Abstract P330: Chronic Kidney Disease is Associated With Short-Term Risk of Hospitalization Among Older Adults

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Eugenia Wong ◽  
Shoshana H Ballew ◽  
Natalie Daya ◽  
Junichi Ishigami ◽  
Casey M Rebholz ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
African American ◽  
Kidney Disease ◽  
Incidence Rate ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Serum Cystatin C ◽  
Binomial Regression ◽  
Rate Ratios

Background: Chronic kidney disease (CKD) is now staged by estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR). Risks of cardiovascular disease, dialysis, and mortality are well described, but risks of hospitalization at older age have not been explored to the same depths. Hypothesis: CKD stages will be associated with risk of all-cause hospitalizations. Methods: The analysis was conducted on 5669 white and African-American participants of the ARIC Visit 5 (2011-2013) cohort (mean age, 76 y; female, 57%; African-American, 23%). CKD was staged according to KDIGO 2012 criteria with eGFR from serum cystatin C (eGFRcys) and ACR. The primary outcome of all-cause hospitalization risk was analyzed by using negative binomial regression to estimate incidence rate ratios (IRR), adjusted for demographics, behaviors, and comorbidities. Results: Over a median follow-up period of 3.5 years (by December 31 st , 2015), 6124 hospitalizations occurred over 19788 person-years (Crude Incidence Rate, 309 per 1000 person-years). Risk of hospitalization increased markedly with lower eGFRcys and higher albuminuria ( Table 1 ). Other baseline comorbidities were also associated with hospitalization risk (IRR [95% CI] for heart failure, coronary heart disease (CHD), stroke, cancer were 1.7 [1.4-2.0], 1.5 [1.3-1.7], 1.3 [1.1-1.6], and 1.2 [0.9-1.5]). Conclusions: Among older adults, both low eGFR and high ACR are strongly related to risk of hospitalization. These findings provide insight for risk stratification and prevention of CKD at older ages. Table 1. Risk of hospitalization by CKD stages defined by eGFR and ACR

scholarly journals The Code of the Street Fights Back! Significant Associations with Arrest, Delinquency, and Violence Withstand Psychological Confounds

2020 ◽  
Vol 17 (7) ◽  
pp. 2432
Author(s):  
Kyle A. Burgason ◽  
Matt DeLisi ◽  
Mark H. Heirigs ◽  
Abdi Kusow ◽  
Jacob H. Erickson ◽  
...  
Keyword(s):  
African American ◽  
Antisocial Behavior ◽  
Juvenile Delinquents ◽  
Regression Models ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Code Of The Street ◽  
Binomial Regression ◽  
The Relationship ◽  
Practical Implications

Since Anderson’s now classic, Code of the Street: Decency, Violence, and the Moral Life of the Inner City, an increasing number of researchers have found a significant association between the code of the street and antisocial behavior. Less researched, however, is the relationship between the code of the street and cognate psychological factors. Building on the hypothesis that the code of the street is simply a reflection of elements of the population who exhibit antisocial traits, our aim in this study is to empirically test whether the observed association between the code of the street and antisocial behavior can withstand psychological confounds among a sample of institutionalized juvenile delinquents. Negative binomial regression models show that the code of the street remained a significant predictor of antisocial behavior despite the specification of psychopathy and temperamental traits and other controls. Moreover, as theorized, differential effects were found for African American delinquents compared to non-African American delinquents. We discuss theoretical and practical implications.

Effect of environmental conditions on injury rates at a Colorado ski resort

2019 ◽  
Vol 26 (4) ◽  
pp. 324-329
Author(s):  
Lauren A Pierpoint ◽  
Zachary Y Kerr ◽  
Gary Grunwald ◽  
Morteza Khodaee ◽  
Tessa Crume ◽  
...  
Keyword(s):  
Environmental Conditions ◽  
Negative Binomial ◽  
Injury Rate ◽  
Negative Binomial Regression ◽  
Injury Rates ◽  
Ski Resort ◽  
Average Temperature ◽  
Binomial Regression ◽  
Rate Ratios ◽  
Packed Powder

ObjectiveTo determine the effect of daily environmental conditions on skiing and snowboarding-related injury rates.MethodsInjury information was collected from a mountainside clinic at a large Colorado ski resort for the 2012/2013 through 2016/2017 seasons. Daily environmental conditions including snowfall, snow base depth, temperature, open terrain and participant visits were obtained from historical resort records. Snowpack and visibility information were obtained for the 2013/2014 through 2014/2015 seasons and included in a subanalysis. Negative binomial regression was used to estimate injury rate ratios (IRRs) and 95% CIs.ResultsThe overall injury rate among skiers and snowboarders was 1.37 per 1000 participant visits during 2012/2013 through 2016/2017. After adjustment for other environmental covariates, injury rates were 22% higher (IRR=1.22, 95% CI 1.14 to 1.29) on days with <2.5 compared with ≥2.5 cm of snowfall, and 14% higher on days with average temperature in the highest quartile (≥−3.1°C) compared with the lowest (<−10.6°C; IRR=1.14, 95% CI 1.03 to 1.26). Rates decreased by 8% for every 25 cm increase in snow base depth (IRR=0.92, 95% CI 0.88 to 0.95). In a subanalysis of the 2013/2014 and 2014/2015 seasons including the same covariates plus snowpack and visibility, only snowpack remained significantly associated with injury rates. Rates were 71% higher on hardpack compared with powder days (IRR=1.71, 95% CI 1.18 to 2.49) and 36% higher on packed powder compared with powder days (IRR 1.36, 95% CI 1.12 to 1.64).ConclusionsEnvironmental conditions, particularly snowfall and snowpack, have a significant impact on injury rates. Injury prevention efforts should consider environmental factors to decrease injury rates in skiers and snowboarders.

Effects of consultant residence out-of-hours on acute paediatric admissions

2020 ◽  
Vol 105 (7) ◽  
pp. 661-663 ◽  
Author(s):  
Robert Scott-Jupp ◽  
Emily Carter ◽  
Nick Brown
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Time Of Day ◽  
Short Stay ◽  
Night Time ◽  
Out Of Hours ◽  
Duration Of Stay ◽  
Binomial Regression ◽  
Rate Ratios ◽  
Short Stay Patients

Acute paediatric units require round-the-clock skilled resident medical cover. Fully trained doctors remaining resident on-site at night and weekends may improve care at these times, but costs are higher. In compensation, more senior doctors may be less likely to admit children.MethodsIn a unit providing 24-hour, 7-day acute services, out-of-hours resident cover has been divided between level 2/3 trainees and consultants. Between 2007 and 2017, night and weekend day shifts were identified as resident consultant or non-resident consultant. Admission numbers (duration of stay of ≥4 hours) were obtained from hospital activity databases. Analyses were undertaken on total admissions and stratified by time of day and duration of stay of >12 or < 12 hours. Incidence rate ratios (IRRs) were derived using negative binomial regression .ResultsFor all out-of-hours and short-stay patients, children were significantly more likely to be admitted when there was no resident consultant: IRRs 1.07 (95% CI 1.04 to 1.09) and 1.09 (95% CI 1.02 to 1.18), respectively. There was no difference between rates stratified into long stay at night or weekend days: IRRs 1.01 (95% CI 0.96 to 1.07) and 1.03 (95% CI 0.99 to 1.18) respectively .ConclusionA resident consultant presence was associated with reduced total, night-time and short-stay admissions.

scholarly journals Hospitalization Risk among Older Adults with Chronic Kidney Disease

2019 ◽  
Vol 50 (3) ◽  
pp. 212-220 ◽  
Author(s):  
Eugenia Wong ◽  
Shoshana H. Ballew ◽  
Natalie Daya ◽  
Junichi Ishigami ◽  
Casey M. Rebholz ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Cystatin C ◽  
Negative Binomial ◽  
Incidence Rates ◽  
Hospitalization Rates ◽  
Increased Risk ◽  
Very High

Introduction: Chronic kidney disease (CKD) risk staging is based on estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). However, the relationship between all-cause hospitalization risk and the current CKD staging system has not been well studied among older adults, despite a high prevalence of CKD and a high risk of hospitalization in old age. Methods: Among 4,766 participants of the Atherosclerosis Risk in Communities study, CKD was staged according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, using creatinine-based eGFR (eGFRcr) and ACR. Incidence rates of all-cause hospitalization associated with each CKD risk group were analyzed using negative binomial regression. Additionally, cause-specific hospitalization risks for cardiovascular, infectious, kidney, and other diseases were estimated. The impacts of using cystatin C-based eGFR (eGFRcys) to estimate the prevalence of CKD and risks of hospitalization were also quantified. Results: Participants experienced 5,548 hospitalizations and 29% had CKD. Hospitalization rates per 1,000 person-years according to KDIGO risk categories were 208–223 (“low risk”), 288–376 (“moderately increased risk”), 363–548 (“high risk”), and 499–1083 (“very high risk”). The increased risk associated with low eGFR and high ACR persisted in adjusted analyses, examinations of cause-specific hospitalizations, and when CKD was staged by eGFRcys or eGFRcr-cys, a combined equation based on both creatinine and cystatin C. In comparison to eGFRcr, staging by eGFRcys increased the prevalence of CKD to 50%, but hospitalization risks remained similarly high. Discussion/Conclusion: In older adults, decreased eGFR, increased ACR, and KDIGO risk stages based on a combination of these measures, were strong risk factors for hospitalization. These relationships were consistent, regardless of the marker used to estimate GFR, but the use of cystatin C resulted in a substantially higher prevalence of CKD than the use of creatinine. Older adults in the population with very high risk stages of CKD have hospitalization rates exceeding 500 per 1,000 person-years.

Abstract 49: The Effect of Gender, Obesity, and Chronic Kidney Disease on Cardiovascular Events

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Paul Kolm ◽  
Zugui Zhang ◽  
James Bowen ◽  
Rubeen Israni ◽  
William S Weintraub ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Black Females ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
End Stage ◽  
Event Rates

Background: Obesity and chronic kidney disease (CKD) are well known risk factors for cardiovascular (CV) events. Studies have shown that in patients with end-stage renal disease, the rate of CV events decreases as body mass index (BMI) increases. These studies, however, used only one measurement of BMI to predict CV events. The objective of this study was to assess whether rates of CV events changed according to variations in BMI and glomerular filtration rate (GFR) over time. Methods: A retrospective cohort of patients followed in outpatient practices from 1995 to 2010 was evaluated. Adult patients with at least 2 records of serum creatinine were included. The practices’ electronic health records (EHRs) were linked to the hospital EHR to assess CV events. GFR (mL/min/1.73m 2 ) was calculated using the Modification of Diet in Renal Disease equation and stratified according to the Kidney Disease Outcomes Quality Initiative guidelines as Normal (≥ 60), CKD stage 3 (30-59) and stage 4-5 (< 30) at each patient’s encounter. Outcomes were identified using ICD9 codes for myocardial infarction, congestive heart failure, coronary heart disease, dysrhythmia, stroke and peripheral vascular disease. The data spanned up to 10 years from a patient’s index to last visit. CV events were modeled as a function of age, gender, race, BMI and CKD status by negative binomial regression for count data. The model included interactions of age, gender, race, BMI and CKD. Results: Over the 10-year period, there were a total of 1,024,891 observations from 39,605 patients with 8,901 CV events. There was a significant age by gender by race by BMI interaction as well as a significant CKD main effect (p < 0.01). Increasing age, being male, black, overweight and having CKD, were associated with higher event rates. However, this association between BMI and event rates was not present for black females over 70, thus the 4-way sex by race by age by BMI interaction (Figure). Conclusion: These results support the hypothesis that overweight / obesity is not protective of CV events in CKD patients.

scholarly journals Effectiveness of Copper-Impregnated Solid Surfaces on Lowering Microbial Bio-Burden Levels in an Acute Care Hospital

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Piyali Chatterjee ◽  
Marjory D Williams ◽  
John D Coppin ◽  
Yonhui Allton ◽  
Hosoon Choi ◽  
...  
Keyword(s):  
Regression Model ◽  
Incidence Rate ◽  
Acute Care ◽  
Negative Binomial ◽  
Acute Care Hospital ◽  
Negative Binomial Regression ◽  
Solid Surfaces ◽  
Negative Binomial Regression Model ◽  
Care Hospital ◽  
Binomial Regression

Abstract Background Microbial bio-burden on high-touch surfaces in patient rooms may lead to acquisition of health care–associated infections in acute care hospitals. This study examined the effect of a novel copper-impregnated solid material (16%–20% copper oxide in a polymer-based resin) on bacterial contamination on high-touch surfaces in patient rooms in an acute care hospital. Methods Five high-touch surfaces were sampled for aerobic bacterial colonies (ABCs) 3 times per day over a 3-day period in 16 rooms with copper installed and 16 rooms with standard noncopper laminate installed on high-touch surfaces. A Bayesian multilevel negative binomial regression model was used to compare ABC plate counts from copper-impregnated surfaces with standard hospital laminate surfaces. Results The mean and median (interquartile range [IQR]) ABC counts from copper-impregnated surfaces were 25.5 and 11 (4–27), and for standard hospital laminate surfaces they were 60.5 and 29 (10–74.3). The negative binomial regression model–estimated incidence rate for ABC counts on plates taken from copper-impregnated surfaces was 0.40 (0.21–0.70) times the incidence rate of ABC counts on plates taken from standard hospital laminate surfaces. Conclusions Copper-impregnated solid surfaces may reduce the level of microbial contamination on high-touch surfaces in patient rooms in the acute care environment, as our study demonstrated a decline in microbial bio-burden on samples taken from copper-impregnated compared with standard hospital laminate high-touch surfaces.

scholarly journals Physical activity and Retirement: Original analysis of responses to the English Adult Active Lives Survey 2016/17

2020 ◽  
Author(s):  
Julii Brainard ◽  
Rachel Cooke ◽  
Kathleen Lane ◽  
Charlotte Salter
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Active Travel ◽  
Full Time ◽  
Binomial Regression ◽  
Original Analysis ◽  
Part Time ◽  
Time Part

AbstractObjectivesOpportunities for older adults to do physical activity may depend on other commitments. To see if reported physical activity was higher or lower among older adults depending on work status: full time, part-time or retired.MethodsThe Active Lives Survey 2016/17 in England was used to see how active people were depending on employment or retirement status. Types of physical activity (PA) considered were: leisure, gardening, active travel and combined total, adjusted for age, sex, BMI, disability, rurality and deprivation in models using hurdle negative binomial regression.ResultsTotal PA was significantly greater for retired persons compared to both full- and part-time workers age 55-64, while being retired or working part-time at age 65-74 meant more PA. People did more leisure or gardening with less work, but active travel decreased with fewer work hours, at all ages. Retirement meant more leisure and gardening PA but less active travel.ConclusionsDemand for opportunities to engage in leisure and gardening PA appears to be high among retired people. Greater promotion of active travel in this cohort may be possible.

Abstract 308: Effect of Watchman Implantation in Atrial Fibrillation Patients on Healthcare Utilization: Insights From National Readmission Database 2016-2017

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Moghniuddin Mohammed ◽  
Sagar Ranka ◽  
Madhu Reddy
Keyword(s):  
Atrial Fibrillation ◽  
Healthcare Utilization ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Index Procedure ◽  
Post Procedure ◽  
Binomial Regression ◽  
Watchman Device ◽  
Rate Ratios ◽  
National Readmission Database

Background: Prior studies have shown that WATCHMAN device can be an alternative for anticoagulation in atrial fibrillation (AF) patients for stroke reduction. Its impact on healthcare utilization in AF population remains unknown. Methods: We queried the 2016-2017 National Readmission Database for all adult AF patients undergoing WATCHMAN procedure using ICD10 codes. All patients discharged alive from February to November were included (N = 13192), and their bleeding/thrombosis related admissions pre- and post-index procedure were recorded. Hierarchical longitudinal negative binomial regression was done to calculate incidence rate ratios (IRR) of admissions pre- and post-procedure with patient and hospital as level 2 and 3 variables, respectively. Person-time was included as an offset variable to account for variation in pre and post-procedure time contribution by each patient. A second model was created that included a blanking period of 2 months post-procedure to account for continued anticoagulation after the procedure. For this analysis, patients who received the procedure in October and November (N = 3265) and also patients who died within 2 months of the procedure (N = 49) were excluded. Results: For 13192 patients, the mean age was 77 years and 39% were female. Overall, we found a decrease of ~23% in all-cause readmissions after the procedure (IRR = 0.77; 95% CI = 0.74-0.81; p<0.001). A much greater decrease in thrombosis related admissions of ~69% (IRR = 0.31, p<0.001) and bleeding related admissions of 46% (IRR=0.54, p<0.001) were noted. When applying the 2-month blanking period after the index procedure, we observed an even greater decrease in all-cause readmissions of ~37% post-procedurally. Similarly, there was a decrease of ~75% and ~74% in thrombosis- and bleeding-related admissions respectively (Figure 1). Conclusions: AF patients undergoing WATCHMAN procedure have a significantly lower readmission rate, especially for thromboembolic/bleeding related readmissions. Thus, there is a trend towards decrease in healthcare utilization post-procedurally. Further studies are needed to confirm and evaluate the reasons for these findings.

Injuries and Illnesses Among American Red Cross Responders—United States, 2008–2012

2014 ◽  
Vol 8 (5) ◽  
pp. 404-410 ◽  
Author(s):  
Kimberly Brinker ◽  
Catherine A. Head ◽  
Candice Y. Johnson ◽  
Renée H. Funk
Keyword(s):  
Negative Binomial ◽  
Occupational Injury ◽  
Occupational Injuries ◽  
Negative Binomial Regression ◽  
Red Cross ◽  
American Red Cross ◽  
Binomial Regression ◽  
Level 3 ◽  
Rate Ratios ◽  
Adjusted Model

ABSTRACTObjectiveOccupational injury and illness rates for volunteer responders have not been well documented. We analyzed data specific to volunteers from the American Red Cross (ARC).MethodsData collected by the ARC between 2008 and 2012 were analyzed to identify disaster factors associated with responder injuries and illnesses. We focused on disaster-relief operation (DRO) level (indicating operational costs, ranging from 3 [lower] to 5+ [higher]); disaster type; region; and year. We calculated injury and illness rates and estimated rate ratios (RR) with 95% CI, using negative binomial regression. Also, we analyzed a total of 113 disasters.ResultsHurricanes had the highest rates of injuries (14/1000 responders) and illnesses (18/1000 responders). In the adjusted model for injuries, RRs were higher for DRO levels 4 (3.6 [CI, 2.0–6.7]) and 5+ (4.9 [CI, 2.2–11.0]) than for level 3. In the adjusted model for illnesses, RRs also were higher for DRO levels 4 (4.4 [CI, 2.6–7.3]) and 5+ (8.6 [CI, 4.1–17.7]) than for level 3.ConclusionsHigher DRO levels were a significant predictor of greater rates of occupational injuries and illnesses. Careful selection of responders, including volunteers, has been warranted for deployments to such disasters. (Disaster Med Public Health Preparedness. 2014;0:1-7)

scholarly journals Environmental and socioeconomic determinants of leptospirosis incidence in Colombia

2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Juan David Gutiérrez ◽  
Ruth Aralí Martínez-Vega ◽  
Hector Botello ◽  
Freddy Jesús Ruiz-Herrera ◽  
Laura Carolina Arenas-López ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Socioeconomic Determinants ◽  
Socioeconomic Variables ◽  
Human Leptospirosis ◽  
Binomial Regression ◽  
Forest Coverage ◽  
Social Marginality ◽  
The Relationship

Human leptospirosis is an infection that most often affects tropical countries. Since 2007, Colombia requires the notification of disease cases, enabling the observation of an increase in cases in recent years. The objectives of this article were to analyze environmental and socioeconomic variables and to evaluate their relationship with human leptospirosis cases. This is an ecological study on human leptospirosis cases aggregated by municipality and reported between 2007 and 2016. Spatial aggregation assessment was made using the Getis-Ord Gi method, and negative binomial regression was used to evaluate the relationship between environmental and socioeconomic variables with human leptospirosis. During the study period, 9,928 cases of human leptospirosis were reported, and 58.9% of municipalities reported at least one case. Four hotspots of human leptospirosis, including 18 municipalities, were identified. The results of the negative binomial model confirmed the importance of the effects of education, poverty and some climatic variables on the decadal incidence rate of human leptospirosis. Our results confirm the importance of socioeconomic determinants such as social marginality associated with violence and education, as well as ecological variables such as rainfall, height above sea level and forest coverage on the incidence rate of human leptospirosis at municipal scale.

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