Trends In Annual Incidence Research Articles

Alcohol Associated Hepatitis Trends Before and Following the Onset of the COVID-19 Pandemic Across Two Distinct Cohorts in the United States and Hong Kong

Background and AimsAlcohol-associated liver disease (ALD) burden has been rising globally, fueled by increases in high-risk alcohol use following the COVID-19 pandemic. We aim to evaluate trends in annual incidence of alcohol-associated hepatitis (AH) before and following onset of the COVID-19 pandemic across two geographically distinct populations in the U.S. and Hong Kong. MethodsUsing U.S. national Veterans Affairs (VA) data and Hong Kong territory-wide data, trends in annual incidence of AH were evaluated from 2000 to 2023. AH was identified using a combination of ICD-9/10 diagnostic codes, laboratory data, and available alcohol use data. ResultsAmong the VA, annual incidence of AH rose steadily from 39.4 to 53.7 per 100,000-persons (2010 to 2020), then declined to 36.2 per 100,000-persons in 2023. Annual AH incidence was substantially lower in Hong Kong, but demonstrated similar trends, peaking at 0.28 per 100,000-persons during the first year of the pandemic. Among both cohorts, incidence of AH was significantly higher in men vs. women, but particularly for the VA cohort, the rise in AH incidence was more rapid in women. Among both cohorts, the highest incidence of AH in 2023 was among the age 40-49 years group (VA: 72.7 per 100,000-persons; Hong Kong: 1.89 per 100,000-persons). ConclusionsWe provide a comprehensive analysis of epidemiological trends in AH incidence across two distinct populations, highlighting the need for continued awareness of targeted interventions to curb unhealthy alcohol use and its complications. Impact and ImplicationsAlcohol-associated hepatitis (AH) is a severe complication of high-risk alcohol use associated with significant morbidity and mortality. Increasing alcohol use fueled by the COVID-19 pandemic has led to parallel increases in alcohol-related co-morbidities. The current study provides a comprehensive analysis of trends in the incidence of AH across two distinct world regions before and following the onset of the COVID-19 pandemic. Better identifying epidemiological trends in AH incidence as well as highlighting populations most effected can help target public health resources and health system interventions to address the dangers of high-risk alcohol use more effectively.

Primary adrenal sarcomas: A national analysis of epidemiological trends, treatment patterns, and outcomes.

Primary adrenal sarcoma (PAS) is an exceedingly rare malignancy with limited data available on its epidemiology, management, and outcomes. This study aimed to characterize the national incidence, treatment patterns, and survival of PAS utilizing a National Cancer Database. The National Cancer Database was queried for patients diagnosed with primary adrenal tumors from 2004 to 2019. Cases with sarcoma histology were identified as PAS. Annual incidence trends, histological distribution, treatment modalities (surgery, chemotherapy, radiation therapy), perioperative outcomes, and overall survival (OS) were analyzed. Of 7213 primary adrenal tumor cases, 332 (4.6%) were PAS. The most common histological subtypes were leiomyosarcoma (37.3%), hemangiosarcoma (27.1%), and sarcoma not otherwise specified (6.0%). Most cases (71.7%) presented as locoregional disease. Treatment included surgery alone (47.8%), surgery plus chemotherapy and/or radiation (27.1%), chemotherapy/radiation alone (13.3%), or no treatment (13.9%). For surgical cases, the median length of stay was 5 days, the 30-day readmission rate was 3.36%, and the 30/90-day mortality rates were 3.65% and 9.90%, respectively. The 5-year OS rate for surgery alone was 43%, with a median OS of 34.6 months. For surgery with radiation/chemotherapy, the 5-year OS rate was 37.3%, with a median OS of 35.4 months. This largest analysis of PAS to date demonstrates that most cases present as locoregional disease amenable to surgical resection, with favorable outcomes. The role of adjuvant therapy remains unclear, as no significant survival difference was observed between surgery alone and multimodal treatment.

Incidence and mortality of community-acquired and nosocomial infections in Japan: a nationwide medical claims database study

BackgroundIt is important to determine the prevalence and prognosis of community-acquired infection (CAI) and nosocomial infection (NI) to develop treatment strategies and appropriate medical policies in aging society.MethodsPatients hospitalized between January 2010 and December 2019, for whom culture tests were performed and antibiotics were administered, were selected using a national claims-based database. The annual trends in incidence and in-hospital mortality were calculated and evaluated by dividing the patients into four age groups.ResultsOf the 73,962,409 inpatients registered in the database, 9.7% and 4.7% had CAI and NI, respectively. These incidences tended to increase across the years in both the groups. Among the patients hospitalized with infectious diseases, there was a significant increase in patients aged ≥ 85 years (CAI: + 1.04%/year and NI: + 0.94%/year, P < 0.001), while there was a significant decrease in hospitalization of patients aged ≤ 64 years (CAI: -1.63%/year and NI: -0.94%/year, P < 0.001). In-hospital mortality was significantly higher in the NI than in the CAI group (CAI: 8.3%; NI: 14.5%, adjusted mean difference 4.7%). The NI group had higher organ support, medical cost per patient, and longer duration of hospital stay. A decreasing trend in mortality was observed in both the groups (CAI: -0.53%/year and NI: -0.72%/year, P < 0.001).ConclusionThe present analysis of a large Japanese claims database showed that NI is a significant burden on hospitalized patients in aging societies, emphasizing the need to address particularly on NI.

Epidemiology of ophthalmic trauma in the United States from 2009–2018: A Nationwide Emergency Department Sample Analysis

PurposeTo determine the incidence, characteristics, disposition, and economic burden of emergency department (ED) visits for ophthalmic trauma in the United States (US). DesignRetrospective study. MethodsThe Nationwide Emergency Department Sample was used to calculate and characterize ED visits for ophthalmic trauma in the US from 2009 to 2018. Linear regression was used to estimate trends in annual incidence and mean inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission. ResultsThere were over 7.3 million ED visits for ophthalmic trauma in the US over the 10 years, with an annual incidence of 233 per 100,000 population. Patients were predominantly male (65 %), 21–44 years old (39 %), and from low-income households (56 %). Only 1 % of patients were hospitalized. Older age, male sex, metropolitan teaching hospitals, and trauma centers were associated with significantly higher odds of inpatient admission. The mean inflation-adjusted ED charge per visit more than doubled over the decade ($1,333 to $3,187) with total charges exceeding $14 billion. Superficial injuries (44 %) and eyelid/orbit wounds (20 %) accounted for the majority of visits. Orbital floor fractures (4 %) and open globe injuries (2 %) accounted for a minority of visits but were responsible for most admissions (49 % and 29 %, respectively) and the highest mean ED charge ($7,157 and $6,808, respectively). ConclusionsOphthalmic trauma represents an increasingly significant burden to EDs in the US. Preventive efforts should target young males from low socioeconomic backgrounds. Strategies to improve outpatient access and redirect non-urgent injuries may help alleviate costs.

Second primary colorectal cancer in adults: a SEER analysis of incidence and outcomes

BackgroundAt present, there was no large epidemiological study exploring the actual incidence and survival of second primary colorectal cancer (spCRC). The different characteristics and survival of patients with spCRC and initial primary colorectal cancer (ipCRC) still need to be elucidated. In addition, the factors leading to different survival status of spCRC and ipCRC were still unclear. Our study plan to explore the annual incidence trend of spCRC as well as the factors influencing the occurrence and survival outcome of spCRC.MethodsThis cohort study analyzed the data of 4680 spCRC patients and 330,937 initial primary colorectal cancer (ipCRC) patients. Whether patients had spCRC and whether spCRC patients survived or died were regarded as outcomes. The annual incidence of spCRC from 2004 to 2016 was analyzed by Jointpoint regression analysis. The truncation points were found, and the annual percentage change (APC) of each segment was calculated to explore the trend of spCRC change in the United States. Univariate and multivariable cox regression analyses were conducted to identify factors associated with the occurrence and prognosis of spCRC patients.ResultsThe total incidence of spCRC was decreased during 2000–2016 on the whole. The overall incidence of spCRC was lowered in both males and females despite 2013–2014, in the left colon, right colon, rectum and others. The incidence of spCRC was decreased in both 18–49 years’ people and ≥ 50 years’ people during 2000–2016, and the incidence of spCRC in the ≥ 50 years’ people group was higher than those of 18–49 years. Insured (OR = 0.867 (0.778–0.966), initial primary site of other digestive (OR = 0.46, 95%CI: 0.42–0.50), rectum (OR = 0.74, 95%CI: 0.66–0.82), or right colon (OR = 0.73, 95%CI: 0.68–0.79), N 1 stage (OR = 0.87, 95%CI: 0.76–0.99), M 1 stage (OR = 0.49, 95%CI: 0.30–0.80), AJCC II stage (OR = 0.70, 95%CI: 0.60–0.82), AJCC III stage (OR = 0.69, 95%CI: 0.56–0.84), and radiation (OR = 0.69, 95%CI: 0.57–0.83) were associated with the risk of spCRC. At the end of follow-up, 2,246 spCRC patients were survived and 2,434 spCRC patients were dead. Patients with spCRC had poor survival probability than patients with ipCRC. Older age (HR = 1.02, 95%CI: 1.02–1.03), male (HR = 1.13, 95%CI: 1.04–1.23), Black (HR = 1.20, 95%CI: 1.06–1.35), uninsured (HR = 1.36, 95%CI: 1.16–1.59), Signet ring cell carcinoma (HR = 1.64, 95%CI: 1.19–2.25), T4 stage (HR = 1.63, 95%CI: 1.32–2.01), N2 stage (HR = 1.36, 95%CI: 1.08–1.72), M1 stage (HR = 4.51, 95%CI: 2.00–10.18), AJCC III (HR = 1.47, 95%CI: 1.08–1.98), and radiation (HR = 1.82, 95%CI: 1.43–2.33) were associated with increased risk of mortality in spCRC patients.ConclusionThe incidence of spCRC was decreased except in people with initial primary tumor grade IV and those aged 15–39 years. The overall survival of spCRC patients was lower than ipCRC patients. Cancer patients with older age, high tumor grade, TNM stage, and AJCC stage should be caution to the occurrence of spCRC and timely interventions should be provided for spCRC patients to improve their outcomes.

Incidence and outcomes of cardiac tamponade in patients with breast cancer.

e13108 Background: Cardiac tamponade (CT) is a cardio-oncological emergency reported to be associated with poor outcomes in some solid tumors, such as lung cancers. There is a paucity of literary evidence on CT in patients with breast cancer. We sought to examine the Nationwide Inpatient Sample (NIS) -the largest inpatient database in the United States- to determine the incidence and factors associated with CT, and the in-hospital outcomes in patients with breast cancer. Methods: We retrospectively explored the NIS database collected from 2016 to 2020. Patients aged ≥ 18 with breast cancer and CT were selected using ICD-10 diagnostic codes. Univariate, multivariate logistic, and negative binomial regression models were used to assess the annual incidence trends, determine factors associated with cardiac tamponade and in-hospital outcomes among patients with breast cancer. Results: A total of 144,405 breast cancer patients (weighted n= 722,025) were examined, of which 345 (0.24%) had CT. The incidence of CT rose from 25 per 10 000 in 2016 to 27.3 per 10 000 cases of breast cancer in 2020 though this was not statistically significant (p=0.409). Patients with CT were more likely to be younger (60 ± 13 vs 66 ± 14, p&lt;0.001), with comorbidity index ≥ 5 (90.72% vs 9.28%, p&lt;0.0001), history of chemotherapy (18.84% vs 12.46%, p=0.0004), history of radiation therapy (17.97% vs 10.80%, p&lt;0.0001), and had Medicare (50.43% vs 49.57%, p&lt;0.001). After multivariate adjustment, comorbidity index ≥ 5 (aOR=5.16, 95% CI: 3.03 - 8.78; p&lt;0.001), and history of irradiation (aOR=1.45, 95% CI: 1.08 - 1.96; p=0.014), were found to be independent predictors of CT. However, the risk of CT was less with age &gt; 65 years (aOR=0.64, 95% CI: 0.47 - 0.87; p=0.004). Regarding in-hospital outcomes, after controlling for other covariates, CT was associated with an increased risk of mortality (aOR=1.71, 95% CI: 1.16 - 2.52; p=0.07) and longer hospital stay (7.25 ± 5.77 vs 4.78 ± 5.45; incidence risk ratio [IRR]:1.49, 95% CI: 1.36 - 1.63; p &lt;0.001). Conclusions: Cardiac tamponade is rare in breast cancer and tends to occur more in patients who are younger, have comorbidities, and prior radiation therapy. It is associated with increased risk of in-hospital mortality and longer stay. Risk stratification of patients with breast cancer when deciding treatment is relevant to reduce the likelihood of CT and improve outcomes. Further studies are needed to establish the optimal management of CT in patients with breast cancer.

Global, regional and national burdens of gout in the young population from 1990 to 2019: a population-based study

ObjectiveTo use data from the Global Burden of Disease (GBD) Study 2019 to report the global, regional and national rates and trends of annual incidence, point prevalence and years lived...

Epidemiology of Culture-Negative Pulmonary Tuberculosis-Alameda County, 2010-2019.

Patients with culture-negative pulmonary TB (PTB) can face delays in diagnosis that worsen outcomes and lead to ongoing transmission. An understanding of current trends and characteristics of culture-negative PTB can support earlier detection and access to care. Describe epidemiology of culture-negative PTB. We utilized Alameda County TB surveillance data from 2010 to 2019. Culture-negative PTB cases met clinical but not laboratory criteria for PTB per US National Tuberculosis Surveillance System definitions. We calculated trends in annual incidence and proportion of culture-negative PTB using Poisson and weighted linear regression, respectively. We further compared demographic and clinical characteristics among culture-negative versus culture-positive PTB cases. During 2010-2019, there were 870 cases of PTB, of which 152 (17%) were culture-negative. The incidence of culture-negative PTB declined by 76%, from 1.9/100 000 to 0.46/100 000 ( P for trend <.01), while the incidence of culture-positive PTB reduced by 37% (6.5/100 000 to 4.1/100 000, P for trend =.1). Culture-negative PTB case-patients were more likely than culture-positive PTB case-patients to be younger (7.9% were children <15 years old vs 1.1%; P < .01), recent immigrants within 5 years of arrival (38.2% vs 25.5%; P < .01), and have a TB contact (11.2% vs 2.9%; P < .01). Culture-negative PTB case-patients were less likely than culture-positive PTB case-patients to be evaluated because of TB symptoms (57.2% vs 74.7%; P < .01) or have cavitation on chest imaging (13.1% vs 38.8%; P < .01). At the same time culture-negative PTB case-patients were less likely to die during TB treatment (2.0% vs 9.6%; P < .01). The incidence of culture-negative PTB disproportionately declined compared with culture-positive TB and raises concern for gaps in detection. Expansion of screening programs for recent immigrants and TB contacts and greater recognition of risk factors may increase detection of culture-negative PTB.

Global trends in the burden of esophageal cancer, 1990-2019: results from the Global Burden of Disease Study 2019.

Esophageal cancer is one of the leading causes of cancer death worldwide. A deeper understanding of the trends in annual incidence, mortality, and disability-adjusted life-years (DALYs) of esophageal cancer is critical for management and prevention. In this study, we report on the disease burden of esophageal cancer in 204 countries and territories between 1990 and 2019 by age, sex, and sociodemographic index (SDI). Data on incidence, mortality, and DALYs were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The estimated numbers and age-standardized rates for esophageal cancer in 2019 are presented in this paper, as well as trends from 1990 to 2019. All estimates are presented as counts and age-standardized rates per 100,000 population, with 95% uncertainty intervals (UIs) for each estimate. In 2019, nearly 535,000 (95% UI: 467,000-595,000) new cases of esophageal cancer occurred globally. Esophageal cancer was responsible for more than 498,000 (95% UI: 438,000-551,000) deaths and 11.7 million (95% UI: 10.4-12.9 million) DALYs. Worldwide age-standardized rates of esophageal cancer, including incidence, deaths, and DALYs, have declined since 1990. However, the trends differ across countries and territories. Notably, there was a nonlinear but generally inverse correlation between age-standardized DALY rates and SDI. Higher age-standardized incidence and death rates were observed in males compared to females, and both increased with age. Regarding risk factors, smoking, alcohol use, and high body-mass index were 3 predominant contributors to esophageal cancer DALYs in 2019 for both sexes worldwide. This study found a global reduction in the esophageal cancer burden, but substantial heterogeneity remains across regions and countries. Hence, the identification of high-risk groups and the exploration of specific local strategies and primary prevention efforts are required.

Evaluation of data quality at the Hungarian National Cancer Registry, 2000–2019

BackgroundThe Hungarian National Cancer Registry (HNCR) was legally established as a population-based cancer registry in 1999, and its operation started in 2000 supporting the planning and development of the Hungarian oncology network as well as informing national cancer control policies. Ensuring comparable, accurate, and complete data on malignant and in situ neoplasms is critical in determining the applicability of the database. The aim of this study was to perform a comprehensive evaluation of the data quality at the HNCR. MethodsBased on qualitative and semiquantitative methods from current international guidelines, we assess the comparability, completeness, validity, and timeliness of the collected data over the diagnostic period 2000–2019, with a focus on the year 2018. ResultsCoding practices and the classification system used at the HNCR are based on the International Classification of Diseases (ICD-10), which differs from the internationally recommended ICD-O. The annual trends in incidence did not indicate major fluctuations, that may have resulted from data collection discrepancies, while comparisons of the mortality-to-incidence ratio (M:I) compared with 1 minus 5-year observed survival indicated some systematic differences requiring further exploration. The age-standardized (European standard) incidence rate per 100 000 measured by the HNCR in 2018 was very high: 647.9 for men and 501.6 for women, 11.6% and 14.6% higher than the International Agency for Research on Cancer (IARC) estimates respectively. Behind the overall differences between the two data sources, we identified that the vast majority were due to ill-defined ICD codes: malignant neoplasm of other and ill-defined sites (C76), and malignant neoplasm without specification of site (C80). Otherwise, there were no major discrepancies by localization. The proportion of morphologically verified cancer cases was 57.8% overall, that of death certificates was 2.3%, and that of unknown primary tumors was 1.4%. ConclusionFurther implementations and interventions are required to ensure that the operations, coding practices, and the classification system used at the national registry are in accordance with international standards, and to increase the completeness and validity of the collected cancer data. In particular, the low morphologically verified proportion questions the overall accuracy of the stated diagnoses within the database. Nevertheless, our examination implies that the data of the HNCR are reasonably comparable, and without doubt fulfill the requirements to support national oncology services and cancer planning. However, most importantly, a review of registry personnel and resource requirements to run the national population-based cancer registry should be an essential part of Hungary’s national cancer strategy.

Epidemiology of upper extremity peripheral nerve injury in South Korea, 2008 to 2018

Peripheral nerve injuries (PNIs) in the upper extremities is an important medical problem, causing significant morbidity at a relatively young age. The epidemiology of PNI in South Korea has not been comprehensively evaluated. The purpose of our study was to examine the incidence of upper extremity PNI in South Korea based on an analysis of nationwide data and to investigate the association between PNI and patients' demographic characteristics. Patient claims data from the Health Insurance Review and Assessment Service from 2008 to 2018 were collected. Demographic characteristics, such as the age, sex, region, admission route, length of hospital stay, healthcare facility level, and cost were evaluated. Annual incidence, body sites affected, damaged nerves, accompanying injuries, and surgical procedures were analyzed. Annual incidence trends, injured anatomical area, seasonal injury trends, and injury trend according to sex were also evaluated. A total of 57,209 cases were identified during the study period. Mean age was 39.7 ± 16.3 years. Of these cases, 51,651 (90.28%) were surgically treated. About 79% of accompanying injuries occurred in the hand area (hand lacerations, 69.5%; fractures or joint dislocations of the hands, 6.86%; crushing injuries of the hands, 2.67%). Overall, injuries to the digital nerve showed the greatest frequency (62.7%). In the upper arm and forearm, the ulnar nerve was most frequently injured; however, in the hand, radial nerve injuries were most common. The annual incidence rate per 100,000 persons decreased from 10.67 in 2008 to 7.88 in 2018. The annual incidence decreased by 0.98 times per year. PNI occurred 33.91 times more frequently in the finger than in the upper arm, and there were 1.16 times more PNIs in the summer and 2.14 times more in men. We investigated the incidence trend and epidemiologic characteristics of upper extremity peripheral nerve injury in South Korea from 2008 to 2018. A decreasing tendency of annual incidence was observed from 2013 onwards. Finger and digital nerve were most commonly injured, and the incidence of PNI was higher in the summer and in men.

Incidence of retinoblastoma in children and adolescents in Brazil: A population-based study.

To estimate the incidence of retinoblastoma in children and adolescents in Brazil based on Population-Based Cancer Registry (PBCR), describing temporal trends and some quality indicators of this registry. Based on secondary data from the PBCR of the National Institute of Cancer (INCA) (2000-2018), by selecting the morphological code of retinoblastoma, the annual incidences per million (0-19 years of age) in each local PBCR were estimated by sex and age group, global combined and by region, in addition to the percentage of diagnosis only by death certificate (DC) or not informed (NI), and the male/female ratio (M/F). An annual incidence trend in the five Brazilian geographic regions was also analyzed using the inflection point regression technique. 675 patients were identified in 28 PBCR, 91% between 0 and 4 years of age. The overall combined incidence per million by age group was: 7.02 (0-4 years old), ranging from 5.25 in the Midwest to 11.26 in the Northeast; 0.46 (5-9 years old); 0.05 (10-14 years old) and 0.03 (15-19 years old). The combined incidence per million, adjusted for the world population, was 2.23 (0-14 years old) and 2.24 (0-19 years old). The DC and NI percentages were 13% and 18%, respectively; the M/F ratio was 1.3. The incidence remained stable throughout the study period, except for the city of São Paulo, where there was a significant reduction of 3.4% per year. In Brazil, except for the Northeast region, the incidences of retinoblastoma were lower than those reported in several countries worldwide, suggesting possible underreporting, and the time series analysis showed a stable trend. Although this pioneering study brings a recent panel of available data on retinoblastoma in Brazil, more precise estimates are needed and welcome for better planning of onco-ophthalmologic care in the country.

Analysing 11 years of incidence trends, clinicopathological characteristics, and forecasts of colorectal cancer in young and old patients: a retrospective cross-sectional study in an Indonesian national referral hospital

ObjectiveTo obtain annual incidence trends, understand clinicopathological characteristics, and forecast the future burden of colorectal cancer (CRC) in Indonesia.Design11-year retrospective cross-sectional study.SettingA national referral hospital in Jakarta, Indonesia.ParticipantsData from 1584...

P043 Resource Utilization and Productivity Loss among Patients with Inflammatory Bowel Disease in Sweden: A Longitudinal Nationwide Population-based Study.

Crohn's disease (CD) and ulcerative colitis (UC) are the two most prevalent forms of inflammatory bowel disease (IBD) causing frequent diarrhea, rectal bleeding, fatigue, and abdominal pain. IBD may result in complications requiring hospitalizations and surgical procedure, hence IBD can negatively impact patients' quality of life, work productivity, and increase societal economic burden. Limited data exists assessing epidemiologic trends and population-level health outcomes among patients with IBD in Sweden. This study assessed the trends in annual incidence and prevalence of CD, annual inpatient and outpatient visits, employment status and sickness absence among adults with IBD in Sweden from 2001 to 2017. Data were acquired from four nationwide registers provided by the National Board of Health and Welfare in Sweden and linked through the unique personal identity number. Individuals aged ≥18 years with ≥2 primary diagnoses of CD (ICD-10 K50) or ≥2 primary diagnoses of UC (ICD-10 K51) from 01/01/2001 to 12/30/2017 were selected. Date of the first CD or UC diagnosis was designated as index date. All individuals were followed until death, lost to follow up or end of study. A total of 30,895 patients with CD and 50,415 with UC were included in the analysis, respectively. The mean follow-up for patients was 10.1 (±5.33) and 10.4 (±5.21) years for CD and UC. The mean (±SD) age among CD patients was 40.4 (±18.4) years and 42.6 (±18.2) years for UC. The most frequently observed comorbid condition was noninfective enteritis and colitis for patients with CD (24.2%) and UC (15.7%). The annual incidence of CD was 10 per 100,000 person-years in 2017, while the incidence of UC was 3 per 100,000 in 2017. 40.6% of CD patients and 30.8% of UC patients had ≥ 1 inpatient admission during 1-year post-index period, of which 53.5% and 51.2% had inpatient care lasting more than 1 week. Among patients with ≥ 1 outpatient services (CD: n = 30,675; UC: n = 50,183), 41.7% and 29.2% of patients had more than 5 visits during 1-year post-index period. Among patients who were eligible for employment and disability benefit analyses who had at least 1-year follow-up (CD: n = 23,731; UC: n = 39,391), 27.9% of CD patients and 23.1% of UC patients were not in employment; among those who were in employment (CD: n = 17,039; UC: n=30,302), 30% and 24.6% reported sickness absence within the calendar year after the index date, respectively. Findings from this study of a large national cohort of patients followed for many years demonstrates the significant epidemiological, clinical, and socioeconomic impact of patients with CD and UC. Further research is needed to understand underlying factors driving inpatient admissions among patients with IBD. With an increasing annual prevalence, IBD continues to impose a substantial public health burden to patients, their families and health care services.

Annual Incidence of Hospitalization for Nonfatal Firearm-Related Injuries in New York From 2005 to 2016

In the US, approximately 40 000 people die due to firearm-related injuries annually. However, nonfatal firearm-related injuries are less precisely tracked. To assess the annual incidence of hospitalization for nonfatal firearm-related injuries in New York and to compare the annual incidence by sex, race/ethnicity, county of residence, and calendar years. This retrospective cross-sectional study used data from the New York Statewide Planning and Research Cooperative System for patients aged 15 years or older who presented to an emergency department in New York with nonfatal firearm-related injuries from January 1, 2005, to December 31, 2016. Data were analyzed from January 15, 2019, to April 21, 2021. A nonfatal firearm-related injury, defined by International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. The annual incidence of nonfatal firearm-related injuries was calculated by determining the number of patients with a nonfatal firearm-related injury each year divided by the total population of New York. The study included 31 060 unique patients with 35 059 hospital encounters for nonfatal firearm-related injuries. The mean (SD) age at admission was 28.5 (11.9) years; most patients were male (90.6%) and non-Hispanic Black individuals (62.0%). The overall annual incidence was 18.4 per 100 000 population. Although decreasing trends of annual incidence were observed across the state during the study period, this trend was not present in all 62 counties, with 32 counties (51.6%) having an increase in the incidence of injuries between 2005 and 2010 and 29 (46.8%) having an increase in the incidence of injuries between 2010 and 2015. In 19 of the 30 counties (63.3%) that had a decrease in incidence in earlier years, the incidence increased in later years. The annual incidence of hospitalization for nonfatal firearm-related injuries in New York during the study period was 18.4 per 100 000 population. Reliable tracking of nonfatal firearm-related injury data may be useful for policy makers, hospital systems, community organizers, and public health officials as they consider resource allocation for trauma systems and injury prevention programs.

Disseminated Intravascular Coagulation and Annual Trends in in-Hospital Outcomes Based on Etiology from 2002 to 2014

Introduction:Disseminated Intravascular Coagulation (DIC) is a systemic pathophysiologic process which occurs in response to an underlying inciting event resulting in a complex interaction between the inflammatory and coagulation pathways. The development of DIC inpatient is often an ominous prognostic indicator with fulminant cases resulting in bleeding and widespread thrombosis ultimately resulting in death. It is not a disease by itself, but rather a sign of underlying disease incited by causes such as sepsis, acute pancreatitis, leukemia, burns, crush injuries, solid tumors, and viral illnesses. The purpose of this study is to identify the annual trends in mortality and morbidity associated with DIC in hospital and its association with specific etiologies.Methods:Using the National Inpatient Sample (NIS) for years 2002-2014, DIC was defined as ICD-9 code 286.6 for a primary or secondary diagnosis in conjunction with ICD-9 and clinical classification software codes to identify the most common etiologies of DIC. Linear regression analysis was used to assess the annual trends in incidence and mortality. We employed univariate logistic regression analysis to calculate odds ratios (OR) for the most common causes of DIC and their relationship with mortality.Results:Among in-hospital admissions between 2002 and 2014, 101,030 patients (N=481,657, weighted) developed DIC. Annual incidence has been increasing steadily from 28,119 in 2002 to 43,570 in 2014. Mortality has remained relatively unchanged at 47% in 2002 and 45% in 2014 (p <0.0001). The mean length of stay (LOS) remained unchanged from 14.10 to 14.25 (p = 0.6369), however the total costs of admission increased from $94,726 to $226,929. Sepsis was associated with 55.5% of all incdiecnes of DIC, pancreatitis 3.7%, burns 0.19%, viral illnesses 1.7%, solid tumors 10%, leukemia 5.8%, and crush injuries 2.4%. A univariate analysis identified an increase association between mortality and etiologies such as sepsis (OR=2.34), burns (OR=1.61), and crush injuries (OR=1.39). A decreased mortality was seen with viral (OR=0.44), leukemia (OR=0.71), solid tumors(OR=0.68), and pancreatitis (OR=0.91).Conclusion:Our study indicated that among the patients admitted with DIC between 2002 and 2014, there was a significant increase in annual incidence while mortality and length of stay remained the same. Notably, the total costs of admissions associated with DIC more than doubled. Sepsis is by far the most commonly associated comorbidity in these patients, and also associated with a higher mortality. Burns and crush injuries also had higher mortalities, while the lowest mortality was seen in viral illnesses and cancers. Due to the highly variable course and high mortality associated with DIC extra vigilance should be exercised when identifying the cause of DIC and the expected course. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Gastroschisis annual incidence, mortality, and trends in extreme Southern Brazil

ObjectiveTo analyze gastroschisis annual incidence, mortality rates, and trends in the Brazilian state of Rio Grande do Sul from the year 2000 to the year 2017. MethodPopulation-based study with the analysis of the temporal trend of gastroschisis annual incidence and mortality rates. Data were obtained from the Live Birth Information System and the Mortality Information System, with the analysis performed by polynomial regression modeling. ResultsThere were 2,612,532 live births, 705 hospitalizations, and 233 deaths due to gastroschisis. The annual incidence of gastroschisis was 2.69 per 10,000 live births. The annual incidence rate increased by 85% in the total period (p = 0.003), and mortality was 33% in the 2000-2017 period. Maternal age < 25 years was a risk factor for gastroschisis (p < 0.001). Children were more likely to be born weighing < 2,500 g (p < 0.001) and with a gestational age < 37 weeks (p < 0.001). The annual incidence trend was to increase, and the mortality trend was to decrease. ConclusionSimilar to what has been described in several regions/countries, there was a trend showing an 85% increase in the annual incidence of gastroschisis (p = 0.003) and the mortality was 33% with a trend of decreasing (p = 0.002).

English hospital episode data analysis (1998\u20132018) reveal that the rise in dog bite hospital admissions is driven by adult cases

Dog bites are a global health issue that can lead to severe health outcomes. This study aims to describe the incidence and sociodemographics of patients admitted to English National Health Service (NHS) hospitals for dog bites (1998–2018), and to estimate their annual direct health care costs. An analysis of patient level data utilising hospital episode statistics for NHS England, including: temporal trends in annual incidence of admission, Poisson models of the sociodemographic characteristics of admitted patients, and direct health care cost estimates. The incidence of dog bite admissions rose from 6.34 (95%CI 6.12–6.56) in 1998 to 14.99 (95%CI 14.67–15.31) admissions per 100,000 population in 2018, with large geographic variation. The increase was driven by a tripling of incidence in adults. Males had the highest rates of admission in childhood. Females had two peaks in admission, childhood and 35–64 years old. Two percent (2.05%, 95%CI 0.93–3.17) of emergency department attendances resulted in admission. Direct health care costs increased and peaked in the financial year 2017/2018 (admission costs: £25.1 million, emergency attendance costs: £45.7million). Dog bite related hospital admissions have increased solely in adults. Further work exploring human–dog interactions, stratified by demographic factors, is urgently needed to enable the development of appropriate risk reduction intervention strategies.

Characteristics of Orbital Floor Fractures in the United States from 2006 to 2017

To examine the incidence, characteristics, and economic burden of orbital floor fractures in the United States. Retrospective, longitudinal study of the Nationwide Emergency Department Sample (NEDS). Patients in the Emergency Department (ED). The NEDS, a representative sample of all hospital-based EDs in the US, was used to identify and describe ED visits with a primary diagnosis of orbital floor fracture from 2006 to 2017. Linear regression was used to estimate the trends in annual incidence and inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission. Incidence, injury mechanisms, demographics, clinical characteristics, disposition, and economic burden. From 2006 to 2017, there were an estimated 350 379 ED visits in the US with a primary diagnosis of orbital floor fracture. The incidence increased by 47% over the study period (P < 0.001): from 7.7 (95% confidence interval [CI], 6.9-8.5) to 11.3 (95% CI, 10.0-12.6) per 100 000 population. The majority were male (67%), aged 21 to 44 years (46%), and from low-income households (32%). The most common cause was assault (43%), which was most frequent in young adults (65%) and increased modestly over time (3.5 to 4.5 per 100 000 population; P= 0.02). The second most common cause was falls (26%), most frequent in patients aged ≥65 years (86%) and more than doubled over time (1.6 to 3.5 per 100 000 population; P < 0.001). The rate of inpatient admission was 14%, with a higher likelihood for patients aged ≥65 years (odds ratio [OR], 2.21; 95% CI, 1.99-2.46; P < 0.001) and falls (OR, 1.54; 95% CI, 1.27-1.86; P < 0.001). The total inflation-adjusted ED charges over the study period exceeded $2 billion, with the mean charge per visit increasing 48% (P < 0.001): from $5881 (95% CI, 5499-6263) to $8728 (95% CI, 8074-9382). Orbital floor fractures are becoming an increasingly common and costly injury in the United States. Preventive strategies aimed at reducing assault and falls will be crucial to mitigate the burden of orbital floor fractures on the healthcare system.

Classifying inpatient deaths among liver and intrahepatic bile duct cancer and the effect of palliative care utilization on overall health care burden.

e16673 Background: Liver cancer and bile duct cancer remain among of the most deadly cancers with a dismal 5 year survival of 2-15%. Patients often end up dying in an in-hospital setting as a result of acute complication of cancer progression. The purpose of this study is to identify annual trends in this sub-population, including cause of admission, palliative care utilization and economic impact on healthcare. Methods: From the years of 2002 to 2014, admissions for patients with a diagnosis of liver and bile duct cancer were identified using the National Inpatient Sample. Annual trends in incidence were compared to overall deaths via the SEER database. Trends were identified in hospital length of stay (LOS), total charges (TC), as well as utilization of palliative care. The effect of palliative care utilization on hospital length of stay and costs were also studied. Results: 73,833 (weighted) patient deaths were recorded from 2002 to 2014, 4,577 in 2002, compared to 6,595 in 2014. Signifying 33% (2002) to 32% (2014) of total deaths related to these cancers. The most common billed primary diagnosis was liver failure at 16.9%, sepsis (15.3%) and renal failure (6.7%). Overall LOS trended down from 5.9 days to 4.8 days (p &lt; 0.001). Palliative consults increased from 8.2% in 2002 to 39.4% in 2014. In 2014, the mean TC for those who received palliative consults versus those who did not was $52,612 and $64,388 respectively (p &lt; 0.001). LOS among these patients did not significantly change at 5.9 and 5.6 days (p = 0.13). When looking at patients with sepsis who did not die, a palliative care consult decreased costs from $87,564 to $75,223 (p &lt; 0.001). LOS was not significantly different at 8.8 days to 8.5 days (p = 0.15). Conclusions: A third of patients with liver and bile duct cancers die in an in-hospital setting. More effort needs to be undertaken to identify these patients and establish appropriate goals of care prior to such an event. Nonetheless, palliative involvement decreased health care resource utilization. Even among patients with sepsis who did not die, a palliative care consult decreased total charges of admission.