scholarly journals Epidemiology and Outcomes of Hospitalizations With Invasive Aspergillosis in the United States, 2009–2013

2018 ◽  
Vol 67 (5) ◽  
pp. 727-735 ◽  
Author(s):  
Marya D Zilberberg ◽  
Brian H Nathanson ◽  
Rachel Harrington ◽  
James R Spalding ◽  
Andrew F Shorr
Keyword(s):  
United States ◽  
High Risk ◽  
Propensity Score ◽  
Confidence Interval ◽  
Invasive Aspergillosis ◽  
Propensity Score Matching ◽  
The United States ◽  
Major Surgery ◽  
Readmission Rates ◽  
Excess Costs

Abstract Background Though invasive aspergillosis (IA) complicates care of up to 13% of patients with immunocompromise, little is known about its morbidity and mortality burden in the United States. Methods We analyzed the Health Care Utilization Project’s data from the Agency for Healthcare Research and Quality for 2009–2013. Among subjects with high-risk conditions for IA, IA was identified via International Classification of Diseases, Ninth Revision, Clinical Modification codes 117.3, 117.9, and 484.6. We compared characteristics and outcomes between those with (IA) and without IA (non-IA). Using propensity score matching, we calculated the IA-associated excess mortality and 30-day readmission rates, length of stay, and costs. Results Of the 66634683 discharged patients meeting study inclusion criteria, 154888 (0.2%) had a diagnosis of IA. The most common high-risk conditions were major surgery (50.1%) in the non-IA and critical illness (41.0%) in the IA group. After propensity score matching, both mortality (odds ratio, 1.43; 95% confidence interval, 1.36–1.51) and 30-day readmission (1.39; 1.34–1.45) rates were higher in the IA group. IA was associated with 6.0 (95% confidence interval, 5.7–6.4) excess days in the hospital and $15542 ($13869–$17215) in excess costs per hospitalization. Conclusions Although rare even among high-risk groups, IA is associated with increased hospital mortality and 30-day readmission rates, excess duration of hospitalization, and costs. Given nearly 40000 annual admissions for IA in the United States, the aggregate IA-attributable excess costs may reach $600 million annually.

scholarly journals Epidemiology and Outcomes of Hospitalizations with Invasive Aspergillosis in the United States, 2010–2013

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S88-S89
Author(s):  
Marya D Zilberberg ◽  
Brian Nathanson ◽  
Rachel Harrington ◽  
James Spalding ◽  
Andrew F Shorr
Keyword(s):  
United States ◽  
Critical Illness ◽  
High Risk ◽  
Invasive Aspergillosis ◽  
The United States ◽  
Major Surgery ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Global Development ◽  
Research Support

Abstract Background Invasive aspergillosis (IA) complicates the care of up to 13% of patients with varying forms of immune compromise. The accompanying morbidity and mortality associated with IA remains high. We sought to describe the epidemiology and outcomes for all hospitalizations associated with IA in the United States. Methods We analyzed the National Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality (AHRQ) for 2010–2013. We identified subjects with high-risk conditions for IA (stem cell or solid organ transplant, critical illness, major surgery, mild-to-moderate immune compromise, severe immune compromise, and other [human immunodeficiency virus, pneumonia, chronic obstructive pulmonary disease]). IA was identified via ICD-9-CM codes 117.3, 117.9, and 484.6. We compared characteristics and outcomes between those with (IA) and without IA (non-IA). We calculated the IA-associated excess mortality, length of stay (LOS) and costs using propensity-score (PS) matching. Results Of the 66,634,683 discharges who met the study inclusion criteria, 154,888 (0.2%) had a diagnosis of IA. Patients with IA were more likely to be male (50.9% IA vs. 46.7% non-IA, P < 0.001), and African American (15.3% IA vs. 12.5% non-IA, P < 0.001). The most common high-risk condition among those not classified as IA was major surgery (50.1%). In the IA group critical illness was noted most frequently (41.0%). The burden of both chronic (median [interquartile range, IQR] number of Elixhauser comorbidities 3 [1, 5] non-IA vs. 4 [3, 6] IA, P < 0.001) and acute (median [IQR] number of procedures during the hospitalization 2 [1, 3] non-IA vs. 3 [1, 6] IA, P < 0.001) illnesses was higher in the IA group than the non-IA. After PS-matching, mortality in IA (14.1%) was 37% higher than in non-IA (10.3%, P < 0.001), translating to an odds ratio = 1.43; 95% CI (1.36, 1.51). IA was associated with 6.0 (95% CI 5.7, 6.4) excess days in the hospital and excess $15,542 (95% CI $13,869, $17,215) in costs/hospitalization. Conclusion Although rare even among high-risk groups, IA is associated with high hospital mortality, excess duration of hospitalization, and costs. Given nearly 40,000 annual IA admissions in the United States, we estimate that the aggregate IA-attributable excess costs may reach $600 million annually. Disclosures M. D. Zilberberg, Astellas: Grant Investigator, Research support. B. Nathanson, EviMed, LLC: Consultant, Consulting fee. R. Harrington, Astellas Pharma Global Development, Inc.: Employee, Salary. J. Spalding, Astellas Pharma Global Development, Inc.: Employee, Salary. A. F. Shorr, Astellas: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. Cidara: Consultant, Consulting fee. Merck: Consultant, Scientific Advisor and Speaker’s Bureau, Research support and Speaker honorarium

scholarly journals The comparison of vaccine hesitancy of COVID-19 vaccination in China and the United States

2021 ◽  
Author(s):  
Taoran Liu ◽  
Zonglin He ◽  
Jian Huang ◽  
Ni Yan ◽  
Qian Chen ◽  
...  
Keyword(s):  
United States ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Discrete Choice ◽  
Choice Experiments ◽  
The United States ◽  
Discrete Choice Experiments ◽  
Vaccine Hesitancy ◽  
The Us ◽  
The Cost

AbstractObjectivesTo investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, viz. China and the United States (US).MethodA cross-national survey was conducted in both China and the US, and discrete choice experiments as well as Likert scales were utilized to assess vaccine preference and the underlying factors contributing to the vaccination acceptance. A propensity score matching (PSM) was performed to enable a direct comparison between the two countries.ResultsA total of 9,077 (5,375 and 3,702, respectively, from China and the US) respondents have completed the survey. After propensity score matching, over 82.0% respondents from China positively accept the COVID-19 vaccination, while 72.2% respondents form the US positively accept it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the US respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the US attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint that the cost of vaccination covers the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Also, respondents from China tend to concerned much more about the adverse effect of vaccination (19.68% vs 6.12%) and have lower perceived severity of being infected with COVID-19.ConclusionWhile the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between countries are observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in two countries, the vaccine rollout strategies should be nation-dependent.

scholarly journals A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vibhu Parcha ◽  
Katherine S. Booker ◽  
Rajat Kalra ◽  
Seth Kuranz ◽  
Lorenzo Berra ◽  
...  
Keyword(s):  
United States ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
The United States ◽  
Study Cohort ◽  
Cross Sectional

AbstractChildren and adolescents account for ~ 13% of total COVID-19 cases in the United States. However, little is known about the nature of the illness in children. The reopening of schools underlines the importance of understanding the epidemiology of pediatric COVID-19 infections. We sought to assess the clinical characteristics and outcomes in pediatric COVID-19 patients. We conducted a retrospective cross-sectional analysis of pediatric patients diagnosed with COVID-19 from healthcare organizations in the United States. The study outcomes (hospitalization, mechanical ventilation, critical care) were assessed using logistic regression. The subgroups of sex and race were compared after propensity score matching. Among 12,306 children with lab-confirmed COVID-19, 16.5% presented with respiratory symptoms (cough, dyspnea), 13.9% had gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain), 8.1% had dermatological symptoms (rash), 4.8% had neurological (headache), and 18.8% had other non-specific symptoms (fever, malaise, myalgia, arthralgia and disturbances of smell or taste). In the study cohort, the hospitalization frequency was 5.3%, with 17.6% needing critical care services and 4.1% requiring mechanical ventilation. Following propensity score matching, the risk of all outcomes was similar between males and females. Following propensity score matching, the risk of hospitalization was greater in non-Hispanic Black (RR 1.97 [95% CI 1.49–2.61]) and Hispanic children (RR 1.31 [95% CI 1.03–1.78]) compared with non-Hispanic Whites. In the pediatric population infected with COVID-19, a substantial proportion were hospitalized due to the illness and developed adverse clinical outcomes.

scholarly journals A Comparison of Vaccine Hesitancy of COVID-19 Vaccination in China and the United States

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 649
Author(s):  
Taoran Liu ◽  
Zonglin He ◽  
Jian Huang ◽  
Ni Yan ◽  
Qian Chen ◽  
...  
Keyword(s):  
United States ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Discrete Choice ◽  
Choice Experiments ◽  
The United States ◽  
Discrete Choice Experiments ◽  
Vaccine Hesitancy ◽  
Health Board ◽  
The Cost

Objectives: To investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, namely, China and the United States (U.S.). Method: A cross-national survey was conducted in both China and the United States, and discrete choice experiments, as well as Likert scales, were utilized to assess vaccine preference and the underlying factors contributing to vaccination acceptance. Propensity score matching (PSM) was performed to enable a direct comparison between the two countries. Results: A total of 9077 (5375 and 3702 from China and the United States, respectively) respondents completed the survey. After propensity score matching, over 82.0% of respondents from China positively accepted the COVID-19 vaccination, while 72.2% of respondents from the United States positively accepted it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the U.S. respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the United States attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint, that the cost of vaccination covered the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Additionally, respondents from China tended to be much more concerned about the adverse effect of vaccination (19.68% vs. 6.12%) and have a lower perceived severity of being infected with COVID-19. Conclusion: Although the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between these countries were observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in the two countries, vaccine rollout strategies should be nation-dependent.

Zoledronic Acid Improves Overall Survival Compared To Pamidronate In Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3182-3182
Author(s):  
Kristen M. Sanfilippo ◽  
Brian F Gage ◽  
Suhong Luo ◽  
Ravi Vij ◽  
Michael H. Tomasson ◽  
...  
Keyword(s):  
United States ◽  
Prognostic Factors ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Bone Disease ◽  
Conflicts Of Interest ◽  
The United States ◽  
Tumor Cell Adhesion ◽  
Multicenter Cohort Study ◽  
Anti Tumor Activity

Abstract Background Recent practice guideline changes suggest all patients with MM should receive bisphosphonates, regardless of the presence of bone disease. Nitrogen-containing bisphosphonates, ZA and PAM, inhibit protein prenylation, a process crucial for osteoclast survival. This inhibition also interferes with tumor cell adhesion, angiogenesis, and proliferation suggesting potential for anti-tumor activity of bisphosphonates. Morgan et al showed increased OS with use of ZA versus clodronate in MM. This increase was independent of the effect on bone disease, supporting anti-tumor activity of ZA. ZA and PAM are the two approved bisphosphonates for MM in the United States. In in-vitro studies, ZA has increased potency compared to PAM, a finding that may result in increased apoptosis of tumor cells. A meta-analysis by Mhaskar et al demonstrated an association between higher bisphosphonate potency and improved OS in MM. In an effort to clarify the effect of ZA versus PAM on OS in MM, we evaluated outcomes in a large cohort of United States Veterans with MM. Methods We identified 1,018 patients with newly diagnosed MM in the Veterans Administration Cancer Registry between 2002 and 2009, who were treated with either PAM or ZA, but not both. Data was collected on age, co-morbidities, date of diagnosis and death, myeloma specific and supportive medications, and baseline lab data. Cox proportional-hazards was used to assess association between bisphosphonate use and OS while controlling for other prognostic factors. Propensity score analyses were performed to reduce confounding by indication, using the inverse probability weighting (IPW) approach of Cole and Hernan and propensity score matching. The covariates for each propensity model were the same as those in the main analysis. Results Of the 1,018 patients in the cohort, 383 received ZA and 635 received PAM. The median follow-up was 26.9 months. After adjustment using propensity score groups, baseline characteristics were well balanced between the groups (Table 1). Kaplan-Meier curves showing OS of patients receiving ZA versus PAM are shown in Figure 1. After controlling for age, weight, comorbidity score, era of diagnosis (before or after 2006), baseline lab characteristics, and treatment, OS was significantly improved with ZA compare to PAM (HR 0.84; 95% CI, 0.72-0.98). In both the IPW and propensity score matching analyses, ZA significantly improved OS in MM (HR 0.84; 95% CI, 0.72-0.97) and (HR 0.83; 95% CI, 0.69-0.99) respectively. Conclusion In this large, multicenter cohort study, ZA improved OS compared to PAM in patients with MM. The benefit persisted even after controlling for known patient and treatment related prognostic factors, as well as controlling for differences in baseline patient characteristics. Bisphosphonates play a key role in the treatment of MM for the prevention of MM bone disease. Evidence suggests that bisphosphonates may also have a direct anti-tumor effect in MM. Our study adds to this growing body of evidence and provides rationale for selecting ZA over PAM in most patients with MM. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Differences in Risk Tolerance and Asset Allocation among White, Black, and Hispanic Households in the United States

2017 ◽  
Vol 10 (1) ◽  
pp. 93
Author(s):  
Takanori Hisada
Keyword(s):  
United States ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Asset Allocation ◽  
Race And Ethnicity ◽  
Wealth Inequality ◽  
The United States ◽  
Risk Tolerance ◽  
Asset Allocations ◽  
Similar Risk

This study examines differences in risk tolerance and asset allocation among white, black, and Hispanic households in the United States. Regressions are run using a sample chosen by propensity score matching because there are substantial differences in the distributions of covariates among race and ethnicity. This study finds that white, black, and Hispanic households are more likely to have similar risk tolerances. In addition, this study finds that all three households are more likely to have similar asset allocations. Simultaneously, in practice, there is wealth inequality between whites and nonwhites. These results imply that differences among race and ethnicity do not affect risk tolerance and asset allocation, and therefore, wealth inequality between whites and nonwhites is not attributed to asset allocation.

Recalibrating Our Understanding of Retention

2017 ◽  
Vol 22 (1) ◽  
pp. 17-26
Author(s):  
Amber L. Stephenson ◽  
David B. Yerger ◽  
D. Alex Heckert
Keyword(s):  
United States ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Organizational Identification ◽  
Predictive Power ◽  
The United States ◽  
Performance Outcomes ◽  
College Retention ◽  
Strong Result ◽  
And Performance

In a study exploring how organizational identification impacted college retention and performance outcomes at a university in the United States, we found the mere act of taking the survey emerged as an unexpectedly strong result. Using propensity score matching, we found that those who took the voluntary survey during the first week of school were 6%, 9%, and 11% more likely to retain by the second, third, and fourth semesters, respectively. Participation in a short survey had notable retention predictive power 18 months later. These results provoke a series of questions on retention much more broadly considered and invite us to recalibrate our understanding of mechanisms for improving retention.

Simulation : The National Security Council

1985 ◽  
Vol 47 ◽  
pp. 3-4
Author(s):  
Douglas W. Simon
Keyword(s):  
United States ◽  
High Risk ◽  
National Security ◽  
Security Council ◽  
The United States ◽  
National Security Council ◽  
Gulf Region ◽  
College Course ◽  
Term Papers ◽  
Global Events

In the spring of 1981 I designed and taught what I considered, at the time, a "high risk" seminar for seventeen junior and senior political science majors. There were to be no textbooks, no lectures, no examinations and no term papers, those hallmarks of the traditional college course. Nevertheless, when the thirteen week course was over, the students were exhausted and claimed that they had never worked so hard in their college careers.The adventure that my students (and I) undertook was a semester long simulation of the United States National Security Council (NSC), dealing with actual global events as they happened. As Washington dealt with a problem, we dealt with the same problem. The simulation was initially offered during the deteriorating situation in Iran and instability in the Gulf region.

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