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.

scholarly journals Laparoscopic Appendectomy Trends and Outcomes in the United States: Data from the Nationwide Inpatient Sample (NIS), 2004–2011

2014 ◽  
Vol 80 (10) ◽  
pp. 1074-1077 ◽  
Author(s):  
Hossein Masoomi ◽  
Ninh T. Nguyen ◽  
Matthew O. Dolich ◽  
Steven Mills ◽  
Joseph C. Carmichael ◽  
...  
Keyword(s):  
United States ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Conversion Rate ◽  
Nationwide Inpatient Sample ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
The United States ◽  
Hospital Charges ◽  
Nationwide Inpatient Sample Database

Laparoscopic appendectomy (LA) is becoming the standard procedure of choice for appendicitis. We aimed to evaluate the frequency and trends of LA for acute appendicitis in the United States and to compare outcomes of LA with open appendectomy (OA). Using the Nationwide Inpatient Sample database, we examined patients who underwent appendectomy for acute appendicitis from 2004 to 2011. A total of 2,593,786 patients underwent appendectomy during this period. Overall, the rate of LA was 60.5 per cent (children: 58.1%; adults: 63%; elderly: 48.7%). LA rate significantly increased from 43.3 per cent in 2004 to 75 per cent in 2011. LA use increased 66 per cent in nonperforated appendicitis versus 100 per cent increase in LA use for perforated appendicitis. The LA rate increased in all age groups. The increased LA use was more significant in male patients (84%) compared with female patients (62%). The overall conversion rate of LA to OA was 6.3 per cent. Compared with OA, LA had a significantly lower complication rate, a lower mortality rate, a shorter mean hospital stay, and lower mean total hospital charges in both nonperforated and perforated appendices. LA has become an established procedure for appendectomy in nonperforated and perforated appendicitis in all rates exceeding OA. Conversion rate is relatively low (6.3%).

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.

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

“Machinery Has Completely Taken Over”: The Diffusion of the Mechanical Cotton Picker, 1949–1964

2008 ◽  
Vol 39 (1) ◽  
pp. 65-96 ◽  
Author(s):  
Craig Heinicke ◽  
Wayne A. Grove
Keyword(s):  
United States ◽  
Environmental Factors ◽  
Educational Attainment ◽  
Technological Change ◽  
Social Institutions ◽  
The United States ◽  
The South ◽  
The West ◽  
Cotton Picker ◽  
Cotton Belt

Hand picking of cotton in the United States virtually disappeared twenty years after the first mechanical harvester was marketed in 1949. Contrary to received accounts, southern social institutions did not impede the diffusion of the mechanical cotton picker from the West to the cotton belt in the South so much as environmental factors and educational attainment did. Rising cotton yields and exogenous technological change drove diffusion by reducing the costs of machine harvesting. Labor displacement resulting from the cotton picker occurred only in a concentrated burst after 1959.

Household Vehicle Consumption Forecasts in the United States, 2000 to 2005

2011 ◽  
Vol 53 (5) ◽  
pp. 593-618 ◽  
Author(s):  
Qiushi Feng ◽  
Zhenglian Wang ◽  
Danan Gu ◽  
Yi Zeng
Keyword(s):  
United States ◽  
The United States ◽  
Household Consumption ◽  
New Method ◽  
The South ◽  
The West ◽  
Automobile Market

Forecasts of household vehicle consumption are important for automobile market analyses. This paper employs the ProFamy extended cohort-component new method to project household vehicle consumption from 2000 to 2025 across four regions of the United States (the Northeast, Midwest, South and West). The results show that the total number of household vehicles in 2025 will reach 235 million, representing a 31% increase over the 25 years. About a half of the increase is due to the consumption of cars, while the household consumption of vans will increase at a faster rate than that of cars and trucks. Household vehicle consumption will grow more in white non-Hispanic and Hispanic households in comparison with black non-Hispanic and Asian and other non-Hispanic households. Owners of household vehicles in the United States will be ageing quickly. Among households of different sizes, the largest increase in household vehicles will come from two-person households. Across the four regions, the largest increase in household vehicle consumption will be in the South, followed by the West, Midwest and Northeast.

scholarly journals 2671. Outcomes of Clostridium difficile Infection in Solid-Organ Transplant Patients: Nationwide Inpatient Sample 2015–2016

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S936-S937
Author(s):  
Rattanaporn Mahatanan ◽  
Prangthip Charoenpong
Keyword(s):  
United States ◽  
Organ Transplant ◽  
The United States ◽  
Solid Organ Transplant ◽  
Hospital Charges ◽  
Solid Organ ◽  
Total Hospital ◽  
Transplant Patients ◽  
History Of ◽  
Secondary Outcomes

Abstract Background Clostridium difficile infection (CDI) is a leading cause of morbidity and mortality in a hospitalized patient. The incidence and severity of nosocomial CDI have increased significantly since the year 2000. Solid-organ transplant recipients (SOT) are at high risk for CDI for multiple reasons including impaired defense mechanisms from immunosuppression, perioperative antibiotic use, and organ failure. For the past decade, there has been the advance modality of diagnosis and treatments for CDI including early detection of toxin, novel antibiotics, and fecal microbiota transplantation. With the innovative measurements and the effort of antibiotic stewardship, the recent study show improvement of mortality in hospitalized CDI; however, there is still lack of such evidence among SOT patients. Therefore, it would be beneficial to scrutinize the prevalence and outcomes of CDI among SOTs with the most current available nationwide database. Methods Our study utilized the 2015 and 2016 National Inpatient Sample (NIS). It is the largest publicly available all-payer inpatient healthcare database in the United States, yielding national estimates of hospital inpatient stays. Patients with history or undergoing SOT transplant procedure who were hospitalized in 2015 and 2016 NIS database were included in our study. We included heart, lung, liver, intestinal, kidney, pancreas, or at least one of these organs transplanted in our definiton of SOT. History of organ tranplants and CDI were extracted by using ICD-9-CM and ICD-10-CM from discharged diagnosis. Baseline characteristic include age, gender, race, median household income were collected. Confounding includes comorbidities which were calculated into charlson comorbidity index (CCI) and discharge diagnosis of pneumonia and urinary tract infection. Primary outcomes include in-patient mortality, hospital length of stay and total hospital charges. Secondary outcomes include transplant failure or rejection, colectomy and disposition of patients. Multivariable logistic regression was used for the adjusted analysis of the primary and secondary outcomes include all confounders and significant covariates. All reported CIs were two-sided 95% intervals, and tests were done at the two-sided 5% significance level. Stata v14.2 (Stata Corp, College Station, Texas) was utilized for all analyses. Results A total of 107,461 discharges of SOTs in 2015–2016 NIS database were included in our study. The mean age was 53 years (SD 17) and 45,666 (42%) were female. History of kidney transplant was found to be the most common (55%) and history of liver tranplants was the second most common (19%) among our population.The incidence of CDI was 3,626 (3.37%) among SOTs. Factors associated with CDI include age (4% increasing of odds for 10-year increment in age), female (OR 1.2; 95% CI 1.16–1.34), history of heart transplant (OR 1.28; 95% CI 1.11–1.48), kidney transplant (OR 0.98; 95% CI 0.82–0.97), UTI (OR 1.65; 95% CI 1.50–1.81) and pneumonia (OR 1.24;; 95% CI 1.122- 1.38). CDI associated with higher inpatient mortality (OR 1.85, 95% CI 1.56–2.20, P < 0.01), longer length of hospital stay (mean difference 5.07 days, 95% CI 4.43–5.71, P < 0.01) and higher total hospital charges (mean difference 43,958 dollars, P < 0.01). Furthermore, SOTs with CDI had higher risk of transplant complication (OR1.67, 95% CI 1.50–1.87, P < 001) and increase risk of colectomy (OR 2.36, 95% CI 1.50–3.72). Those who had CDI were less likely to be discharged home when compare to non-CDI (OR 0.53, 95% CI 0.49–0.58, P < 0.01). Conclusion Our study found that CDI associated with significant overall worse outcomes among hospitalized solid-organ transplant patients. Multicenter prospective study is considered as a future direction to evaluate the impact to healthcare. Despite the improvement of overall mortality of CDI in general population in the United States from prior study, CDI in SOTs remains problematic. More attention is needed in this particular field. Disclosures All authors: No reported disclosures.

Regional differences in total hospital charges between open and robotically assisted radical prostatectomy in the United States

2018 ◽  
Vol 37 (7) ◽  
pp. 1305-1313 ◽  
Author(s):  
Felix Preisser ◽  
Sebastiano Nazzani ◽  
Elio Mazzone ◽  
Sophie Knipper ◽  
Marco Bandini ◽  
...  
Keyword(s):  
United States ◽  
Radical Prostatectomy ◽  
Regional Differences ◽  
The United States ◽  
Hospital Charges ◽  
Total Hospital

5. Japan expands its war with China

2014 ◽  
pp. 66-80
Author(s):  
Gerard L. Weinberg
Keyword(s):  
United States ◽  
The Netherlands ◽  
Southeast Asia ◽  
South Pacific ◽  
The United States ◽  
The South ◽  
The West ◽  
The Pacific ◽  
East And Southeast Asia

Japan had been in open war with China since July 1937 and was continuing occasional advances against Chinese resistance. ‘Japan expands its war with China’ describes how German victories in the West in early 1940 suggested an opportunity to close off much of China's outside aid. In July 1941, Japanese forces occupied the southern part of French Indo-China, moving away from war with China to prepare attacks on territories controlled by the Netherlands, Britain, and the United States in East and Southeast Asia as well as the South Pacific. Japan's attack on Pearl Harbour in December 1941 brought the United States fully into the war, in both the Pacific and in Europe.

Regional Variation in Homicide Rates: Why Is the West So Violent?

1989 ◽  
Vol 4 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Patrick W. O’Carroll ◽  
James A. Mercy
Keyword(s):  
United States ◽  
Mutual Effect ◽  
The United States ◽  
Homicide Rate ◽  
Geographic Pattern ◽  
The South ◽  
The West ◽  
Homicide Rates ◽  
Two Factors ◽  
Very High

Scientists have long been interested in the fact that the South has consistently had the highest crude homicide rates in the United States. Past investigations, however, have generally been predicated on the assumption that this geographic pattern was not attributable to or substantially altered by the age or race structures of the populations being compared. In this study, we calculated age-adjusted homicide rates for each of three race categories—white, black, and other—for each state and region in the United States in 1980. We found that for each race group, homicide rates were highest, not in the South, but in the West. Moreover, homicide rates for blacks were lower in the South than in any other region of the country. We infer that, for 1980 at least, the high crude homicide rate in the South results from the mutual effect of two factors: (1) blacks have very high homicide rates compared with whites, and (2) blacks make up a larger proportion of the population in the South than in other regions of the country. It remains to be determined whether the age-adjusted, race-stratified rates of past decades also show this pattern.

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