR) and standardised mortality ratios (SMR). Results: 2217 patients admitted to UHB with a proven diagnosis of COVID-19 were included. 58.2% were male, 69.5% White and the majority (80.2%) had co-morbidities. 18.5% were of South Asian ethnicity, and these patients were more likely to be younger (median age 61 vs.77), have no co-morbidities (27.8% vs. 16.6%) but a higher prevalence of diabetes mellitus (48.1% vs 28.2%) than White patients. SAR and SMR suggested more admissions and deaths in South Asian patients than would be predicted. These patients were more likely to present with severe disease. South Asian ethnicity was associated with an increased risk of death (Hazard Ratio 1.67 (95%CI 1.34 – 2.10)) after adjusting for age, sex, deprivation and comorbidities. Interpretation: Current evidence suggests those of South Asian ethnicity may be at risk of worse COVID019 outcomes, further studies needs to establish the underlying mechanistic pathways. Funding Statement: HDRUK Hub PIONEER Declaration of Interests: S Gallier, C Mainey, P Nightingale, D McNulty, A Kolesnyk, M Ahmed, H Crothers, F Evison, A Liaqat, L Irshad, M. Harris, T Nabavi, P Cockwell, D Pagano, report no conflicts of interest. S Ballreports funding support from the HDFR-UK, K Reeves reports funding support from the NIHR, E Sapey reports funding support from the MRC, Wellcome Trust, NIHR and British Lung Foundation. K. Nirantharakumar reports funding from MRC, Wellcome Trust, NIHR, Vifor and AstraZeneca. A.K Dennistonreports funding from HDR-UK, Wellcome Trust and Fight for Sight. Ethics Approval Statement: This retrospective cohort study, using prospectively collected data was conducted as part of DECOVID, an HRA and London - City & East Research Ethics Committee approved research database (Ethics number 20/HRA/1689).

The association between dementia severity and hospitalisation profile in a newly assessed clinical cohort: the South London and Maudsley case register

ObjectivesTo evaluate the risk and common causes of hospitalisation in patients with newly diagnosed dementia and variation by severity of cognitive impairment.SettingWe used data from a large London mental healthcare...

Pregnancy, childbirth, and puerperium outcomes in female firefighters in Korea

BackgroundFemale firefighters are exposed to hazardous environmental (chemical and physical) and working (shift work, psychological, and ergonomic factors) conditions that have reported or are suspected of adverse effects on reproductive health. However, no previous studies have reported on pregnancy, childbirth, and puerperium outcomes (PCPOs) in female firefighters.MethodsThe present study compared hospital admissions for PCPOs, based on 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, among Korean female firefighters with those of the general Korean population. Standardized admission ratios (SARs) and their 95% confidence intervals (CIs) were calculated.ResultsThe study population included 1,766 female firefighters. Total follow-up duration was 9,659 person-years. Compared to the general female population, the female firefighters' SARs were higher in all admissions for PCPOs (SAR, 1.92; 95% CI: 1.79–2.05); pregnancy and abortive outcomes (SAR, 1.56; 95% CI: 1.12–2.12); other maternal disorders predominantly related to pregnancy (SAR, 2.65; 95% CI: 1.99–3.46); maternal care related to the fetus, amniotic cavity, and possible delivery problems (SAR, 2.13; 95% CI: 1.74–2.57); labor and delivery complications (SAR, 1.55; 95% CI: 1.15–2.06); delivery (SAR, 1.94; 95% CI: 1.80–2.08); and complications predominantly related to puerperium (SAR, 4.68; 95% CI: 2.02–9.23).ConclusionThe results of this study showed high SARs in all and specific subcategories of PCPOs in female firefighters.

General hospital admission rates in people diagnosed with personality disorder.

To determine the frequency of all-cause general hospital admissions for individuals with personality disorder (PD) in a large clinical population using linked secondary mental healthcare and hospitalisation data. A retrospective cohort study, using anonymised electronic mental health records from South London and Maudsley NHS Foundation Trust (SLaM), linked to Hospital Episodes Statistics in England. People with PD aged 15years or older, receiving care within SLaM between April 2007 and March 2013, were identified and compared to residents from the local catchment area. Standardised admission ratios (SARs) were calculated for all major categories of causes of general hospital admission for this defined group, with local residents in 2011 UK Census as the standard population. For the 7677 people identified with PD, SAR for all causes of admission was 2.75 (95% CI: 2.70, 2.81). Both men and women with PD had increased SARs across multiple ICD-10 categories, including circulatory, respiratory, digestive, nervous, and musculoskeletal system disorders and endocrine, blood and infectious disorders. Sensitivity analysis (removing the impact of repeated admissions by same individual for same diagnosis in the same year) yielded similar findings. By comparison with members of the general population, individuals with a diagnosis of personality disorder are at significantly higher risk of hospital admission resulting from a wide range of physical health problems.

Injury-related hospital admission of female firefighters in South Korea

Purpose. The main objective of this study was to ascertain whether injury-related hospital admission in all South Korea female firefighters is greater than that in the general population. Methods. To perform this comparison, the standardized admission ratios (SARs) and their 95% confidence intervals (CIs) were calculated by person-years and mortality computation software. Results. Compared to the general population, the SARs for overall injury (SAR = 1.57, 95% CI [1.24, 1.96]) and for injury to the lower back (SAR = 2.78, 95% CI [1.81, 4.07]) in the female firefighters were significantly higher. The SARs for injury to the knee (SAR = 2.48, 95% CI [1.18, 4.55]) in emergency medical services (EMS) workers were significantly higher than those in the general population. Conclusions. Our study shows that the SARs of overall injury and injury to the lower back in female firefighters and knee injury in the EMS were significantly higher than those in the general population. Further studies are needed to protect the lower back of firefighters and the knees of EMS.

Hospital admissions for respiratory system diseases in adults with intellectual disabilities in Southeast London: a register-based cohort study

BackgroundIntellectual disability (ID) carries a high impact on need for care, health status and premature mortality. Respiratory system diseases contribute a major part of mortality among people with ID, but...

Central nervous system diseases of organic solvents exposed workers based on nationwide medical surveillance-data in Korea.

New light is being shed on the relationship between chronic neurotoxicity of the central nervous system (CNS) and exposure to low-level organic solvents (OS). However, there are few longitudinal studies with a large sample size. A cohort of OS-exposed male workers was selected who had undergone an OS-associated specialized medical check-up at least once between 2000 and 2004 in Korea. The standardized admission ratios (SAR) for CNS diseases were calculated with reference to the Korean adult male population. Adjusted relative risks (ARR) were also estimated in comparison to noise-exposed male workers. There were 238,574 OS-exposed workers, yielding 954,772 person-years of exposure. OS-exposed workers were at elevated risk of "other extrapyramidal and movement disorders" (G25) with a SAR = 2.95 (95% CI: 1.41-5.42) and "systemic atrophies primarily affecting the CNS" (G10-G13) SAR = 2.08 (95% CI: 1.03-3.74). There were no significant differences between the OS-exposed workers and noise-exposed workers. A limited number of CNS diseases identified through hospital admissions data and short observation periods reduced statistical power to determine effect size. OS exposure was positively associated with "other extrapyramidal and movement disorder and systemic atrophies primarily affecting the CNS.

A large, nationwide, longitudinal study of central nervous system diseases among Korean workers exposed to manganese.

In occupational epidemiologic studies, the low incidence and chronic process of central nervous system (CNS) diseases has complicated the determination of the relationship between increased morbidity and manganese (Mn) exposure. Therefore, through this large cohort study, we evaluated CNS disease morbidity among Korean workers exposed to Mn Data were collected from Mn-associated specialized medical check-up 2000 and 2004 in Korea. The number of workers admitted to hospital because of clinically diagnosed CNS disease was analyzed in male workers exposed to Mn (n = 104,544). As a control reference population, 2% of Korean men were randomly selected and their hospital admission data were analyzed. For Mn-exposed workers, Standardized admission ratios (SARs) for CNS disease, as determined by ICD-10 classifications, were estimated in reference to the control population During follow up, 64 workers admitted because of CNS diseases. Chronic exposure to Mn (≥ 10 years) was significantly associated with the SAR (95% CI) of extrapyramidal and movement disorders (SAR: 2.03, 95% CI: 1.05-3.55), in particular, other extrapyramidal and movement disorders (SAR: 4.81, 95% CI: 1.29-12.32). Also borderline association (SAR = 4.88, 90% CI: 1.05-7.04) was noted for secondary Parkinsonism among workers with chronic Mn exposure. SARs (95% CI) for other degenerative nervous system diseases were significantly higher in Mn-exposed workers compared with the control population (SAR: 3.60, 95% CI: 1.16-8.40) CONCLUSION: In conclusion, Mn-exposed workers exhibited significantly elevated SARs for degenerative nervous system diseases and extrapyramidal and movement disorders, compared to the age-matched reference population, suggesting a relatedness with Mn exposure.

0088 Nervous System Disease among Korean Workers Exposed to Manganese

ObjectivesExposure to excess levels of manganese in occupational settings has been associated with a neurological syndrome. So morbidity of nervous system disease among Korean workers exposed to manganese described through...

PF.46 Childhood Hospital Admissions of Children Conceived Following Assisted Reproductive Technology

The purpose of this project was to compare paediatric hospital admission rates of children conceived via assisted reproductive technology with that of the population as a whole.Consent-based ART register and...

Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment

ObjectivesReducing emergency admissions is a priority for the NHS. A single hospital's emergency care system was reorganised with the principles of front-loaded investigations, integration of specialties, reduced duplication, earlier decision...

Does integrated emergency care reduce mortality and non-elective admissions? a retrospective analysis

ObjectivesThe authors reconfigured the emergency care system of Addenbrookes Hospital, Cambridge. The medical admissions unit and the emergency department (ED) have been combined into one emergency assessment unit. This paper...

The risk of hospitalisation for infectious pneumonia in mineral dust exposed industries

ObjectivesThe purpose of the study was to elucidate the relationship between industries characterised by mineral dust exposure and infectious pneumonia.MethodsThe authors applied a retrospective record linkage design and used the...

Integrated emergency care reduces hospital admissions and reduces in hospital mortality

IntroductionWe closed our Medical Admissions Unit and relocated the staff into an enlarged Emergency Department. We streamlined our assessment processes to reduce duplication of effort. We aimed to evaluate the...

Differences in Severity-Adjusted Pediatric Hospitalization Rates Are Associated With Race/Ethnicity

Racial/ethnic disparities in health care delivery have been well described, but little is known about such disparities for children who seek emergency care. The objective of this study was to test the hypothesis that severity-adjusted emergency department pediatric admission rates are associated with race/ethnicity. Secondary analyses were conducted of an established database of 16 emergency departments that participated in a national study to validate the Pediatric Risk of Admission II score, which is used to measure severity of illness. Patients were randomly selected by the coordinating center from daily emergency department visit logs. Crude and severity-adjusted admission rates were compared among the 3 most common races/ethnicities: white, black, and Hispanic. Adjusted admission rates were calculated by using the standardized admission ratio, which was calculated by dividing the observed admissions by the predicted admissions, when predicted was calculated from the Pediatric Risk of Admission II score. After exclusion of 3 sites that recorded race/ethnicity in <10% of patients, there were 13 sites with 8952 patients in the 3 major race/ethnicity groups. Black and Hispanic patients were similar to each other and different from white patients; therefore, these 2 groups were combined for analyses. Both crude (8.2% vs 5.3%) and severity-adjusted (standardized admission ratio: 1.71 vs 1.1) admission rates were higher in white than in nonwhite patients. Standardized admission ratios were close to 1.0 in both race/ethnicity groups in the higher quintiles of illness severity. In contrast, white patients were admitted at 1.5 to 2 times the expected rate in the lowest 2 quintiles of severity. There are differences in both crude and adjusted admission rates between white and black/Hispanic patients. The results are more consistent with high rates of discretionary admissions for white patients with low illness severity than with underadmitting severely ill black or Hispanic patients.

Patients with type 2 diabetes had higher rates of hospitalization than the general population

Objective We describe the rate, causes, and predictors of hospitalization for all patients with type 2 diabetes in a diabetes clinic in Turin, Italy and compare their hospitalization rates with those of the general population. Study design and setting All patients were recruited and followed up for hospital admissions from January 1996 to June 2000. The role of risk factors was analyzed with a conditional proportional hazard model for repeated events. Results More than 50% of the patients had been admitted to hospital at least once for any cause, and 30% had had multiple admissions, accounting for nearly 90% of all days in hospital. For these patients, older age, high glycated hemoglobin level, obesity, insulin treatment, presence of nephropathy, coronary and peripheral artery disease and comorbidity were statistically independent predictors of hospital admission. The standardized hospital admission ratios were 158.8 for men <65 years of age and 113.3 for men ≥65 years and 245.2 for women <65 years of age and 135.3 for women ≥65 years of age. The highest ratios were for diabetes, vascular (cardiac and cerebral) diseases, and eye diseases in younger women. Conclusion Patients with type 2 diabetes, and particularly younger women, had higher rates of hospitalization than the general population, with an excess risk of about 30%.

Controlling for provider of treatment in the modelling of respiratory disease risk near cokeworks.

The improved quality of hospital admissions data makes them a valuable resource for researchers. However, we show that, when multiple providers of health care are considered, the provider (in this case hospital) may act like other confounders such as socio-economic status, and hence must be controlled for. Such control is not as straightforward as for conventional confounders, however, but we describe a method that is appropriate under certain assumptions. We also describe a number of other statistical issues, such as the modelling of spatial and non-spatial overdispersion, that arose during the use of hospital data in a study to investigate the possible adverse health effects of living in proximity to six cokeworks groups in England and Wales. The outcome data that we consider consist of hospital admissions for all respiratory disease in the under-5s. The ecological level of the analysis is the census-defined enumeration district, and the main (proxy) exposure measure utilised is the spatial location of the enumeration district population-weighted centroid in relation to the cokeworks. We focus on the Teesside cokeworks group, for which we also had sulphur dioxide measurements from dispersion modelling as an alternative exposure measure. The major local providers varied appreciably in their standardized admission ratios for respiratory disease, and when provider was controlled for, the size of the observed excess risk found close to the cokeworks was decreased, making control for the provider of health care vital. However, the presence of multiple pollution sources, in addition to the usual shortcomings of ecological studies, makes interpretation difficult.

Geographical variation in acute psychiatric admissions within New York City 1990–2000: growing inequalities in service use?

The paper analyses geographical variations in use of acute psychiatric inpatient services within New York City and how these have changed from 1990 to 2000. We review literature suggesting reasons for the variations observed. Data from the New York State Department of Health Statewide Planning Research and Cooperative System were combined with population census data to produce age standardized ratio indicators of admissions and of bed days, as measures of use of general hospitals for psychiatric conditions, by males aged 15–64, in Zip Code Areas of New York City, in 1990 and 2000. Geographical variations in hospital use were related to proximity to general hospitals with psychiatric beds and to socio-economic status of local populations (as recorded in the 1990 and 2000 population censuses). Areas close to psychiatric hospitals areas show high admission levels. Controlling for this, Zip Code Areas with higher concentrations of poverty, of African American residents or of persons living alone were associated with relatively high admission ratios. These relationships vary somewhat between diagnostic groups. Area inequalities in standardized admission ratios persisted and widened between 1990 and 2000, and the highest hospital admission ratios were increasingly concentrated where social and economic disadvantage was greatest. Various possible reasons for this trend are explored. We conclude that increasing intensity of poverty in disadvantaged areas is not likely to provide an explanation and that the trends are more likely to result from changes in hospital management and funding affecting access to hospital services.

Factores asociados a la hospitalización por procesos sensibles a cuidados ambulatorios en los municipios

ObjectivesTo describe variability in admission rates for ambulatory care sensitive conditions (ASSC) in municipalities in the catchment area of a tertiary hospital and to determine the influence of primary care characteristics, socioeconomic factors, health of the population, and geographical accessibility to the hospital on this variability. MethodsAn ecological study was carried out in 34 municipalities in the area served by the Hospital Virgen de las Nieves in Granada (Spain) including all admissions for ASSC from 1997 to 1999. The admission rates for men and women were calculated separately and were age-standardized by the indirect method. The following factors were analyzed as independent variables: characteristics of primary care (type of healthcare model and type of center), socioeconomic factors (unemployment rate, income per capita, number of business establishments, size of municipality), health (mortality rate), and accessibility (time in minutes from the municipality to the hospital). A multiple lineal regression model was estimated. ResultsA total of 9.8% of all hospital admissions were due to ASSC. The mean annual admission rate was 10 admissions per 1.000 inhabitants. This rate was higher for men and for persons aged more than 74 years. The standardized admission ratios were not statistically different from 1 in 56% of the municipalities and were higher than 1 in 26% and lower than 1 in 18%. Sixty-two percent of the variability in rates for men was associated with time taken to reach the hospital, size of municipality, the interaction between both variables, and mortality. Eighteen percent of the variability in rates for women was associated with time taken to reach the hospital and the unemployment rate. ConclusionsVariability in admission rates for ASSC was not associated with primary care characteristics in the geographical area analyzed. Accessibility (measured as time to the hospital) was the only variable associated with higher rates in both men and women. Admission rates for ASSC among women were higher when unemployment rates were higher, and rates among men were higher in larger municipalities and in those with higher mortality.