scholarly journals Association of Socioeconomic Disadvantage With Mortality and Readmissions Among Older Adults Hospitalized for Pulmonary Embolism in the United States

2021 ◽  
Author(s):  
Rishi K. Wadhera ◽  
Eric A. Secemsky ◽  
Yun Wang ◽  
Robert W. Yeh ◽  
Samuel Z. Goldhaber
Keyword(s):  
United States ◽  
Older Adults ◽  
Pulmonary Embolism ◽  
The United States ◽  
Mortality Rates ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Socioeconomically Disadvantaged ◽  
Vein Thrombosis ◽  
Advanced Therapies

Background In the United States, hospitalizations for pulmonary embolism (PE) are increasing among older adults insured by Medicare. Although efforts to reduce health disparities have intensified, it remains unclear whether clinical outcomes differ between socioeconomically disadvantaged and nondisadvantaged Medicare beneficiaries hospitalized with PE. Methods and Results In this study, there were 53 386 Medicare fee‐for‐service beneficiaries age ≥65 years hospitalized for PE between October 2015 and January 2017. Of these, 5494 (10.3%) were socioeconomically disadvantaged and 47 892 (89.7%) were nondisadvantaged. Socioeconomically disadvantaged adults were of similar age as nondisadvantaged adults (77.1 versus 77.0), more likely to be female (68.5% versus 54.2%), and less likely to receive advanced therapies (11.0% versus 12.1%). After adjustment for demographics, 90‐day all‐cause mortality rates were similar between disadvantaged and nondisadvantaged adults. In contrast, 1‐year mortality rates were higher among socioeconomically disadvantaged adults (hazard ratio [HR], 1.16; 95% CI, 1.10–1.22), although these differences were partially attenuated after additional adjustments for comorbidities and PE severity (HR, 1.09; 95% CI, 1.02–1.16). Risk‐adjusted 30‐day and 90‐day all‐cause readmission rates were substantially higher among socioeconomically disadvantaged patients (30‐day HR, 1.14 [95% CI, 1.06–1.22]; 90‐day HR, 1.18 [95% CI, 1.12–1.25]). In addition, 90‐day readmissions attributed to PE, deep vein thrombosis, and/or bleeding were higher among socioeconomically disadvantaged patients (HR, 1.16; 95% CI, 1.02–1.32). Conclusions Socioeconomically disadvantaged older adults hospitalized with PE have higher 1‐year mortality rates compared with their nondisadvantaged counterparts. Nearly 1 in 3 socioeconomically disadvantaged older adults was readmitted within 90 days of a hospitalization for PE. Targeted strategies are needed to improve transitional and ambulatory care for this vulnerable population.

Risk Factors and Epidemiology of Pulmonary Embolism

2020 ◽  
Author(s):  
Aaron B Waxman ◽  
Aaron W Aday
Keyword(s):  
United States ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Recurrent Events ◽  
Hormone Replacement ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
The United States ◽  
Vein Thrombosis ◽  
Thromboembolic Pulmonary Hypertension ◽  
Deep Vein

More than 200,000 individuals are hospitalized with an acute pulmonary embolism in the United States annually. Despite advances in diagnosis and treatment, pulmonary embolism accounts for nearly 1% of all cardiovascular-related deaths each year in the United States alone. Those who survive an acute episode remain at a risk of recurrent events as well as ongoing dyspnea, reduced quality of life, and chronic thromboembolic pulmonary hypertension. Recognized risk factors for pulmonary embolism include advanced age, obesity, smoking, malignancy, immobilization from any cause, pregnancy and the postpartum period, oral contraceptives, and hormone replacement therapy. Numerous heritable and acquired thrombophilias increase the risk of pulmonary embolism. Additionally, inflammation and autoimmune disorders are increasingly recognized as potent risk factors for pulmonary embolism. This review contains 3 figures, 6 tables, 54 references. Key Words: anticoagulation, deep vein thrombosis, epidemiology, genetics, inflammation, malignancy, pulmonary embolism, thrombosis, venous thromboembolism

scholarly journals The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States

2020 ◽  
Author(s):  
Robert D. Becher ◽  
Brent Vander Wyk ◽  
Linda Leo-Summers ◽  
Mayur M. Desai ◽  
Thomas M. Gill
Keyword(s):  
United States ◽  
Older Persons ◽  
Cumulative Risk ◽  
The United States ◽  
Community Living ◽  
Major Surgery ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal

ABSTRACTImportanceAs the population of the United States (US) ages, there is considerable interest in ensuring safe and high-quality surgical care for older persons. Yet, valid, generalizable data on the occurrence of major surgery in the geriatric population are sparse.ObjectiveTo estimate the incidence and cumulative risk of major surgery in older persons over a 5-year period and evaluate how these estimates differ according to demographic and geriatric characteristics.DesignProspective longitudinal study.SettingContinental US from 2011 to 2016.Participants5,571 community-living fee-for-service Medicare beneficiaries, aged 65+, from the National Health and Aging Trends Study (NHATS).Main Outcomes and MeasuresMajor surgeries were identified through linkages with data from the Centers for Medicare & Medicaid Services. Data on frailty and dementia were obtained from the baseline NHATS assessment.ResultsThe nationally-representative incidence of major surgery per 100 person-years was 8.8 (95% confidence interval [CI], 8.2-9.5), with estimates of 5.2 (95% CI, 4.7-5.7) and 3.7 (95% CI, 3.3-4.1) for elective and non-elective surgeries. The adjusted incidence of major surgery peaked at 10.8 (95% CI, 9.4-12.4) in persons 75-79 years, increased from 6.6 (95% CI, 5.8-7.5) in the non-frail group to 10.3 (95% CI, 8.9-11.9) in the frail group, and was similar by sex (males 8.6 [95% CI, 7.7-9.6]; females 8.3 [95% CI, 7.5-9.1]) and dementia (no 8.6 [95% CI, 7.9-9.3]; possible 7.8 [95% CI, 6.3-9.6]; probable 8.1 [95% CI, 6.7-9.9]). The 5-year cumulative risk of major surgery was 13.8% (95% CI, 12.2%-15.5%), representing nearly 5 million unique older persons (4,958,048 [95% CI, 4,345,342-5,570,755]), including 12.1% (95% CI, 9.5%-14.6%) in persons 85-89 years, 9.1% (95% CI, 7.2%-11.0%) in those ≥90 years, 12.1% (95% CI, 9.9%-14.4%) in those with frailty, and 12.4% (95% CI, 9.8%-15.0%) in those with probable dementia.Conclusions and RelevanceMajor surgery is a common event in the lives of community-living older persons, including high-risk vulnerable subgroups such as the oldest old, those with frailty or dementia, and those undergoing non-elective surgery. The burden of major surgery in older Americans will add to the challenges ahead for the US health care system in our aging society.KEY POINTSQuestionWhat is the incidence and cumulative risk of major surgery in older persons in the United States?FindingsIn this prospective longitudinal study, data from 5,571 community-living fee-for-service Medicare beneficiaries were used to calculate nationally-representative estimates for the incidence and cumulative risk of major surgery over a 5-year period. Nearly 9 major surgeries were performed annually for every 100 older persons, and more than 1 in 7 Medicare beneficiaries underwent a major surgery over 5 years, representing nearly 5 million unique older persons.MeaningMajor surgery is a common event in the lives of community-living older persons.

scholarly journals Driving Status and Transportation Disadvantage Among Medicare Beneficiaries

2018 ◽  
Vol 39 (9) ◽  
pp. 935-943 ◽  
Author(s):  
Miriam Ryvicker ◽  
Evan Bollens-Lund ◽  
Katherine A. Ornstein
Keyword(s):  
United States ◽  
Older Adults ◽  
Well Being ◽  
The United States ◽  
Community Dwelling ◽  
Medicare Beneficiaries ◽  
Coordination Strategies ◽  
Representative Study ◽  
Nationally Representative ◽  
Community Dwelling Older Adults

Transportation disadvantage may have important implications for the health, well-being, and quality of life of older adults. This study used the 2015 National Health Aging Trends Study, a nationally representative study of Medicare beneficiaries aged 65 and over ( N = 7,498), to generate national estimates of transportation modalities and transportation disadvantage among community-dwelling older adults in the United States. An estimated 10.8 million community-dwelling older adults in the United States rarely or never drive. Among nondrivers, 25% were classified as transportation disadvantaged, representing 2.3 million individuals. Individuals with more chronic medical conditions and those reliant on assistive devices were more likely to report having a transportation disadvantage ( p < .05). Being married resulted in a 50% decreased odds of having a transportation disadvantage ( p < .01). Some individuals may be at higher risk for transportation-related barriers to engaging in valued activities and accessing care, calling for tailored interventions such as ride-share services combined with care coordination strategies.

Abstract 236: Trends in Hospitalization for Digoxin Toxicity and Subsequent Outcomes Among Medicare Beneficiaries in the United States, 1999-2011

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Sudhakar V Nuti ◽  
Frederick A Masoudi ◽  
James V Freeman ◽  
Karthik Murugiah ◽  
Nihar R Desai ◽  
...  
Keyword(s):  
United States ◽  
Hospital Mortality ◽  
The United States ◽  
National Sample ◽  
Digoxin Toxicity ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Annual Change ◽  
Hospital Discharge Diagnosis ◽  
Annual Decline

Objective: To characterize changes in rates of hospitalization for digoxin toxicity and trends in the associated mortality and readmission among older adults over a 12-year period in the United States. Methods: We studied 33,952,331 Medicare fee-for-service beneficiaries 65 years or older with a hospital discharge diagnosis of digoxin toxicity in the United States from 1999 to 2011. Outcome measures were rates of hospitalization for digoxin toxicity; in-hospital mortality; 30-day mortality; and 30-day readmission. Results: There were 20,957 hospitalizations for a principal or secondary diagnosis of digoxin toxicity between 1999 and 2011. The rate declined significantly from 15.2 per 100,000 person-years (95% confidence interval [CI]: 14.7-15.7) in 1999 to 2.1 per 100,000 person-years (95% CI: 1.9-2.3) in 2011 (p<0.001), representing an adjusted annual decline of 17.0% (95% CI: 16.2-17.0) (Figure 1). Between 1999 and 2011, the observed in-hospital and 30-day mortality rates associated with hospitalization for digoxin toxicity declined significantly, from 6.0% (95% CI: 5.2-6.8) to 3.3% (95% CI: 2.0-5.1) (p<0.01) and 14.0% (95% CI: 13.0-15.2) to 10.6% (95% CI: 8.2-13.4) (p<0.05), respectively, representing an annual decline for in-hospital mortality of 5.0% (95% CI: 3.7-7.2) and for 30-day mortality of 4.0% (95% CI: 3.1-5.7). The overall observed 30-day readmission rate declined significantly from 23.5% (95% CI: 22.1-24.9) in 1999 to 18.9% (95% CI: 15.6-22.3) in 2011 (p<0.05), but there was no significant decline in the adjusted annual change in 30-day readmission (1.0%, 95% CI: 0.0-1.7). Conclusions: In a national sample of Medicare beneficiaries, the rate of hospitalization for digoxin toxicity and subsequent mortality declined significantly between 1999 and 2011.

Risk Factors and Epidemiology of Pulmonary Embolism

2020 ◽  
Author(s):  
Aaron B Waxman ◽  
Aaron W Aday
Keyword(s):  
United States ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Recurrent Events ◽  
Hormone Replacement ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
The United States ◽  
Vein Thrombosis ◽  
Thromboembolic Pulmonary Hypertension ◽  
Deep Vein

More than 200,000 individuals are hospitalized with an acute pulmonary embolism in the United States annually. Despite advances in diagnosis and treatment, pulmonary embolism accounts for nearly 1% of all cardiovascular-related deaths each year in the United States alone. Those who survive an acute episode remain at a risk of recurrent events as well as ongoing dyspnea, reduced quality of life, and chronic thromboembolic pulmonary hypertension. Recognized risk factors for pulmonary embolism include advanced age, obesity, smoking, malignancy, immobilization from any cause, pregnancy and the postpartum period, oral contraceptives, and hormone replacement therapy. Numerous heritable and acquired thrombophilias increase the risk of pulmonary embolism. Additionally, inflammation and autoimmune disorders are increasingly recognized as potent risk factors for pulmonary embolism. This review contains 3 figures, 6 tables, 54 references. Key Words: anticoagulation, deep vein thrombosis, epidemiology, genetics, inflammation, malignancy, pulmonary embolism, thrombosis, venous thromboembolism

scholarly journals Hip Fracture-Related Mortality among Older Adults in the United States: Analysis of the CDC WONDER Multiple Cause of Death Data, 1999–2013

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Carlos H. Orces
Keyword(s):  
United States ◽  
Older Adults ◽  
Hip Fracture ◽  
Cause Of Death ◽  
The United States ◽  
Mortality Rates ◽  
Online Data ◽  
Annual Percent Change ◽  
Death Record ◽  
Related Mortality

Objectives. To examine trends in hip fracture-related mortality among older adults in the United States between 1999 and 2013. Material and Methods. The Wide-Ranging Online Data for Epidemiological Research system was used to identify adults aged 65 years and older with a diagnosis of hip fracture reported in their multiple cause of death record. Joinpoint regression analyses were performed to estimate the average annual percent change in hip fracture-related mortality rates by selected characteristics. Results. A total of 204,254 older decedents listed a diagnosis of hip fracture on their death record. After age adjustment, hip fracture mortality rates decreased by −2.3% (95% CI, −2.7%, and −1.8%) in men and −1.5% (95% CI, −1.9%, and −1.1%) in women. Similarly, the proportion of in-hospital hip fracture deaths decreased annually by −2.1% (95% CI, −2.6%, and −1.5%). Of relevance, the proportion of cardiovascular diseases reported as the underlying cause of death decreased on average by −4.8% (95% CI, −5.5%, and −4.1%). Conclusions. Hip fracture-related mortality decreased among older adults in the United States. Downward trends in hip fracture-related mortality were predominantly attributed to decreased deaths among men and during hospitalization. Moreover, improvements in survival of hip fracture patients with greater number of comorbidities may have accounted for the present findings.

scholarly journals Time Trends in Pulmonary Embolism Mortality Rates in the United States, 1999 to 2018

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Karlyn A. Martin ◽  
Rebecca Molsberry ◽  
Michael J. Cuttica ◽  
Kush R. Desai ◽  
Daniel R. Schimmel ◽  
...  
Keyword(s):  
United States ◽  
Pulmonary Embolism ◽  
Inflection Point ◽  
The United States ◽  
Mortality Rates ◽  
Mortality Trends ◽  
Annual Percent Change ◽  
Younger Adults ◽  
Men And Women ◽  
Percent Change

Background Although historical trends before 1998 demonstrated improvements in mortality caused by pulmonary embolism (PE), contemporary estimates of mortality trends are unknown. Therefore, our objective is to describe trends in death rates caused by PE in the United States, overall and by sex‐race, regional, and age subgroups. Methods and Results We used nationwide death certificate data from Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research to calculate age‐adjusted mortality rates for PE as underlying cause of death from 1999 to 2018. We used the Joinpoint regression program to examine statistical trends and average annual percent change. Trends in PE mortality rates reversed after an inflection point in 2008, with an average annual percent change before 2008 of −4.4% (−5.7, −3.0, P <0.001), indicating reduction in age‐adjusted mortality rates of 4.4% per year between 1999 and 2008, versus average annual percent change after 2008 of +0.6% (0.2, 0.9, P <0.001). Black men and women had approximately 2‐fold higher age‐adjusted mortality rates compared with White men and women, respectively, before and after the inflection point. Similar trends were seen in geographical regions. Age‐adjusted mortality rates for younger adults (25–64 years) increased during the study period (average annual percent change 2.1% [1.6, 2.6]) and remained stable for older adults (>65 years). Conclusions Our study findings demonstrate that PE mortality has increased over the past decade and racial and geographic disparities persist. Identifying the underlying drivers of these changing mortality trends and persistently observed disparities is necessary to mitigate the burden of PE‐related mortality, particularly premature preventable PE deaths among younger adults (<65 years).

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