scholarly journals Cumulative COVID-19 Disparities in Nursing Home: Focusing on Geographical Factors and Racial Components

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 869-870
Author(s):  
Sungjae Hong ◽  
Shannon Meija
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Disease Prevalence ◽  
Rural Nursing ◽  
Rural And Urban ◽  
Black Residents ◽  
The Impact ◽  
Over Time

Abstract The impact of COVID-19 has been greatest in vulnerable US populations. This study examines the cumulative geographical and racial disparities of COVID-19 cases in nursing homes. Analysis of COVID-19 Nursing Home Data from Centers for Medicare & Medicaid Services was limited to weekly reports from the nursing homes that reported the ratio of black residents, from 2020-05-31 to 2021-01-17 (N=268,222 from 8,026 nursing homes). The outcomes were weekly COVID-19 cases and death per 1,000 occupied beds. Nursing homes were categorized by a geographic (rural vs. urban) and racial composition (>50% of residents are black vs. else). Elapsed time and county-level weekly COVID-19 cases and deaths/1,000 people were the key covariates. Multilevel zero-inflated negative binomial regression revealed evidence of cumulative COVID-19 disparity between rural and urban nursing homes. At the earliest time, COVID-19 incidence was lower in rural nursing homes than in urban nursing homes (IRR=0.406 for cases, 0.034 for death). The significant interaction with time implied that, over and above evolving disease prevalence, rural nursing homes became more likely than urban nursing homes to experience COVID-19 over time (IRR=1.057 for cases, 1.193 for death). Nursing homes, with >50% black residents, were more likely to experience COVID-19 than their counterparts at the earliest time (IRR=1.339 for cases, 5.630 for death), but independent of local disease prevalence, this disparity decreased over time (IRR=0.973 for cases, 0.972 for death). Our findings suggest that racial and geographic factors contribute to the cumulation of disadvantage during the COVID-19 crisis at the second half of 2020.

scholarly journals Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative

2017 ◽  
Vol 27 (6) ◽  
pp. 464-473 ◽  
Author(s):  
Shawna N Smith ◽  
M Todd Greene ◽  
Lona Mody ◽  
Jane Banaszak-Holl ◽  
Laura D Petersen ◽  
...  
Keyword(s):  
Patient Safety ◽  
Nursing Home ◽  
Urinary Tract ◽  
Nursing Homes ◽  
Safety Culture ◽  
Negative Binomial ◽  
Patient Safety Culture ◽  
Infection Rates ◽  
Tract Infections ◽  
Over Time

BackgroundRecent efforts to reduce patient infection rates emphasise the importance of safety culture. However, little evidence exists linking measures of safety culture and infection rates, in part because of the difficulty of collecting both safety culture and infection data from a large number of nursing homes.ObjectiveTo examine the association between nursing home safety culture, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPS), and catheter-associated urinary tract infection rates (CAUTI) using data from a recent national collaborative for preventing healthcare-associated infections in nursing homes.MethodsIn this prospective cohort study of nursing homes, facility staff completed the NHSOPS at intervention start and 11 months later. National Healthcare Safety Network-defined CAUTI rates were collected monthly for 1 year. Negative binomial models examined CAUTI rates as a function of both initial and time-varying facility-aggregated NHSOPS components, adjusted for facility characteristics.ResultsStaff from 196 participating nursing homes completed the NHSOPS and reported CAUTI rates monthly. Nursing homes saw a 52% reduction in CAUTI rates over the intervention period. Seven of 13 NHSOPS measures saw improvements, with the largest improvements for ‘Management Support for Resident Safety’ (3.7 percentage point increase in facility-level per cent positive response, on average) and ‘Communication Openness’ (2.5 percentage points). However, these increases were statistically insignificant, and multivariate models did not find significant association between CAUTI rates and initial or over-time NHSOPS domains.ConclusionsThis large national collaborative of nursing homes saw declining CAUTI rates as well as improvements in several NHSOPS domains. However, no association was found between initial or over-time NHSOPS scores and CAUTI rates.

Variations in death notification of nursing home residents to Australian Coroners

2018 ◽  
Vol 25 (5) ◽  
pp. 357-363
Author(s):  
Joseph Elias Ibrahim ◽  
Chebiwot Kipsaina ◽  
Cathy Martin ◽  
David Leo Ranson ◽  
Lyndal Bugeja
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Resident ◽  
Negative Binomial ◽  
Nursing Home Residents ◽  
Comprehensive Model ◽  
Manner Of Death ◽  
Home Setting ◽  
The Impact ◽  
Age Of Death

ObjectivesTo examine the impact of changes to the reporting requirements in coronial legislation on the nature and frequency of nursing home resident deaths reported to Coroners.DesignNational retrospective study of a population cohort of nursing home resident deaths.SettingAccredited Australian nursing homes between July 2000 and June 2013.ParticipantsResidents who died in nursing homes accredited by the Aged Care Standards and Accreditation Agency reported to Coroners.Main outcome measuresWe explored three death-reporting models in the nursing home setting: comprehensive model, selective ‘mechanism of death’ model and selective ‘age of death’ model. These models were examined by manner of death subgroups: natural, falls-related and other external causes using the outcome measure of deaths notified to the Coroner per 1000 residents. We used an interrupted time series analysis using generalised linear regression with a negative binomial probability distribution and a log link function.ResultsThe comprehensive model showed the proportion of reportable deaths due to natural causes far exceeded those from falls and other external cause. In contrast, the selective notification models reduced the total number of reportable deaths. Similarly, the selective ‘age of death’ model showed a decline in the reportable external cause deaths.ConclusionsVariation in the causes, locations and ages of persons whose deaths are legally required to be notified to Coroners impacts the frequency and nature of deaths of nursing home residents investigated by Coroners. This demonstrates that legislation needs to be carefully framed and applied to ensure that the prevention mandate of Coroners in Australia is to be achieved.

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Healthcare Intervention ◽  
Odds Ratios ◽  
Care Needs ◽  
Environmental Cleaning ◽  
The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

scholarly journals Association Between Federal Value-Based Incentive Program Implementation and Hospital-Onset C. difficile Infection Rates

2020 ◽  
Vol 41 (S1) ◽  
pp. s133-s133
Author(s):  
Mohammad Alrawashdeh ◽  
Chanu Rhee ◽  
Heather Hsu ◽  
Grace Lee
Keyword(s):  
Program Implementation ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Neutralization Assay ◽  
Nucleic Acid Amplification ◽  
Teaching Hospitals ◽  
Future Research ◽  
Testing Methods ◽  
Toxigenic Culture ◽  
The Impact

Background: The Hospital-Acquired Conditions Reduction Program (HACRP) and Hospital Value-Based Purchasing (HVBP) are federal value-based incentive programs that financially reward or penalize hospitals based on quality metrics. Hospital-onset C. difficile infection (HO-CDI) rates reported to the CDC NHSN became a target quality metric for both HACRP and HVBP in October 2016, but the impact of these programs on HO-CDI rates is unknown. Methods: We used an interrupted time-series design to examine the association between HACRP/HVBP implementation in October 2016 and quarterly rates of HO-CDI per 10,000 patient days among incentive-eligible acute-care hospitals conducting facility-wide HO-CDI NHSN surveillance between January 2013 and March 2019. Generalized estimating equations were used to fit negative binomial regression models to assess for immediate program impact (ie, level change) and changes in the slope of HO-CDI rates, controlling for each hospital’s predominant method for CDI testing (nucleic acid amplification including PCR (NAAT), enzyme immunoassay for toxin (EIA), or other testing method including cell cytotoxicity neutralization assay and toxigenic culture). Results: Of the 265 study hospitals studied, most were medium-sized (100–399 beds, 55%), not-for-profit (77%), teaching hospitals (70%), and were located in a metropolitan area (87%). Compared to EIA, rates of HO-CDI were higher when detected by NAAT (incidence rate ratio [IRR], 1.55; 95% CI, 1.41–1.70) or other testing methods (IRR, 1.47; 95% CI, 1.26–1.71). Controlling for CDI testing methods, HACRP/HVBP implementation was associated with an immediate 6% decline in HO-CDI rates (IRR, 0.94; 95% CI, 0.89–0.99) and a 4% decline in slope per year-quarter thereafter (IRR, 0.96; 95% CI, 0.95–0.97) (Fig. 1). Conclusions: HACRP/HVBP implementation was associated with both immediate and gradual improvements in HO-CDI rates, independent of CDI testing methods of differing sensitivity. Future research may evaluate the precise mechanisms underlying this improvement and if this impact is sustained in the long term.Funding: NoneDisclosures: None

scholarly journals The association between a conditional cash transfer programme and malaria incidence: a longitudinal ecological study in the Brazilian Amazon between 2004 and 2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Layana Costa Alves ◽  
Mauro Niskier Sanchez ◽  
Thomas Hone ◽  
Luiz Felipe Pinto ◽  
Joilda Silva Nery ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Negative Binomial ◽  
Malaria Incidence ◽  
Panel Study ◽  
Negative Binomial Regression ◽  
Brazilian Amazon ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Percentage Point Increase ◽  
The Impact

Abstract Background Malaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with nearly all (99%) Brazilian cases in the Amazon region. The Bolsa Família Programme (BFP) is a conditional cash transfer (CCT) programme launched in 2003 to reduce poverty and has led to improvements in health outcomes. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, however this relationship is underexplored. This study investigated the association between BFP coverage and malaria incidence in Brazil. Methods A longitudinal panel study was conducted of 807 municipalities in the Brazilian Amazon between 2004 and 2015. Negative binomial regression models adjusted for demographic and socioeconomic covariates and time trends were employed with fixed effects specifications. Results A one percentage point increase in municipal BFP coverage was associated with a 0.3% decrease in the incidence of malaria (RR = 0.997; 95% CI = 0.994–0.998). The average municipal BFP coverage increased 24 percentage points over the period 2004–2015 corresponding to be a reduction of 7.2% in the malaria incidence. Conclusions Higher coverage of the BFP was associated with a reduction in the incidence of malaria. CCT programmes should be encouraged in endemic regions for malaria in order to mitigate the impact of disease and poverty itself in these settings.

scholarly journals The impact of teaching on the duration of common urological operations

2016 ◽  
Vol 10 (5-6) ◽  
pp. 172 ◽  
Author(s):  
Blayne Welk ◽  
Jennifer Winick-Ng ◽  
Andrew McClure ◽  
Chris Vinden ◽  
Sumit Dave ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Potential Effect ◽  
Sensitivity Analyses ◽  
Teaching Hospitals ◽  
Operative Duration ◽  
Open Radical Prostatectomy ◽  
Academic Hospitals ◽  
The Impact

Introduction: The ability of academic (teaching) hospitals to offer the same level of efficiency as non-teaching hospitals in a publicly funded healthcare system is unknown. Our objective was to compare the operative duration of general urology procedures between teaching and non-teaching hospitals. Methods: We used administrative data from the province of Ontario to conduct a retrospective cohort study of all adults who underwent a specified elective urology procedure (2002–2013). Primary outcome was duration of surgical procedure. Primary exposure was hospital type (academic or non-teaching). Negative binomial regression was used to adjust relative time estimates for age, comorbidity, obesity, anesthetic, and surgeon and hospital case volume.Results: 114 225 procedures were included (circumcision n=12 280; hydrocelectomy n=7221; open radical prostatectomy n=22 951; transurethral prostatectomy n=56 066; or mid-urethral sling n=15 707). These procedures were performed in an academic hospital in 14.8%, 13.3%, 28.6%, 17.1%, and 21.3% of cases, respectively. The mean operative duration across all procedures was higher in academic centres; the additional operative time ranged from 8.3 minutes (circumcision) to 29.2 minutes (radical prostatectomy). In adjusted analysis, patients treated in academic hospitals were still found to have procedures that were significantly longer (by 10‒21%). These results were similar in sensitivity analyses that accounted for the potential effect of more complex patients being referred to tertiary academic centres.Conclusions: Five common general urology operations take significantly longer to perform in academic hospitals. The reason for this may be due to the combined effect of teaching students and residents or due to inherent systematic inefficiencies within large academic hospitals.

scholarly journals Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit?

2018 ◽  
Vol 55 ◽  
pp. 004695801878799
Author(s):  
R. Tamara Konetzka ◽  
Hari Sharma ◽  
Jeongyoung Park
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Fixed Effects ◽  
Online Survey ◽  
Market Competition ◽  
Consumer Welfare ◽  
Data Sets ◽  
For Profit ◽  
The Impact ◽  
The Relationship

An ongoing concern about medical malpractice litigation is that it may induce provider exit, potentially affecting consumer welfare. The nursing home sector is subject to substantial litigation activity but remains generally understudied in terms of the effects of litigation, due perhaps to a paucity of readily available data. In this article, we estimate the association between litigation and nursing home exit (closure or change in ownership), separating the impact of malpractice environment from direct litigation. We use 2 main data sources for this study: Westlaw’s Adverse Filings database (1997-2005) and Online Survey, Certification and Reporting data sets (1997-2005). We use probit models with state and year fixed effects to examine the relationship between litigation and the probability of nursing home closure or change in ownership with and without adjustment for malpractice environment. We examine the relationship on average and also stratify by profit status, chain membership, and market competition. We find that direct litigation against a nursing home has a nonsignificant effect on the probability of closure or change in ownership within the subsequent 2 years. In contrast, the broader malpractice environment has a significant effect on change in ownership, even for nursing homes that have not been sued, but not on closure. Effects are stronger among for-profit and chain facilities and those in more competitive markets. A high-risk malpractice environment is associated with change of ownership of nursing homes regardless of whether they have been directly sued, indicating that it is too blunt an instrument for weeding out low-quality nursing homes.

scholarly journals Influenza Vaccination Coverage of Healthcare Workers in Nursing Homes in France and Related Determinants, 2018- 2019 Season: A Cross-Sectional Survey

2021 ◽  
Author(s):  
Sophie Vaux ◽  
Laure Fonteneau ◽  
Anne-Gaëlle Venier ◽  
Arnaud Gautier ◽  
Sophan Soing Altrach ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Healthcare Workers ◽  
Negative Binomial ◽  
Nursing Assistants ◽  
Influenza Vaccines ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Background The burden of influenza morbidity and mortality in nursing homes (NH) is high. Vaccination of residents and healthcare workers (HCW) is the main prevention strategy. Despite recommendations, HCW vaccination coverage is generally low. Methods We performed a nationwide cross-sectional survey of NH using a single-stage stratified random sampling design to estimate influenza vaccination coverage in nursing home HCW in France during the 2019-2020 season, and to identify measures likely to increase it. A multivariate analysis was performed using a negative binomial regression. Results Overall influenza vaccination coverage in HCW was 31.9% (95% CI [29.7-34.1]). It varied according to occupational category: 75.5% [69.3-81.7] for physicians, 42.9% [39.4-46.4] for nurses, 26.7% [24.5-29.0] for nursing assistants, and 34.0% [30.1-38.0] for other paramedical personnel. When considering all professionals (i.e., HCW and non-medical professionals), overall vaccination coverage was 30.6% [28.2-33.0]. Vaccination coverage was higher in private nursing homes, in i) small nursing homes, ii) when vaccination was offered free of charge (RRa: 1.4, [1.1-1.8]), iii) when vaccination promotion for professionals included individual (RRa: 1.6 [1.1-2.1]) or collective (RRa: 1.3 [1.1-1.5]) information sessions, videos or games (RRa: 1.4 [1.2-1.6], iv) when information on influenza vaccines was provided (RRa: 1.2 [1.0-1.3], and finally, vi) when a vaccination point of contact - defined as an HCW who could provide reliable information on vaccination - was nominated within the nursing home (RRa: 1.7 [1.3-2.2]). Conclusions Urgent and innovative actions are required to increase coverage in HCW. Vaccination programmes should include free vaccination and education campaigns, and particularly target nursing assistants. The results of this nationwide study provide keys for improving influenza vaccination coverage in HCW. Programmes should ensure that information on influenza vaccines is provided by a vaccination point of contact in NH using attractive media. Combining the different prevention measures proposed could increase coverage in NH nationwide by over 50%.

scholarly journals 44. Impact of Nursing Home (NH) Universal Decolonization and COVID Prevention Training on COVID-19 Burden During the 2020-2021 Winter Surge in Orange County (OC), California (CA)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S32-S32
Author(s):  
Gabrielle Gussin ◽  
Raveena Singh ◽  
Shruti K Gohil ◽  
Raheeb Saavedra ◽  
Thomas Tjoa ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Training Program ◽  
Material Support ◽  
Linear Mixed Effects ◽  
Cleaning Products ◽  
Quasi Experimental ◽  
Work Shifts ◽  
Prevention Training ◽  
The Impact

Abstract Background OC is the 6th largest U.S. county with 70 NHs. Universal decolonization (chlorhexidine for routine bathing, and twice daily nasal iodophor Mon-Fri every other week) was adopted in 24 NHs prior to the COVID-19 pandemic, and 12 NHs (11 of those adopting decolonization) participated in a COVID prevention training program with a rolling launch from July-Sept 2020. We evaluated the impact of these initiatives on staff and resident COVID cases. Methods We conducted a quasi-experimental study of the impact of decolonization and COVID prevention training on staff and resident COVID cases during the CA winter surge (11/16/20-1/31/21), when compared to non-participating NHs. Decolonization NHs received weekly visits for encouraging adherence during the pandemic, and NHs in the COVID training program received 3 in-person training sessions for all work shifts plus weekly feedback about adherence to hand hygiene, masking, and breakroom safety using video monitoring. We calculated incident 1) staff COVID cases, 2) resident COVID cases, and 3) resident COVID deaths adjusting for NH average daily census. We assessed impact of initiatives on these outcomes using linear mixed effects models testing the interaction between any training participation and calendar date when clustering by NH. Because of the overlap of the two initiatives, we evaluated ‘any training’ vs ‘no training.’ Results 63 NHs had available data. 24 adopted universal decolonization, 12 received COVID training (11 of which participated in decolonization), and 38 were not enrolled in either. During the winter surge, the 63 NHs experienced 1867 staff COVID cases, 2186 resident COVID cases, and 251 resident deaths due to COVID, corresponding to 29.6, 34.7, and 4.0 events per NH, respectively. In NHs participating in either initiative, staff COVID cases were reduced by 31% (OR=0.69 (0.52, 0.92), P=0.01), resident COVID cases were reduced by 43% (OR=0.57 (0.39, 0.82), P=0.003), and resident deaths were reduced (non-significantly) by 26% (OR=0.74 (0.46, 1.21), P=0.23). The grey box represents the California COVID-19 winter surge (11/16/20-1/31/21). Incident and cumulative COVID-19 cases and deaths for each nursing home were divided by the nursing home’s average daily census and multiplied by 100, representing events per 100 beds, which were aggregated across groups. Conclusion NHs are vulnerable to COVID-19 outbreaks. A universal decolonization and COVID prevention training initiative in OC, CA significantly reduced staff and resident COVID cases in this high-risk care setting. Disclosures Gabrielle Gussin, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Raveena Singh, MA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Raheeb Saavedra, AS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Robert Pedroza, BS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Chase Berman, BS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)

scholarly journals Trends of limb amputation considering type, level, sex and age in Saskatchewan, Canada 2006–2019: an in-depth assessment

2022 ◽  
Vol 80 (1) ◽  
Author(s):  
Samuel Kwaku Essien ◽  
David Kopriva ◽  
A. Gary Linassi ◽  
Audrey Zucker-Levin
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Limb Amputation ◽  
Annual Percent Change ◽  
Discharge Data ◽  
Resident Population ◽  
True Incidence ◽  
Depth Analysis ◽  
The Impact ◽  
Extremity Amputation

Abstract Background Most epidemiologic reports focus on lower extremity amputation (LEA) caused specifically by diabetes mellitus. However, narrowing scope disregards the impact of other causes and types of limb amputation (LA) diminishing the true incidence and societal burden. We explored the rates of LEA and upper extremity amputation (UEA) by level of amputation, sex and age over 14 years in Saskatchewan, Canada. Methods We calculated the differential impact of amputation type (LEA or UEA) and level (major or minor) of LA using retrospective linked hospital discharge data and demographic characteristics of all LA performed in Saskatchewan and resident population between 2006 and 2019. Rates were calculated from total yearly cases per yearly Saskatchewan resident population. Joinpoint regression was employed to quantify annual percentage change (APC) and average annual percent change (AAPC). Negative binomial regression was performed to determine if LA rates differed over time based on sex and age. Results Incidence of LEA (31.86 ± 2.85 per 100,000) predominated over UEA (5.84 ± 0.49 per 100,000) over the 14-year study period. The overall LEA rate did not change over the study period (AAPC -0.5 [95% CI − 3.8 to 3.0]) but fluctuations were identified. From 2008 to 2017 LEA rates increased (APC 3.15 [95% CI 1.1 to 5.2]) countered by two statistically insignificant periods of decline (2006–2008 and 2017–2019). From 2006 to 2019 the rate of minor LEA steadily increased (AAPC 3.9 [95% CI 2.4 to 5.4]) while major LEA decreased (AAPC -0.6 [95% CI − 2.1 to 5.4]). Fluctuations in the overall LEA rate nearly corresponded with fluctuations in major LEA with one period of rising rates from 2010 to 2017 (APC 4.2 [95% CI 0.9 to 7.6]) countered by two periods of decline 2006–2010 (APC -11.14 [95% CI − 16.4 to − 5.6]) and 2017–2019 (APC -19.49 [95% CI − 33.5 to − 2.5]). Overall UEA and minor UEA rates remained stable from 2006 to 2019 with too few major UEA performed for in-depth analysis. Males were twice as likely to undergo LA than females (RR = 2.2 [95% CI 1.99–2.51]) with no change in rate over the study period. Persons aged 50–74 years and 75+ years were respectively 5.9 (RR = 5.92 [95% Cl 5.39–6.51]) and 10.6 (RR = 10.58 [95% Cl 9.26–12.08]) times more likely to undergo LA than those aged 0–49 years. LA rate increased with increasing age over the study period. Conclusion The rise in the rate of minor LEA with simultaneous decline in the rate of major LEA concomitant with the rise in age of patients experiencing LA may reflect a paradigm shift in the management of diseases that lead to LEA. Further, this shift may alter demand for orthotic versus prosthetic intervention. A more granular look into the data is warranted to determine if performing minor LA diminishes the need for major LA.

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