scholarly journals Time Trends in the Burden of Hospitalizations with Invasive Aspergillosis in the United States, 2004–2013

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S73-S74
Author(s):  
Marya D Zilberberg ◽  
Rachel Harrington ◽  
James Spalding ◽  
Andrew F Shorr
Keyword(s):  
United States ◽  
Invasive Aspergillosis ◽  
Time Trends ◽  
The United States ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Care Utilization ◽  
Global Development ◽  
The South ◽  
Research Support

Abstract Background Invasive aspergillosis (IA) remains a burdensome illness and is associated with substantial mortality. With increasing use of aggressive chemotherapy and immunomodulatory treatments, the prevalence of IA is likely to have grown. However, little is known about the current US burden of IA-related hospitalizations. Methods Using aggregated data available on the interactive website from the Agency of Healthcare Research and Quality’s Health Care Utilization Project Net, we examined the annual volume of IA-related hospitalizations in the United States, based on the presence of the ICD-9-CM codes 117.3, 117.9, and 484.6. Age-adjusted volumes were derived through population incidence calculated using year-specific censal and intercensal US population estimates available from the US Census Bureau. We additionally determined time trends in IA as the principal diagnosis (PD) and its associated charges. Results Between 2004 and 2013, the number of annual hospitalizations with IA grew from 29,774 (standard error, SE 2,425) to 51,870 (SE 2,642), a 74.2% overall increase. This increase was most notable among those aged 45–64 and 65–84 years. Regionally, the South contributed the plurality of the cases (40%), and the Northeast the fewest (17%) with the remainder split evenly between the West and the Midwest. When age-adjusting to year 2013, the growth in the volume of cases was slightly more modest (44.2%), going from 35,968 cases in 2004 to 51,870 in 2013. The proportion of IA hospitalizations in which IA was the PD dropped, from 14.4% in 2004 to 9.3% in 2013. Despite mean hospital length of stay (LOS) decreasing from 13.3 (SE 0.07) in 2004 to 11.5 (SE 0.6) days in 2013, the corresponding mean hospital charges rose from $71,164 (SE $5,248) to $123,005 (SE $9,738). The aggregate US inflation-adjusted hospital charges for IA PD rose from $436,074,445 in 2004 to $592,358,369 in 2013. Conclusion The rate of growth in IA-related hospitalizations in the United States between 2004 and 2013 was substantial. The plurality of cases appears to arise in the South. Despite a moderate decrease in LOS during the time period studied, there was a modest rise in the corresponding hospital charges. The aggregate US annual hospital bill for IA PD discharges is over $0.5 billion. Disclosures M. D. Zilberberg, Astellas Pharma Global Development, Inc.: grant investigator, research support R. Harrington, Astellas Pharma Global Development, Inc.: employee, former employee and salary J. Spalding, Astellas Pharma Global Development, Inc.: employee, salary A. F. Shorr, Astellas Pharma Global Development, Inc.: 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 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

Abstract 15333: Choosing Where to Live or Die: Regional Variation in Outcomes Following Out-of-hospital Cardiac Arrest (OHCA) in the United States

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Aiham Albaeni ◽  
May A. Beydoun ◽  
Shaker M. Eid ◽  
Bolanle Akinyele ◽  
Lekshminarayan RaghavaKurup ◽  
...  
Keyword(s):  
United States ◽  
Care Delivery ◽  
The United States ◽  
Hospital Charges ◽  
Trauma Patients ◽  
The South ◽  
The West ◽  
Total Hospital ◽  
North East ◽  
Nationwide Inpatient Sample Database

Background: Regional Differences in health outcomes following OHCA has been poorly studied, and was the focus of this investigation. Methods: We used the 2002 to 2012 Nationwide Inpatient Sample database to identify adults ≥ 18 years old, with an ICD-9 code principal diagnosis of cardio respiratory arrest (427.5) or ventricular fibrillation (427.1). Trauma patients were excluded. In 4 predefined federal geographic regions: North East, Midwest, South and West, means and proportions of total hospital charges (adjusted to the 2012 consumer price index,) and mortality rate were calculated. Multiple linear and logistic regression models, were adjusted for patient demographics, hospital characteristics and Charlson Comorbidity Index. Trends in binary outcome were examined with YearхRegion interaction terms. Results: From 2002 to 2012, of 155,592 OHCA patients who survived to hospital admission , 26,007 (16.7%) were in the Northeast, 39,921 (25.7% ) in the Midwest, 56,263 (36.2%) in the South, and 33,401 (21.5% ) in the West. Total hospital charges (THC) rose significantly over the years across all regions of the United States ( P trend <0.0001), and were higher in the West Vs the North East (THC>$109,000/admission, AOR 1.85; 95% CI 1.53-2.24, p<0.0001), and not different in other regions. Compared to the Northeast, mortality was lower in the Midwest ( AOR 0.86, 95% CI 0.77-0.97 p=0.01), marginally lower in the South ( AOR 0.91, 95% CI 0.82-1.01 p=0.07), with no difference detected between the West and the Northeast ( AOR 1.02, 95% CI 0.90-1.16 P=0.78). Increased expenditure was not rewarded by an increase in survival, as trends in Mortality did not differ significantly between regions (YearхRegion effects P>0.05, P trend =0.29). Conclusions: Nationwide, there is a considerable variability in survival and charges associated with caring for the post arrest patient. Higher charges did not yield better outcomes. Further investigation is needed to optimize health care delivery.

Trends and presentation patterns of acute rheumatic fever hospitalisations in the United States

2019 ◽  
Vol 29 (11) ◽  
pp. 1387-1390
Author(s):  
Tyler Bradley-Hewitt ◽  
Chris T. Longenecker ◽  
Vuyisile Nkomo ◽  
Whitney Osborne ◽  
Craig Sable ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Rheumatic Fever ◽  
Private Insurance ◽  
Case Fatality ◽  
The United States ◽  
Hospital Charges ◽  
The South ◽  
Asian Pacific Islanders ◽  
Asian Pacific

AbstractObjective:Rheumatic fever, an immune sequela of untreated streptococcal infections, is an important contributor to global cardiovascular disease. The goal of this study was to describe trends, characteristics, and cost burden of children discharged from hospitals with a diagnosis of RF from 2000 to 2012 within the United States.Methods:Using the Kids’ Inpatient Database, we examined characteristics of children discharged from hospitals with the diagnosis of rheumatic fever over time including: overall hospitalisation rates, age, gender, race/ethnicity, regional differences, payer type, length of stay, and charges.Results:The estimated national cumulative incidence of rheumatic fever in the United States between 2000 and 2012 was 0.61 cases per 100,000 children. The median age was 10 years, with hospitalisations significantly more common among children aged 6–11 years. Rheumatic fever hospitalisations among Asian/Pacific Islanders were significantly over-represented. The proportion of rheumatic fever hospitalisations was greater in the Northeast and less in the South, although the highest number of rheumatic fever admissions occurred in the South. Expected payer type was more likely to be private insurance, and the median total hospital charges (adjusted for inflation to 2012 dollars) were $16,000 (interquartile range: $8900–31,200). Median length of stay was 3 days, and the case fatality ratio for RF in the United States was 0.4%.Conclusions:Rheumatic fever persists in the United States with an overall downwards trend between 2003 and 2012. Rheumatic fever admissions varied considerably based on age group, region, and origin.

Abstract TMP119: Incidence, Presentation and Outcomes of Brain Arteriovenous Malformations in Adult Population in United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Vamshi Balasetti ◽  
Wei Huang ◽  
Nitish Kumar ◽  
Iryna Lobanova ◽  
Farhan Siddiq ◽  
...  
Keyword(s):  
United States ◽  
Hospital Admissions ◽  
Adult Population ◽  
The United States ◽  
Severe Disability ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Diagnostic Code ◽  
Discharge Disposition ◽  
Icd 10

Background: Data regarding national estimates of brain arteriovenous malformation (BAVM) among adults in United States data are scant, often biased by limitations of single center and regional studies. Identification of such patients in nationally representative datasets was not possible until recently due to a new specific ICD-10 code. Objective: To characterize inpatient burden, expenditures, associated comorbidities (including intracerebral hemorrhages and seizures) and treatments of BAVM among adults in United States. Methods: Patients with BAVM were identified from the Nationwide Inpatient Sample (NIS) database for the year 2016 using ICD-10 diagnostic code (Q28.2). The primary outcome was to determine the prevalence of BAVM in the adult (18 and above) in-patient population in the United States. Secondary outcomes included determining inpatient mortality, morbidity, comorbidities, hospital length of stay (LOS) and total hospital charges. Outcome was classified by discharge disposition into none to minimal and moderate to severe disability. Results: Of the total 7,135,090 reported hospital discharges in 2016, an estimated 1733 (0.02%) had the diagnosis of BAVM; 1547 were adults with ages 18 or greater (mean age [SD] 54 (18); 783 (50.6%) were men). Patients with BAVM were whites (n= 921, 59.5%), African-Americans (n=224, 14.4%) and Hispanic (n=212, 13.7%). Underlying hypertension was identified in 677 (43.1%) patients. Clinical presentation was intracerebral hemorrhage (n=260, 16.8%), seizures (n=234, 15.1%) and subarachnoid hemorrhage (n=75, 4.8%). Endovascular treatment was performed in 272 (17.5%) patients and surgical treatment was performed in 45 (2.9%) patients. None to minimal disability was seen in 1023 (66.1%) and moderate to severe disability was seen in 469 (30.3%) of the patients. In hospital mortality was 2.59% (n=40). Average LOS (SD) was 4 days (8.6) with mean hospitalization charges (SD) of $121,186 (153553.1). Conclusion: There are 1547 hospital admissions for BAVM among adults in United States every year. The overall outcomes were good with high rates of none to minimal disability but the hospitalization charges were higher than expected and may be important for resource allocation.

Health Outcomes and Health Care Utilization Among Obstetric Deliveries With Concurrent CKD in the United States

2020 ◽  
Vol 75 (1) ◽  
pp. 148-150 ◽  
Author(s):  
Andrea L. Oliverio ◽  
Lindsay K. Admon ◽  
Laura H. Mariani ◽  
Tyler N.A. Winkelman ◽  
Vanessa K. Dalton
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
Health Outcomes ◽  
The United States ◽  
Care Utilization

Against Slave Power? Slavery and Runaway Slaves in Mexico-United States Relations, 1821–1857

2019 ◽  
Vol 35 (2) ◽  
pp. 143-170
Author(s):  
Gerardo Gurza-Lavalle
Keyword(s):  
United States ◽  
Foreign Policy ◽  
The United States ◽  
The South ◽  
Runaway Slaves ◽  
The Us ◽  
El Alto ◽  
Upper South ◽  
Lower South

This work analyses the diplomatic conflicts that slavery and the problem of runaway slaves provoked in relations between Mexico and the United States from 1821 to 1857. Slavery became a source of conflict after the colonization of Texas. Later, after the US-Mexico War, slaves ran away into Mexican territory, and therefore slaveholders and politicians in Texas wanted a treaty of extradition that included a stipulation for the return of fugitives. This article contests recent historiography that considers the South (as a region) and southern politicians as strongly influential in the design of foreign policy, putting into question the actual power not only of the South but also of the United States as a whole. The problem of slavery divided the United States and rendered the pursuit of a proslavery foreign policy increasingly difficult. In addition, the South never acted as a unified bloc; there were considerable differences between the upper South and the lower South. These differences are noticeable in the fact that southerners in Congress never sought with enough energy a treaty of extradition with Mexico. The article also argues that Mexico found the necessary leeway to defend its own interests, even with the stark differential of wealth and resources existing between the two countries. El presente trabajo analiza los conflictos diplomáticos entre México y Estados Unidos que fueron provocados por la esclavitud y el problema de los esclavos fugitivos entre 1821 y 1857. La esclavitud se convirtió en fuente de conflicto tras la colonización de Texas. Más tarde, después de la guerra Mexico-Estados Unidos, algunos esclavos se fugaron al territorio mexicano y por lo tanto dueños y políticos solicitaron un tratado de extradición que incluyera una estipulación para el retorno de los fugitivos. Este artículo disputa la idea de la historiografía reciente que considera al Sur (en cuanto región), así como a los políticos sureños, como grandes influencias en el diseño de la política exterior, y pone en tela de juicio el verdadero poder no sólo del Sur sino de Estados Unidos en su conjunto. El problema de la esclavitud dividió a Estados Unidos y dificultó cada vez más el impulso de una política exterior que favoreciera la esclavitud. Además, el Sur jamás operó como unidad: había diferencias marcadas entre el Alto Sur y el Bajo Sur. Estas diferencias se observan en el hecho de que los sureños en el Congreso jamás se esforzaron en buscar con suficiente energía un tratado de extradición con México. El artículo también sostiene que México halló el margen de maniobra necesario para defender sus propios intereses, pese a los fuertes contrastes de riqueza y recursos entre los dos países.

A Systematic Review on Barriers to Palliative Care in Oncology

2021 ◽  
pp. 104990912098328
Author(s):  
Jyotsana Parajuli ◽  
Judith E. Hupcey
Keyword(s):  
United States ◽  
Systematic Review ◽  
Palliative Care ◽  
Full Text ◽  
Literature Search ◽  
Intervention Development ◽  
The United States ◽  
Care Utilization ◽  
Review Of Literature ◽  
Meta Analyses

The number of people with cancer and the need for palliative care among this population is increasing in the United States. Despite this growing need, several barriers exist to the utilization of palliative care in oncology. The purpose of this study was to synthesize the evidence on the barriers to palliative care utilization in an oncology population. A systematic review of literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, and Psych Info databases were used for the literature search. Articles were included if they: 1) focused on cancer, (2) examined and discussed barriers to palliative care, and c) were peer reviewed, published in English, and had an accessible full text. A total of 29 studies (8 quantitative, 18 qualitative, and 3 mixed-methods) were identified and synthesized for this review. The sample size of the included studies ranged from 10 participants to 313 participants. The barriers to palliative care were categorized into barriers related to the patient and family, b) barriers related to providers, and c) barriers related to the healthcare system or policy. The factors identified in this review provide guidance for intervention development to mitigate the existing barriers and facilitate the use palliative care in individuals with cancer.

scholarly journals A Comparative Discussion of the Judicial Disqualification of Directors under the South African Companies Act

2020 ◽  
pp. 1-24
Author(s):  
Rehana Cassim
Keyword(s):  
United States ◽  
United Kingdom ◽  
South African ◽  
United States Of America ◽  
The United States ◽  
The South ◽  
The United Kingdom ◽  
Locus Standi

Abstract Section 162 of the South African Companies Act 71 of 2008 empowers courts to declare directors delinquent and hence to disqualify them from office. This article compares the judicial disqualification of directors under this section with the equivalent provisions in the United Kingdom, Australia and the United States of America, which have all influenced the South African act. The article compares the classes of persons who have locus standi to apply to court to disqualify a director from holding office, as well as the grounds for the judicial disqualification of a director, the duration of the disqualification, the application of a prescription period and the discretion conferred on courts to disqualify directors from office. It contends that, in empowering courts to disqualify directors from holding office, section 162 of the South African Companies Act goes too far in certain respects.

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