scholarly journals Opioid Abuse and Dependence during Pregnancy

2014 ◽  
Vol 121 (6) ◽  
pp. 1158-1165 ◽  
Author(s):  
Ayumi Maeda ◽  
Brian T. Bateman ◽  
Caitlin R. Clancy ◽  
Andreea A. Creanga ◽  
Lisa R. Leffert
Keyword(s):  
United States ◽  
Preterm Labor ◽  
Nationwide Inpatient Sample ◽  
Temporal Trends ◽  
The United States ◽  
Opioid Abuse ◽  
Therapeutic Interventions ◽  
Crude Incidence ◽  
Obstetrical Outcomes ◽  
The Impact

Abstract Background: The authors investigated nationwide trends in opioid abuse or dependence during pregnancy and assessed the impact on maternal and obstetrical outcomes in the United States. Methods: Hospitalizations for delivery were extracted from the Nationwide Inpatient Sample from 1998 to 2011. Temporal trends were assessed and logistic regression was used to examine the associations between maternal opioid abuse or dependence and obstetrical outcomes adjusting for relevant confounders. Results: The prevalence of opioid abuse or dependence during pregnancy increased from 0.17% (1998) to 0.39% (2011) for an increase of 127%. Deliveries associated with maternal opioid abuse or dependence compared with those without opioid abuse or dependence were associated with an increased odds of maternal death during hospitalization (adjusted odds ratio [aOR], 4.6; 95% CI, 1.8 to 12.1, crude incidence 0.03 vs. 0.006%), cardiac arrest (aOR, 3.6; 95% CI, 1.4 to 9.1; 0.04 vs. 0.01%), intrauterine growth restriction (aOR, 2.7; 95% CI, 2.4 to 2.9; 6.8 vs. 2.1%), placental abruption (aOR, 2.4; 95% CI, 2.1 to 2.6; 3.8 vs. 1.1%), length of stay more than 7 days (aOR, 2.2; 95% CI, 2.0 to 2.5; 3.0 vs. 1.2%), preterm labor (aOR, 2.1; 95% CI, 2.0 to 2.3; 17.3 vs. 7.4%), oligohydramnios (aOR, 1.7; 95% CI, 1.6 to 1.9; 4.5 vs. 2.8%), transfusion (aOR, 1.7; 95% CI, 1.5 to 1.9; 2.0 vs. 1.0%), stillbirth (aOR, 1.5; 95% CI, 1.3 to 1.8; 1.2 vs. 0.6%), premature rupture of membranes (aOR, 1.4; 95% CI, 1.3 to 1.6; 5.7 vs. 3.8%), and cesarean delivery (aOR, 1.2; 95% CI, 1.1 to 1.3; 36.3 vs. 33.1%). Conclusions: Opioid abuse or dependence during pregnancy is associated with considerable obstetrical morbidity and mortality, and its prevalence is dramatically increasing in the United States. Identifying preventive strategies and therapeutic interventions in pregnant women who abuse drugs are important priorities for clinicians and scientists.

The Impact of BMI on Adult Blunt Trauma Outcomes

2019 ◽  
Vol 85 (12) ◽  
pp. 1354-1362
Author(s):  
Rahman Barry ◽  
Milad Modarresi ◽  
Rodrigo Aguilar ◽  
Jacqueline Sanabria ◽  
Thao Wolbert ◽  
...  
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Blunt Trauma ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Obese Patients ◽  
The Impact

Traumatic injuries account for 10% of all mortalities in the United States. Globally, it is estimated that by the year 2030, 2.2 billion people will be overweight (BMI ≥ 25) and 1.1 billion people will be obese (BMI ≥ 30). Obesity is a known risk factor for suboptimal outcomes in trauma; however, the extent of this impact after blunt trauma remains to be determined. The incidence, prevalence, and mortality rates from blunt trauma by age, gender, cause, BMI, year, and geography were abstracted using datasets from 1) the Global Burden of Disease group 2) the United States Nationwide Inpatient Sample databank 3) two regional Level II trauma centers. Statistical analyses, correlations, and comparisons were made on a global, national, and state level using these databases to determine the impact of BMI on blunt trauma. The incidence of blunt trauma secondary to falls increased at global, national, and state levels during our study period from 1990 to 2015, with a corresponding increase in BMI at all levels ( P < 0.05). Mortality due to fall injuries was higher in obese patients at all levels ( P < 0.05). Analysis from Nationwide Inpatient Sample database demonstrated higher mortality rates for obese patients nationally, both after motor vehicle collisions and mechanical falls ( P < 0.05). In obese and nonobese patients, regional data demonstrated a higher blunt trauma mortality rate of 2.4% versus 1.2%, respectively ( P < 0.05) and a longer hospital length of stay of 4.13 versus 3.26 days, respectively ( P = 0.018). The obesity rate and incidence of blunt trauma secondary to falls are increasing, with a higher mortality rate and longer length of stay in obese blunt trauma patients.

Abstract WP354: Ten-year Temporal Trends in Medical Complications Following Acute Intracerebral Hemorrhage in the United States

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Fadar O Otite ◽  
Priyank Khandelwal ◽  
Amer M Malik ◽  
Seemant Chaturvedi ◽  
Ralph L Sacco ◽  
...  
Keyword(s):  
United States ◽  
Intracerebral Hemorrhage ◽  
Nationwide Inpatient Sample ◽  
Temporal Trends ◽  
The United States ◽  
Medical Complications ◽  
Innovative Strategies ◽  
The Us ◽  
Acute Intracerebral Hemorrhage ◽  
Over Time

Background: Data on medical complications following intracerebral hemorrhage (ICH) are sparse. We assessed trends in the prevalence of urinary tract infection (UTI), pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism (PE), acute renal failure (ARF) and acute myocardial infarction (AMI) following ICH in the United States and evaluated their association with in-hospital mortality (IM), cost, length-of-stay (LOS) and home disposition (HD). Methods: Adults admitted to US hospitals from 2004-2013 (n=582,736) were identified from the Nationwide Inpatient Sample. Weighted complication risks were computed by sex and by mechanical ventilation (MV) status. Multivariate models were used to evaluate trends in complication and to assess their association with IM, cost, LOS, and HD. Results: Overall risks of UTI, pneumonia, sepsis, DVT, PE, ARF and AMI following ICH were 14.8%, 7.7%, 4.1%, 2.7%, 0.7%, 8.2% and 2.0% respectively. Risks differed by sex (UTI: females (F) 19.8% vs males (M) 9.9%; ARF: M 10.6% vs F 5.9%; sepsis: M 4.8% vs F 3.4%) and by MV status (pneumonia: MV 17.7% vs non-MV 3.9%; DVT: MV 4.3% vs non-MV 3.2%). From 2004 to 2103, odds of DVT and ARF increased while odds of pneumonia, sepsis and mortality declined over time (figure 1). Each complication was associated with > 2.5-day increase in mean LOS, > $8,000 increase in cost and reduced odds of HD. ARF and AMI were associated with increased IM in all patients; sepsis and pneumonia were associated with increased IM only in non-MV patients while UTI and DVT were associated with reduced IM in all patients. Conclusion and Relevance: Despite IM reduction, ARF and DVT risk following ICH in the US have increased while odds of sepsis and pneumonia have declined over time. All complications were associated with increased cost, LOS and reduced odds of HD but their associations with IM were variable, likely due in part to survival bias. Innovative strategies are needed to prevent ICH-associated medical complications.

scholarly journals Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

2020 ◽  
Author(s):  
Brian Neelon ◽  
Fedelis Mutiso ◽  
Noel T Mueller ◽  
John L Pearce ◽  
Sara E Benjamin-Neelon
Keyword(s):  
United States ◽  
Social Vulnerability ◽  
Negative Binomial ◽  
Temporal Trends ◽  
The United States ◽  
Systems Science ◽  
Crossover Effect ◽  
Death Rates ◽  
The Impact ◽  
Over Time

Background: Emerging evidence suggests that socially vulnerable communities are at higher risk for coronavirus disease 2019 (COVID-19) outbreaks in the United States. However, no prior studies have examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. The purpose of this study was to examine temporal trends among counties with high and low social vulnerability and to quantify disparities in these trends over time. We hypothesized that highly vulnerable counties would have higher incidence and death rates compared to less vulnerable counties and that this disparity would widen as the pandemic progressed. Methods: We conducted a retrospective longitudinal analysis examining COVID-19 incidence and death rates from March 1 to August 31, 2020 for each county in the US. We obtained daily COVID-19 incident case and death data from USAFacts and the Johns Hopkins Center for Systems Science and Engineering. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention in which higher scores represent more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles. We adjusted for percentage of the county designated as rural, percentage in poor or fair health, percentage of adult smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, and the proportion tested for COVID-19 in the state. Results: In unadjusted analyses, we found that for most of March 2020, counties in the upper SVI quartile had significantly fewer cases per 100,000 than lower SVI quartile counties. However, on March 30, we observed a crossover effect in which the RR became significantly greater than 1.00 (RR = 1.10, 95% PI: 1.03, 1.18), indicating that the most vulnerable counties had, on average, higher COVID-19 incidence rates compared to least vulnerable counties. Upper SVI quartile counties had higher death rates on average starting on March 30 (RR = 1.17, 95% PI: 1.01,1.36). The death rate RR achieved a maximum value on July 29 (RR = 3.22, 95% PI: 2.91, 3.58), indicating that most vulnerable counties had, on average, 3.22 times more deaths per million than the least vulnerable counties. However, by late August, the lower quartile started to catch up to the upper quartile. In adjusted models, the RRs were attenuated for both incidence cases and deaths, indicating that the adjustment variables partially explained the associations. We also found positive associations between COVID-19 cases and deaths and percentage of the county designated as rural, percentage of resident in fair or poor health, and average daily PM2.5. Conclusions: Results indicate that the impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties over time. This highlights the importance of protecting vulnerable populations as the pandemic unfolds.

The impact of race on hospitalization outcomes for goodpasture’s syndrome in the United States: nationwide inpatient sample 2003–2014

2020 ◽  
pp. 1-5
Author(s):  
Wisit Cheungpasitporn ◽  
Charat Thongprayoon ◽  
Michael A. Mao ◽  
Boonphiphop Boonpheng ◽  
Tarun Bathini ◽  
...  
Keyword(s):  
United States ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Goodpasture's Syndrome ◽  
Goodpasture’S Syndrome ◽  
The Impact

Abstract 118: Factors and Hospital Charges Associated With Prolonged Length of Hospitalization in Patients Admitted With Ischemic Stroke in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Mohammad Rauf A Chaudhry ◽  
Iqra N Akhtar ◽  
Mohsain Gill ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Hospital Charges ◽  
Median Length ◽  
The Impact ◽  
Length Of Hospitalization

Background and Purpose: The duration of hospitalization and associated factors are not well studied in national cohorts. We identified the proportion and determinants of prolonged hospitalization and determined the impact on hospital charges using nationally representative data. Methods: National estimates of length of stay, mortality, and hospital charges incurred in patients admitted with primary diagnosis of ischemic stroke (ICD-9 CM diagnosis-related code 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, and 436) using Nationwide Inpatient Sample data from 2010 to 2015. Nationwide Inpatient Sample is the largest all-payer inpatient care database in the United States. Patient who were transferred from another acute hospital or had mortality within 2 days of admission were excluded from the analysis. All the variables pertaining to hospitalization were compared in four quartiles based on distribution data for length of hospital stay (≤2, 3 to 4, 5 to 6 and ≥7 days). Results: A total of 2,490,136 patients were admitted with the diagnosis of ischemic attack during the study period. The median length of stay for hospitalization was 4 days. The length of hospitalization was ≤2, 3 to 4, 5 to 6 and ≥7 days in 706,550 (28.4%), 842,872 (33.8%), 417,592 (16.8%) and 523,122 (21.0%) patients, respectively. The mean hospitalization charges were $22,819, $32,593, $ 45,486 and $97,868 for patients hospitalized in four quartiles, respectively. In the multivariate analysis, the following patient factors and in hospital complications were associated with above median length of hospitalization of ≥4 days: age >65 years (odds ratio [OR], 1.06), women (OR, 1.07), history of alcohol use (OR, 1.29), deep venous thrombosis (OR, 2.67), urinary tract infection (OR, 1.68), pneumonia (OR, 1.53), sepsis (OR, 1.85), pulmonary embolism (OR, 1.48), admission to urban teaching hospitals (OR, 1.07), Medicaid insurance (OR, 1.53), and hospital location in Northeast US region (OR, 1.86; all P values <0.0001). Conclusions: The hospital stay in more than half of patients admitted with ischemic stroke is 4 days or greater. Strategies that focus on modifiable factors associated with prolonged hospital stay may reduce the hospitalization charges in United States.

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