scholarly journals Increasing Age Has Limited Impact on Risk of Clostridium difficile Infection in an Elderly Population

2018 ◽  
Vol 5 (7) ◽  
Author(s):  
Margaret A Olsen ◽  
Dustin Stwalley ◽  
Clarisse Demont ◽  
Erik R Dubberke
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Clostridium Difficile ◽  
Health Care Utilization ◽  
Clostridium Difficile Infection ◽  
Elderly Population ◽  
Univariate Analysis ◽  
Model Performance ◽  
Care Utilization ◽  
Increased Risk

Abstract Background Numerous studies have found increased risk of Clostridium difficile infection (CDI) with increasing age. We hypothesized that increased CDI risk in an elderly population is due to poorer overall health status with older age. Methods A total of 174 903 persons aged 66 years and older coded for CDI in 2011 were identified using Medicare claims data. The comparison population consisted of 1 453 867 uninfected persons. Potential risk factors for CDI were identified in the prior 12 months and organized into categories, including infections, acute noninfectious conditions, chronic comorbidities, frailty indicators, and health care utilization. Multivariable logistic regression models with CDI as the dependent variable were used to determine the categories with the biggest impact on model performance. Results Increasing age was associated with progressively increasing risk of CDI in univariate analysis, with 5-fold increased risk of CDI in 94–95-year-old persons compared with those aged 66–67 years. Independent risk factors for CDI with the highest effect sizes included septicemia (odds ratio [OR], 4.1), emergency hospitalization(s) (OR, 3.9), short-term skilled nursing facility stay(s) (OR, 2.7), diverticulitis (OR, 2.2), and pneumonia (OR, 2.1). Exclusion of age from the full model had no impact on model performance. Exclusion of acute noninfectious conditions followed by frailty indicators resulted in lower c-statistics and poor model fit. Further exclusion of health care utilization variables resulted in a large drop in the c-statistic. Conclusions Age did not improve CDI risk prediction after controlling for a wide variety of infections, other acute conditions, frailty indicators, and prior health care utilization.

scholarly journals 3442 Among Hospitalized Patients, Cannabis use is Associated with Reduced risk of Clostridium Difficile infection

2019 ◽  
Vol 3 (s1) ◽  
pp. 33-34
Author(s):  
Adeyinka Charles Adejumo ◽  
Terence Ndonyi Bukong
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Hospitalized Patients ◽  
Cannabis Use ◽  
Care Utilization ◽  
P Value ◽  
Adjusted Relative Risk ◽  
Increased Risk ◽  
The Impact ◽  
Reduced Risk

OBJECTIVES/SPECIFIC AIMS: Clostridium Difficile Infection (CDI), a prevalent cause of diarrhea, is the most notorious hospital-acquired infection, resulting in an alarming mortality and health care utilization rates. Herein, we investigate the impact of cannabis use, which is gaining significant legalization for recreational use, on the risk of CDI. METHODS/STUDY POPULATION: We selected adult records (age ≥ 18 years) from the Nationwide Inpatient Sample 2014, and identified cannabis users and other clinical conditions using ICD-9-CM codes. With multivariate logistic modeling, we generated propensity scores for cannabis users and matched them to non-users in a 1:1 ratio (104,936:104,936). We then estimated the adjusted relative risk (aRR) for having CDI using conditional Possion regression models with generalized estimating equations [SAS 9.4]. RESULTS/ANTICIPATED RESULTS: Among the matched hospitalizations (n=209,872), cannabis usage was associated with a reduced incidence of CDI (505.8[464.7-550.6] vs. 694.9[645.8-747.70] per 100,000 hospitalizations), resulting in a 27% reduced risk of CDI (aRR:0.73[0.65-0.81]; p-value:<0.0001). Non-dependent and dependent cannabis users respectively had 22% and 78% reduced likelihood of CDI when compared to non-cannabis users (0.78[0.69-0.90] & 0.22[0.12-0.40]). Furthermore, dependent users had less risk of CDI compared to non-dependent users (0.28[0.16-0.51]). Comparatively, abusive use of other substances like alcohol and tobacco was associated with increased risk for CDI (1.30[1.13-1.49] & 1.24[1.10-1.40]) DISCUSSION/SIGNIFICANCE OF IMPACT: Unlike alcohol and tobacco abuse which are associated with elevated risk for CDI, cannabis use, is related to a decreased risk of CDI amongst hospitalized patients. Further prospective and molecular mechanistic studies are required to elucidate how cannabis impacts CDI.

Health Care Utilization and Costs by Metabolic Syndrome Risk Factors

2009 ◽  
Vol 7 (4) ◽  
pp. 305-314 ◽  
Author(s):  
D.M. Boudreau ◽  
D.C. Malone ◽  
M.A. Raebel ◽  
P.A. Fishman ◽  
G.A. Nichols ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Metabolic Syndrome ◽  
Health Care Utilization ◽  
Care Utilization

General Health, Health Care Utilization, and Medical Comorbidity in Dysthymia

1993 ◽  
Vol 23 (3) ◽  
pp. 211-238 ◽  
Author(s):  
Robert H. Howland
Keyword(s):  
Health Care ◽  
Major Depression ◽  
Health Care Utilization ◽  
General Health ◽  
Public Health Problem ◽  
Care Utilization ◽  
Medical Comorbidity ◽  
Medical Settings ◽  
Poor General Health ◽  
Increased Risk

Objective: This article reviews the literature on the general health, health care utilization, prevalence, medical comorbidity, and treatment of dysthymia in medical settings. Method: The literature was searched by using MEDLINE and by reviewing the bibliographies of recent publications. Studies were selected that included health data on patients with dysthymia or chronic depression according to DSM-III, DSM-III-R, ICD-9, or RDC criteria, or patients who were described as having persistent depressive symptoms. Results: This review shows that dysthymic patients are at increased risk for poor general health and frequently use medical services. Compared to the general population, dysthymia is more prevalent in primary care and among patients with various medical and neurological conditions, sleep disorders, chronic fatigue, hypothyroidism, and somatoform disorders. Pharmacotherapy is effective, but has not been well studied. Non-tricyclic antidepressants might be especially useful. Psychotherapy studies are virtually nonexistent. Conclusions: Although dysthymia is considered a minor depressive condition, these findings show that it is a significant public health problem, comparable to major depression. Recent efforts to improve the recognition and treatment of major depression in medical settings, therefore, should be extended to include the entire spectrum of depressive disorders. Future studies should investigate the type and pattern of medical comorbidity and health care utilization, different antidepressant and psychosocial therapies, and the clinical and biological correlates of treatment response in different chronic depressive subtypes in medical settings and compare them to major depressive and subsyndromal depressive conditions.

scholarly journals Determinants of Health Care Utilization among the Elderly Population in Jimma Town, Oromia Region, Southwest Ethiopia

2019 ◽  
Vol 5 (3) ◽  
Author(s):  
Terfa Yonas Biratu ◽  
Germossa Gugsa Nemera ◽  
Hailu Fikadu Balcha ◽  
Feyisa Garuma Tolu ◽  
Jeleta Fikru Tafese ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Elderly Population ◽  
The Elderly ◽  
Determinants Of Health ◽  
Care Utilization ◽  
Southwest Ethiopia ◽  
Jimma Town
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