Trends In Hospitalizations Research Articles

Temporal trends and patterns in cause-specific mortality and hospitalisations after incident atrial fibrillation in England from 2001 to 2017

Abstract Background Atrial fibrillation (AF) incidence is increasing, and in high income countries outstrips that of many cancers.(1) Following AF diagnosis reports of temporal trends of mortality are conflicting,(2-7) whilst reports of hospitalisation provide an incomplete picture of drivers of admission.(4,8) Purpose To investigate trends in cause-specific mortality and hospitalisation for patients with incident AF, including by age, sex, socioeconomic status and diagnostic care setting. Methods We used linked primary and secondary care records of 72 412 patients in England aged ≥16 years with incident AF between Jan 1, 2001 and Dec 31, 2017. The primary outcomes were all-cause and cause-specific mortality and hospitalisation at 1 year following diagnosis. Poisson regression estimated rate ratios (RRs) with 95% confidence intervals (CIs) comparing 2001/02 and 2016/17, adjusted for age, sex, region, socioeconomic status and 18 major comorbidities. Results Mean age at diagnosis was 75·6 years (SD 12·4), and 44 762 (61·8%) had ≥3 comorbidities. One-year mortality following incident AF was 20·0% and declined over the study period (RR 2016/17 vs. 2001/02, 0·72; 95% CI, 0·65–0·80) with larger declines for cardiovascular (RR 0·46; 95% CI, 0·37-0·58) and cerebrovascular mortality (RR 0·41; 95% CI, 0·29–0·60) than other causes of death (Figure 1). By 2016/17 dementia (67, 8·0%) accounted for more deaths than myocardial infarction, heart failure and acute stroke combined (56, 6·7%), and for patients aged ≥80 years death from non-cardio/cerebrovascular causes did not decline (RR 1·05; 95% CI 0·88–1·25). Mortality was higher for patients in the most deprived socioeconomic quintile compared with those in the least deprived quintile (RR 1·22; 95% CI 1·15–1·29), and for those diagnosed in hospital compared with primary care (RR 2·58; 95% CI 2·48-2·68), but similar between men and women. Hospitalisation within the first year after AF diagnosis was high (1·72 hospitalisations per patient-year at risk), with infection the most common cause and cardio/cerebrovascular diseases representing less than a fifth of all admissions (Figure 2). Hospitalisations increased (RR 1·17; 95% CI 1·13-1·22), driven by admissions for non-cardio/cerebrovascular causes (RR 1·42; 95% CI 1·39-1·45). Individuals aged ≥80 years experienced a greater increase in hospitalisation compared with younger individuals (RR 1·39, 95% CI 1·30-1·48) particularly for non-cardio/cerebrovascular causes (RR 1·54, 95% CI 1·44-1·65). Patterns for hospital admissions by sex and diagnostic setting were similar to those observed for mortality, but frequency of hospitalisation was similar between most and least deprived individuals. Conclusion For patients newly diagnosed with AF, cardiovascular and cerebrovascular mortality has declined, and hospitalisations for non-cardio/cerebrovascular diseases increased. The changing outcomes of AF require new strategies to reduce its health burden.Figure 1:Temporal trends in mortalityFigure 2:Temporal trends in admission

Peripartum cardiomyopathy delivery hospitalization and postpartum readmission trends, risk factors, and outcomes

ObjectiveTo evaluate risk for peripartum cardiomyopathy during delivery and postpartum hospitalizations, and analyze associated trends, risk factors, and clinical outcomes. MethodsThe 2010–2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations along with postpartum readmissions occurring within five months of delivery discharge were analyzed. Risk factors associated with peripartum cardiomyopathy were analyzed with unadjusted and adjusted logistic regression models with odds ratios as measures of effect. Risk for severe adverse outcomes associated with peripartum cardiomyopathy was analyzed. Trends were analyzed with joinpoint regression. ResultsOf 39,790,772 delivery hospitalizations identified, 9,210 were complicated by a diagnosis of peripartum cardiomyopathy (2.3 per 10,000). Risk for a 5-month readmission with a peripartum cardiomyopathy diagnosis was 4.8 per 10,000. Factors associated with peripartum cardiomyopathy during deliveries included preeclampsia with severe features (OR 18.9, 95 % CI 17.2, 20.7), preeclampsia without severe features (OR 6.9, 95 % CI 6.1, 7.8), multiple gestation (OR 4.7, 95 % CI 4.1, 5.3), chronic hypertension (OR 10.1, 95 % CI 8.9, 11.3), and older maternal age. Associations were attenuated but retained significance in adjusted models. Similar estimates were found when evaluating associations with postpartum readmissions. Peripartum cardiomyopathy readmissions were associated with 10 % of overall postpartum deaths, 21 % of cardiac arrest/ventricular fibrillation diagnoses, 18 % of extracorporeal membrane oxygenation cases, and 40 % of cardiogenic shock. In joinpoint analysis, peripartum cardiomyopathy increased significantly during delivery hospitalizations (average annual percent change [AAPC] 2.2 %, 95 % CI 1.0 %, 3.4 %) but not postpartum readmissions (AAPC 0.0 %, 95 % CI −1.6 %, 1.6 %). ConclusionRisk for peripartum cardiomyopathy increased during delivery hospitalizations over the study period. Obstetric conditions such as preeclampsia and chronic medical conditions that are increasing in prevalence in the obstetric population were associated with the highest odds of peripartum cardiomyopathy.

Abstract 18033: Nationwide Trends in Major Adverse Cardiac and Cerebrovascular Events Hospitalizations and Cardiac Arrests in Young Women (18-44 Years), 2016-2019

Introduction: Incidence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) and cardiac arrests are increasing in younger women aged 18 - 44 years in the context of increasing metabolic syndrome and nontraditional risk factors such as stress, anxiety, and depression. We aim to assess recent trends in hospitalizations associated with MACCE and cardiac arrest in them. Methods: National Inpatient Sample database from 2016 - 2019 was used to examine temporal trends, risk factors, disparities, and outcomes related to hospitalization for MACCE and cardiac arrest in young women (18-44 years). We used the Chi-square test to evaluate the differences and multivariate logistic regression analysis for outcome analysis. Results: A total of 24,882,601 young women admissions were identified, in which 0.8% had MACCE and 0.1% had cardiac arrest. Between 2016 - 2019, there is a statistically significant increase in MACCE (0.7 % to 0.9 %) and cardiac arrests (0.1% to 0.2 %), p<0.001. African Americans experienced higher adjusted odds of MACCE compared to whites (OR 1.06, 95% CI: 1.02-1.09, p<0.001). Asian, white, and Hispanics experienced the lowest (0.1%) increase, while Native Americans experienced the highest (0.6%) increase in MACCE. There is a decrease in adjusted odds in Hispanics and Asians compared to whites in both MACCE and Cardiac arrest with statistical significance. Hypertension was African Americans’ most prevalent risk factor (62%). Length of stay was the same in all races (4 days) except in whites (3 days), with p value < 0.001. The total cost of hospitalization was highest in Hispanics (95067USD) and least in blacks (75074USD). Conclusion: The rise in MACCE and cardiac arrest cases among young women highlights the need to expand the literature on the causes of these trends, female specific risk factors and racial disparities. The declining cardiovascular health of this population demands targeted prevention, early treatment and management strategies.

Abstract 18180: Contemporary Nationwide Trends in Major Adverse Cardiac and Cerebrovascular Events in Young Hospitalized Adults With Dependent Cannabis Use in Absence of Concomitant Tobacco, Alcohol or Cocaine Use Disorder, 2016-2019

Introduction: Recreational cannabis use has been on the rise among young adults in recent years. Dependent cannabis use disorder (CUD) has been linked to various cardiac events, but its impact on young adults in the absence of concomitant substance abuse remains unclear. We aim to analyze the nationwide trends in hospitalizations for major adverse cardiac and cerebrovascular events (MACCE) in this specific population. Methods: We identified hospitalized young adults (18-44 years) using National Inpatient Sample (2016 -2019), excluding those with concomitant substance abuse (tobacco, alcohol, and cocaine). They were divided into CUD+ and CUD- groups. We assessed the trends in hospitalizations for MACCE, including all-cause mortality (ACM), acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS), using ICD 10 codes. Results: Of 27.4 million hospitalizations among young adults without other substance abuse, 4.2% (1.1 million) had CUD. The rates of hospitalizations for MACCE (1.71% vs. 1.35%), AMI (0.86% vs. 0.54%), CA (0.27% vs. 0.24%), and AIS (0.27 vs. 0.24%), were higher in the CUD+ group compared to the CUD- group (P < 0.001). However, the rate of ACM hospitalizations (0.30% vs. 0.44%) were lower in the CUD+ group. From 2016 to 2019, the CUD+ group exhibited a relative increase of 5% in MACCE and 20% in AMI hospitalizations, which were lower compared to the respective increases of 22% and 36% in the CUD- group (Ptrend<0.05). Additionally, there was a relative decrease of 13% in ACM hospitalizations among the CUD+ group, whereas the CUD- group experienced a relative increase of 10% (Ptrend<0.05). Conclusion: The CUD+ group had higher rates of MACCE admissions, but the growing trends were more pronounced in the CUD- group through the years. Interestingly, the CUD+ group exhibited lower rates of ACM compared to the CUD- group. Further research is needed to better understand this complex relationship.

Abstract 18970: Sex Differences and In-Hospital Outcomes of Acute Coronary Syndrome Among Patients With Mediastinal Radiation Exposure: Insights From the National Inpatient Sample (2009-2020)

Background There is a paucity of data about the sex disparities and temporal trends in outcomes of Acute Coronary Syndrome (ACS) patients with prior mediastinal radiation. Methods: The National Inpatient Sample database years 2009 to 2020 was queried for ACS hospitalizations of patients with prior mediastinal radiation. The primary outcome was MACCE (major cardiovascular events) and secondary outcomes included other hospital cardiovascular outcomes including hospital resource utilization. Results: A total 23385 hospitalizations for ACS with prior mediastinal radiation exposure were identified. Females accounted for 15904 (68.01%) of the cases. Median age was 70 vs 72 and the majority of the cases were whites 82.79% vs 78.22% for females and males respectively. Cases were mostly non-ST elevation MI in both genders 75.98% vs 79.71% while ST-elevation MI represented 24.02% vs 20.29% of them. Female patients with ACS had a higher burden of hypertension, diabetes mellitus, hyperlipidemia and obesity, however, males had a higher burden of Peripheral vascular disease, chronic heart failure and smoking. After propensity matching, primary outcome related to MACCE was higher in males (aOR1.803, 95%CI (1.65-1.96)) along with cardiogenic shock (aOR: 1.77, 95%CI (1.55-2.02)) and Mechanical Circulatory Support (MCS) use (aOR: 1.48, 95%CI (1.29 -1.71)). Similar findings were noted after the subgroup analysis in STEMI and NSTEMI where males had the worst In-hospital outcomes compared to females. Overall, we observed an increasing trend in ACS hospitalizations among females from 2.85% in 2009 to 7.91% in 2020 however, mortality decreased over the years from 8.69% in 2009 to 3.51% in 2020. Conclusions: This nationwide observational analysis showed significant disparities and burden of cardiovascular comorbidities among male and female ACS patients with prior mediastinal radiation history, with higher hospitalization rates among females but higher mortality among males.

Abstract 18447: Comparative Seasonal Variation in Outcomes Among Patients Hospitalized for Heart Failure in Cold- and Warm-Climate States

Background: Despite emerging evidence that extreme heat and air pollution exposure are linked to adverse cardiovascular disease outcomes, paradoxical seasonal trends in heart failure hospitalizations and deaths have been observed, with peaks occurring in winter months. This study aimed to explore how seasonal variations in heart failure admissions differ among individuals hospitalized in cold-climate and warm-climate states. Methods: Population-level, state-wide data were used to explore outcomes among all individuals hospitalized for heart failure in Texas (1999-2016) and New York (1994-2007). Seasonal variation was assessed using time of discharge (January-March, April-June, July-September, October-December). Multivariable logistic and linear regression were used to explore the relationship between time of discharge and the primary outcomes of interest: mortality and length of stay (LOS). Analyses were adjusted for age, sex, race, ethnicity, and comorbidities (hypertension, hyperlipidemia, diabetes, CAD, arrhythmias, anemia, COPD, tobacco use). Results: Among individuals hospitalized for heart failure in both Texas and New York, mortality and LOS were significantly increased during winter months compared to spring, summer, and early fall (Table). While similar seasonal trends were observed across states, the observed effect sizes were smaller in the Texas population. Conclusions: Among patients hospitalized for heart failure in Texas and New York, there is an increase in mortality and LOS during winter months. However, the differences in effect sizes after controlling for traditional risk factors suggests that other variables (i.e., temperature fluctuations) may affect these seasonal trends and warrants further exploration.

Temperature variability associated with respiratory disease hospitalisations, hospital stays and hospital expenses the warm temperate sub-humid monsoon climate

ObjectivesThe abrupt change of climate has led to an increasing trend of hospitalised patients in recent years. This study aimed to analyse the temperature variability (TV) associated with respiratory disease (RD) hospitalisations, hospital stays and hospital expenses. Study designThe generalized linear model combined with distributed lag non-linear model was used to investigate the association between TV and RD hospitalisations. MethodsTV was determined by measuring the standard deviation of maximum and minimum temperatures for the current day and the previous 7 days. RD hospitalisations data were obtained from three major tertiary hospitals in Huaibei City, namely, the Huaibei People's Hospital, the Huaibei Hospital Of Traditional Chinese Medicine and the Huaibei Maternal and Child Health Care Hospital. First, using a time series decomposition model, the seasonality and long-term trend of hospitalisations, hospital stays and hospital expenses for RD were explored in this warm temperate sub-humid monsoon climate. Second, robust models were used to analyse the association between TV and RD hospitalisations, hospital stays and hospital expenses. In addition, this study stratified results by sex, age and season. Third, using the attributable fraction (AF) and attributable number (AN), hospitalisations, hospital stays and hospital expenses for RD attributed to TV were quantified. ResultsOverall, 0.013% of hospitalisations were attributed to TV0-1 (i.e. TV at the current day and previous 1 day), corresponding to 220 cases, 1603 days of hospital stays and 1,308,000 RMB of hospital expenses. Females were more susceptible to TV than males, and the risk increased with longer exposure (the highest risk was seen at TV0-7 [i.e. TV at the current day and previous 7 days] exposure). Higher AF and AN were observed at ages 0–5 years and ≥65 years. In addition, it was also found that TV was more strongly linked to RD in the cool season. The hot season was positively associated with hospital stays and hospital expenses at TV0-3 to TV0-7 exposure. ConclusionsExposure to TV increased the risk of hospitalisations, longer hospital stays and higher hospital expenses for RD. The findings suggested that more attention should be paid to unstable weather conditions in the future to protect the health of vulnerable populations.

Nationwide Trends in Hospitalizations with Heart Failure Preserved Ejection Fraction and Subsequent Cardiovascular Outcomes in Elderly Patients with Leukemia [2016-2019]

Background: Leukemia and the therapeutic treatments for leukemia are both associated with cardiovascular side effects. Heart failure is one of the most identified side effects related to cancer or cancer-related therapies. Evidence suggests a higher risk of HFrEF (heart failure with reduced ejection fraction) and its consequences, there is limited data on the trends of HFpEF admissions in Leukemia patients. In this study, we are using a nationally representative population to study the trends in HFpEF-related admissions and outcomes in elderly Leukemia patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample from the 2016-2019 dataset. Elderly patients older than 65 years with leukemia were selected and the trends of HFpEF were studied over these 4 years. In this study, we used both univariable and multivariable regression analysis to adjust the odds ratio and compared and followed the trends over 4 years. Co-primary outcomes were major adverse cardiac and cerebrovascular events [MACCE - all-cause mortality, acute myocardial infarction (AMI), acute ischemic stroke (AIS), and cardiac arrest] in HFpEF patients among the leukemia cohort. Results: There was a significantly higher prevalence and increasing trends of HFpEF admissions in cohort with leukemia vs non-leukemia between 2016 to 2019 (from 11.6% to 14.4% in leukemia vs. from 10.3% to 13.0%, p trend <0.001). A total of 66,345 admissions with HFpEF in leukemia patients were studied over a period of 4 years, with a median age of 81 [Table 1]. The majority of the patients studied were whites (87%), Medicare patients (93.6%), and urban teaching locations (66.5%). The baseline characteristics trends were matched in all the cohorts and significant comorbidities observed over a period of 2016-2019 were hypertension (75.8% and 70.2%), diabetes (35.8% and 38.7%), hyperlipidemia (46% and 52.1%), prior MI (9.5% and 9.9%), prior PCI (8.3% and 9.7%), prior CABG (10.8% and 9.5%%), alcohol use (0.9% and 1.4%), drug use (0.3% and 0.9%), chronic pulmonary disease (35.5% and 37.9%), obesity (14.5% and 18.1%), prior chemotherapy (4.4.% and 5.1%), prior radiotherapy (1.9% and 2.7%), and CKD (44.6% and 47.8%). On following the trends from 2016 to 2019 we established that Leukemia patients with HFpEF had no significant improvement in in-hospital outcomes of MACCE including all-cause mortality, myocardial Ischemia, acute ischemic stroke, and cardiac arrest between 2016 and 2019 when potential confounders were adjusted. The univariate and multivariable-adjusted odds ratios for all-cause mortality, AMI, cardiac arrest, AIS, and MACCE were 0.97 and 1.04, 1.16 and 1.21, 0.99 and 1.00, 1.49 and 1.49, and 1.06 and 1.12, respectively when compared for Leukemia-HFpEF cohort of 2019 vs. 2016 (p>0.05). Median hospital stay and cost were stable during the study duration without any significantly increasing or decreasing trends. Conclusion: There were significantly increasing trends in hospitalizations with HFpEF in elderly leukemia patients without any substantial improvement in acute cardiovascular events between 2016 and 2019. It has been established that cardiovascular outcomes are closely associated with leukemia and related chemotherapy, there is no standardized risk stratification or assessment tool to assess the management of MACEE in Leukemia patients. Furthermore, prospective studies are required to better understand and address the association of leukemia-related treatments and their impact on HFpEF risk and MACCE in the long term.

Trends in hospital coding for people experiencing homelessness in Canada, 2015-2020: a descriptive study.

In 2018, hospitals were mandated to record homelessness using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA code Z59.0). We sought to answer whether the coding mandate affected the volume of patients identified as experiencing homelessness in acute inpatient hospitalizations and if there was any geographic variation. We conducted a serial cross-sectional study describing 6 fiscal years (2015/16 to 2020/21) of hospital administrative data from the Hospital Morbidity Database. We reported frequencies and percentages of hospitalizations with a Z59.0 diagnostic code and disaggregated by several types of Canadian geographies. Controlling for fiscal quarter (coded Q1 to Q4) and province or territory, adjusted logistic regression models quantified the odds of Z59.0 being coded during hospital stays. The frequency and percentage of people experiencing homelessness in hospitalization records across Canada increased from 6934 (0.12%) in 2015/16 to 21 529 (0.41%) in 2020/21. Trends varied by province and territory. Recording of the Z59.0 code increased following the mandate (adjusted odds ratio 2.29, 95% confidence interval 2.25-2.32), relative to the pre-mandate period. The 2018 coding mandate coincided with an increase in the use of the Z59.0 code to document homelessness in health care administrative data; however, trends varied by jurisdiction. The ICD-10-CA code Z59.0 presents a promising opportunity for standardized and routinely collected data to identify people experiencing homelessness in hospital administrative data.

Abstract 175: Impact of COVID‐19 on Intracranial Aneurysm Treatment and Outcomes: A Nationwide Propensity Score Matched Study.

Introduction The coronavirus disease 2019 (COVID‐19) pandemic has had a global impact on healthcare systems. There is limited data on the influence of COVID‐19 on treatment and outcomes in patients with intracranial aneurysms. We aimed to investigate the impact of COVID‐19 on the overall complications, including ischemic stroke and subarachnoid hemorrhage (SAH) rates in patients treated for intracranial aneurysms (IAs). Methods This national, multicenter, retrospective cohort study included patients diagnosed and treated for IAs from January 2016 to December 2020 in the National Inpatient Sample (NIS). A total of 57,715 admissions were identified. Of these, 45,979 occurred pre‐COVID and 11,736 during the COVID pandemic period. The outcome data points included the occurrence of postprocedural ischemic strokes or SAHs, death, non‐routine discharge, total charges (US dollars), and length of stay (days). A 1:1 propensity score matching protocol was applied using a K‐nearest neighbor approach to evaluate differences in the outcome data points between the pre‐COVID and during COVID periods. The trends during the study period were assessed using piecewise joinpoint regression with the Mann‐Kendall test. Results Overall, the mean age was 65 years, with most of the patients (69.9%) being females. Endovascular interventions were performed in 82.9% of pre‐COVID IAs admissions compared to 82.4% during the COVID period, while open surgical treatment was performed in 17.1% of pre‐COVID and 17.6% of the patients during COVID (p=0.625). After matching, there were no differences in length of stay (p=0.266), non‐home discharge (p=0.475), and in‐hospital mortality rates (p=0.305) between the two periods; however, the overall complication rate was significantly higher during the pandemic (31.1% vs. 28.3%; p<0.001). From 2016 to 2020, an upward trend in hospitalizations for ischemic stroke was seen among patients treated for IAs (6.1% to 7.9%; p=0.04). No trends were observed with respect to the occurrence of SAH or death (p=0.31). Patients hospitalized after treatment of IAs during the COVID pandemic had significantly higher odds of ischemic strokes (OR 1.13; 95% CI 1.05 to 1.22; p=0.03) but not SAH (OR 0.97; 95% CI 0.88 to 1.06; p=0.89). Conclusion The COVID‐19 pandemic has significantly impacted the healthcare system. In patients receiving treatment for IAs, this analysis noted a correlation between the COVID‐19 pandemic and postoperative complications, notably ischemic strokes. Unraveling the pandemic’s “black box” leads to awareness of plausible breaches within the system, which acts as a crucial component in improving situational readiness and preparedness in the event of similar large‐scale crises.

Longitudinal Trends in Pediatric Hospitalizations Complicated by AKI in the United States

Longitudinal Trends in Pediatric Hospitalizations Complicated by AKI in the United States

Minnesota Data Sharing May Be Model For Near-Real-Time Tracking Of Drug Overdose Hospital And ED Trends.

The drug overdose epidemic in the US necessitates detailed and timely data to inform public health responses. In this article we describe how an electronic health record (EHR) data-sharing collaboration across health systems in Minnesota that was developed in response to the COVID-19 pandemic was adapted to monitor trends in substance use-related hospital and emergency department (ED) visits. We found large increases in methamphetamine- and opioid-involved hospital and ED visits. Throughout the study period, Native American, Black, and multiple-race people experienced the highest rates of drug-involved hospital and ED visits. Monitoring drug-involved health care use through EHR data has the potential to help public health officials detect trends in near real time before mortality spikes and may also inform early intervention. The use of EHR data also allows for detailed monitoring of the impact of the drug overdose epidemic across racial and ethnic groups.

Pediatric Hospitalization Trends at Children’s and General Hospitals, 2000-2019

This study examines whether pediatric inpatient care has been redistributed from general hospitals into children’s hospitals.

Trends of hospitalisation for cardiovascular diseases among people with diabetes in Australia

ObjectiveTo describe trends in hospitalisation for subtypes of cardiovascular diseases among people with diabetes. MethodsThe data sources included the Australian diabetes registry, admitted hospitalisation datasets, and death registry from 2011 to 2019. The outcomes comprised hospital admissions for: all CVD; all cerebrovascular diseases, ischaemic and haemorrhagic stroke; angina and ischaemic heart disease (AIHD); non-ST elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI); atrial fibrillation and flutter (AFF). Data were analysed using Stata and Joinpoint regression software.Rates were standardised for age and sex. Annual percentage change (APC) was reported. ResultsIn type 1 diabetes, there were increases in hospitalisation for all cerebrovascular diseases (APC 4.5, 95 % CI: 1.2, 7.9) and ischaemic stroke (2.3, 95 % CI: 1.6, 3.0). There were declines in STEMI (-2.6, 95 % CI: −5.0, −0.1) and AIHD (-3.1, 95 % CI: −5.5, −0.7). In type 2 diabetes, hospitalisation for all CVD declined (-0.9, 95 % CI: −1.4, −0.3). Hospitalisation rates for ischaemic stroke increased (4.1, 95 % CI: 3.1, 5.1). There were declines in NSTEMI (-2.5, 95 % CI: −3.2, −1.8) and AIHD (-4.2, 95 % CI: −4.8, −3.5). ConclusionIn type 1 and 2 diabetes, hospitalisation for ischaemic stroke increased while coronary diagnoses declined.

Trend in HPV-related hospitalization in years 2015-21 in a Southern Italian Region

Abstract Background The Human papillomavirus (HPV) is the most common cause of sexually transmitted infections in the general population. Genotypes are classified into two main class, high-risk and low-risk genotypes, according to their capacity to induce cancers. The low-risk class (types 6-11) is associated to anal and genital lesions. The high-risk is responsible for up to 4.5% of all new cancer cases yearly. The aim of this study was to evaluate the incidence of HPV-related hospitalizations and its trend in a Southern Italian Region in years 2015-2021. Methods It was a retrospective study performed in Abruzzo Region, Italy. All admissions performed during years 2015-2021 were extracted from the hospital discharge record. The study included genital warts, head-neck cancers, anal cancers, cervical cancers, genitourinary cancers and penile cancers. Annual hospitalization rates for each HPV-related disease were calculated per 100,000 inhabitants using the related attributable fractions. The Joinpoint model was used to evaluate the time trends of standardized rates and the average annual percent change (APC). Results During study period, totally 5492 HPV-related admissions were performed. The great part was related to cervical cancer (3386 cases) and to genital warts (638 cases). The great reduction was reported among genital warts, decreased from 8.5 admissions in 2015 to 5.9/100,000 in 2021 with APC of -8.03 (95%CI -11.91 - -0.33). The other most important reduction was referred to anal cancer (APC -4.79, 95%CI -16.91 -6.43) and genitourinary cancers (APC -3.72, 95%CI -11.21-7.20). Considering the first year of pandemic (year 2020), the great part of considered diseases reported a decrease, particularly among cervical cancer (PC -10.8 from 2019 to 2020). Conclusions HPV-related hospitalizations decrease in Abruzzo during study period. These results could be useful to policy maker in improving vaccination coverage and screening adherence. Key messages • HPV-related hospitalizations represent a heavy burden for healthcare services. • During years 2015-21, a decrease in HPV-related hospitalizations was observed.

Australian vaccine preventable disease epidemiological review series: tetanus 2003-2019.

Background We examined trends in tetanus notification, hospitalisation and death data from 2003-2019 to assess the impact of adult tetanus booster recommendations in Australia. Methods Tetanus notifications and deaths from the National Notifiable Diseases Surveillance System; hospitalisations from the Australian Institute of Health and Welfare National Hospital Morbidity Database; and deaths from the Australian Coordinating Registry were analysed by age group, sex, Aboriginal and Torres Strait Islander status and state/territory. Annual rates were calculated using Australian Bureau of Statistics mid-year estimated resident populations from 2003-2019 as denominators. To assess the impact of a recommended booster dose of reduced antigen content diphtheria-tetanus-acellular pertussis (dTpa) vaccine for adults aged ≥ 65 years, notification, hospitalisation and death rates of tetanus per 100,000 population were compared pre (2003-2012) and post (2013-2019) the recommendation's introduction. Results There were 63 notifications of tetanus from 2003-2019 with an average annual incidence rate of 0.02/100,000. Similar to previous studies, the burden of tetanus in the Australian population continues to disproportionately affect the elderly, with those aged ≥ 65 years encompassing 63% (40/63) of notifications and 100% (11/11) of the deaths observed in this timeframe. Following the introduction of a recommendation for those aged ≥ 65 years to receive a dTpa booster, average annual notification and hospitalisation rates in those aged ≥ 65 years were significantly lower (notifications: 0.11/100,000 in 2003-2012 and 0.05/100,000 in 2013-2019, p = 0.01; hospitalisations: 0.24/100,000 in 2003-2012 and 0.10/100,000 in 2013-2019, p = 0.01]). The average annual death rate was similar in the two periods (0.002/100,000), although based on small numbers. Conclusions The findings of this analysis suggest a positive impact from the 2013 recommendation. However, the burden is still disproportionately higher in those aged ≥ 65 years and strategies to improve vaccination coverage in older Australians are recommended.

No Significant Change in Trend of Hospitalizations for Acute Coronary Syndrome in Japan Before and After Introduction of Heated Tobacco Products.

No Significant Change in Trend of Hospitalizations for Acute Coronary Syndrome in Japan Before and After Introduction of Heated Tobacco Products.

Liver Iron Overload Drives COVID-19 Mortality: a Two-Sample Mendelian Randomization Study.

Iron overload has been associated with an increased risk of COVID-19 severity and mortality in observational studies, but it remains unclear whether these associations represent causal effects. We performed a two-sample Mendelian randomization (MR) to determine associations between genetic liability to iron overload and the risk of COVID-19 severity and mortality. From genome-wide association studies of European ancestry, single-nucleotide polymorphisms associated with liver iron (n = 32,858) and ferritin (n = 23,986) were selected as exposure instruments, and summary statistics of the hospitalization (n = 16,551) and mortality (n = 15,815) of COVID-19 were utilized as the outcome. We used the inverse-variance weighted (IVW) method as the primary analysis to estimate causal effects, and other alternative approaches as well as comprehensive sensitivity analysis were conducted for estimating the robustness of identified associations. Genetically predicted high liver iron levels were associated with an increased risk of COVID-19 mortality based on the results of IVW analysis (OR = 1.38, 95% CI: 1.05-1.82, P = 0.02). Likewise, sensitivity analyses showed consistent and robust results in general (all P > 0.05). A higher risk of COVID-19 hospitalization trend was also observed in patients with high liver iron levels without statistical significance. This study suggests that COVID-19 mortality might be partially driven by the iron accumulation in the liver, supporting the classification of iron overload as one of the independent death risk factors. Therefore, avoiding iron overload and maintaining normal iron levels may be a powerful measure to reduce COVID-19 mortality.

THU304 Diabetic Ketoacidosis In Pregnancy: A Nationwide Analysis Of Trend In Hospitalizations, Comorbidities And Outcomes

Abstract Disclosure: V. Master: None. M. Faisaluddin: None. S. Fatima: None. D. Parekh: None. S. Charatz: None. Introduction: Diabetic Ketoacidosis (DKA) is an obstetric emergency associated with high materno-fetal morbidity and mortality. Aim: To analyse the trend of DKA hospitalizations among pregnant women, and to evaluate the comorbidities and in hospital outcomes associated with DKA events in United States. Methods: A national population- based study was conducted in the US. Hospitalizations during pregnancy from 2015 - 2020 were identified using ICD- 10 codes (E101) from Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS) database. Pregnant women with DKA and without DKA formed the two comparison cohorts. Demographic characteristics, baseline comorbidities, and outcomes such as maternal mortality, fetal mortality, length of stay (LOS), and cost of hospitalization were compared. A two- tailed p-value of p< 0.05 was used to determine the statistical significance. Results: 11,215 out of 14,613,248 hospitalizations during pregnancy were identified with DKA from 2015 - 2020. An increasing trend in DKA hospitalizations per 100,000 pregnancy related hospitalizations was noted, highest in 2017 and 2020. Demographic distribution was similar in both groups. Comorbidities such as pre-eclampsia, eclampsia, gestational hypertension, tobacco and alcohol use were more common in the DKA group (p<0.0001). DKA was associated with higher maternal (0.18% vs 0.01%) and fetal mortality rates (2.9% vs 0.7%) compared to non-DKA group (p<0.0001). The median length of hospital stay was higher (3 days vs 2 days), along with the median cost of hospitalization ($25,248 vs $18,306) among pregnant DKA patients. Other in hospital outcomes such as need for mechanical ventilation, cardiac arrest, cardiac arrhythmias, acute kidney injury, need for dialysis, and septic shock, were all higher in DKA patients (p<0.0001). Conclusion: DKA in pregnancy is associated with high maternal and fetal mortality, longer LOS, higher cost of hospitalizations, and other maternal morbidities, as compared to non-DKA hospitalizations during pregnancy. A high index of suspicion for DKA should be maintained in all pregnant women, along with prompt evaluation and treatment. Presentation: Thursday, June 15, 2023

Hospitalisation Trends for Choroid and Retina Diseases in the Past 20 Years: An Ecological Study in Australia.

Choroidal and retinal disorders significantly contribute to vision impairment, often necessitating hospitalization for the purposes of diagnosis, treatment, and continued care. The aim of this study was to examine hospitalisation trends of choroid and retina diseases in the past 20 years in Australia. This was an ecological study that used publically available data in Australia from 1998 to 2021. The National Hospital Morbidity Database (NHMD) is an online database that was used to collect the data for this study. We used the chi-squared test to assess the difference between the hospitalisation rates between 1998 and 2021. During the study period, hospital admission rate for choroid and retina diseases increased by 13.21-fold [from 29.54 (95% CI 28.77-30.32) in 1998 to 419.70 (95% CI 417.21-422.20) in 2021 per 100,000 persons, p<0.001]. Same-day hospital admission patients accounted for 90.3% of the total number of episodes. Rates of same-day hospital admission increased by 37.70-fold [from 9.24 (95% CI 8.81-9.68) in 1998 to 357.78 (95% CI 355.48-360.09) in 2021 per 100,000 persons]. Rates of overnight-stay hospital admission decreased by 19.3% [from 20.34 (95% CI 19.69-20.98) in 1998 to 16.41 (95% CI 15.91-16.90) in 2021 per 100,000 persons]. Females contributed to 54.6% of the total number of hospital admission. Admission rate among females increased by 16.01-fold [from 23.68 (95% CI 22.70-24.66) in 1998 to 402.78 (95% CI 399.33-406.22) in 2021 per 100,000 persons]. Admission rate among males increased by 8.69-fold [from 35.57 (95% CI 34.36-36.78) in 1998 to 344.80 (95% CI 341.58-348.02) in 2021 per 100,000 persons]. In this ecological investigation, we found that the admission rate for choroid and retina disorders increased dramatically. The preponderance of these admissions were made up of females and elderly patients. Future research is required to identify additional risk factors for disorders of this type.