Abstract T P137: Temporal Trends in Hospitalization for Ischemic Stroke in the United States, 2000-2010

Background: Recent population-based studies have revealed declining ischemic stroke hospitalization rates in the US, particularly among whites, but no study has assessed recent nationwide trends in race/ethnic-, age- and sex-specific stroke hospitalization rates in the US. Aims: To assess temporal trends in race/ethnic-, age-, and sex-specific rates of hospitalization for ischemic stroke in the US. Methods: Temporal trends in hospitalization for ischemic stroke (ICD-9 codes 433.x1, 434, 436) from 2000 to 2010 were assessed among adults ≥25 years using the Nationwide Inpatient Sample. Age-, sex-, and race/ethnic-specific stroke hospitalization rates were calculated using the weighted number of hospitalizations as the numerator and the US civilian population as the denominator. Age-adjusted rates were standardized to the 2000 US Census population. Results: From 2000 to 2010, age-adjusted stroke hospitalization rates decreased from 169 to 138 per 100,000 (overall rate reduction 18.3%). The decline in stroke hospitalizations was driven by the ≥65 age group, with the sharpest decline among 65-84 year olds (Figure). Sex-specific rates showed higher age-adjusted rates in women, with a steeper reduction in women than in men (from 228 to 180 vs. 183 to 157 per 100,000). Race/ethnic-specific trends revealed that hospitalizations decreased for whites and Hispanics but increased for blacks (from 144 to 193 per 100,000 in black men and from 191 to 211 per 100,000 in black women). Discussion: Although overall stroke hospitalizations have decreased in the US, the reduction has been more pronounced among older individuals, whites and Hispanics. Renewed efforts at targeting risk factor control among blacks and middle-aged individuals may be warranted. Figure 1.

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Abstract WMP94: Temporal Trends in Racial, Age, and Sex-Specific Utilization of Decompressive Hemicraniectomy Among Acute Ischemic Stroke Patients in the United States

Stroke ◽

10.1161/str.51.suppl_1.wmp94 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sai P Polineni ◽

Fadar O Otite ◽

Seemant Chaturvedi

Keyword(s):

United States ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Temporal Trends ◽

Age Groups ◽

The United States ◽

Decompressive Hemicraniectomy ◽

Study Results ◽

Over Time ◽

Age And Sex

Background: The aim of this study is to evaluate current trends in racial, age, and sex-specific utilization of decompressive hemicraniectomy (HC) in acute ischemic stroke (AIS) patients in the United States over the last decade. Methods: All adult patients with a diagnosis of AIS were identified from the 2004-2015 Nationwide Inpatient Sample (weighted N=4,792,428) using International Classification of Diseases Ninth revision (ICD-9) codes. Proportion of patients undergoing HC in various age, race, and sex groups were ascertained using ICD-9 procedural codes. Temporal trends were mapped by year in order to track changes in utilization over time. Analysis of utilization disparities and trends within age, sex, and race subgroups was conducted via multivariate logistic regression. Results: Of all eligible AIS patients from 2004-2015, 0.25% underwent HC (.08 in 2004 to .46 in 2015). Increased utilization over time was seen in both men (.13 to .57) and women (.08 to .54), with women showing comparable odds of utilization to men [OR: 0.95 (95% CI: .87-1.04, p=0.27)]. Similarly, increased utilization trends were seen in all age groups (Figure 1) with the highest rates in the 18-39 subgroup (1.41%). Compared to trends in this younger subgroup (.43 to 2.12), patients aged 60-79 experienced a similar overall increase but at lower utilization rates (.06 to .37). Compared to white patients in multivariate models, blacks did not show significant differences in odds of HC [1.09 (.96-1.24, p=0.20)], while patients from Hispanic [1.25 (1.03-1.51, p=0.02)] and other [1.26 (1.04-1.52, p=0.02)] race-ethnic groups showed increased odds. Conclusions: From 2004-2015, hemicraniectomy rates have seen substantial increases in all age, sex, and race groups. The increasing rates of hemicraniectomies among those over age 60 suggest that there has been at least partial acceptance of DESTINY 2 study results.

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137-02: Temporal Trends in Hospitalization Rates for Acute Ischemic Stroke among Nonagenarians with Atrial Fibrillation in the United States: A 15 Year Experience

EP Europace ◽

10.1093/europace/18.suppl_1.i177 ◽

2016 ◽

Vol 18 (suppl_1) ◽

pp. i177-i177

Author(s):

Ghanshyam Palamaner Subash Shantha ◽

Hardik Doshi ◽

Anita Kumar ◽

Siva Krothapalli ◽

Gopi Dandamudi ◽

...

Keyword(s):

United States ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Temporal Trends ◽

The United States ◽

Hospitalization Rates

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Stroke hospitalization and case-fatality in the United States, 1988–1997

Stroke ◽

10.1161/str.32.suppl_1.320-a ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 320-320

Author(s):

Jing Fang ◽

Hillel Cohen ◽

Michael H Alderman

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Ischemic Stroke ◽

Case Fatality ◽

The United States ◽

Hospital Death ◽

Stroke Mortality ◽

Hospital Case ◽

Hospitalization Rates ◽

The Us

23 Age-adjusted stroke mortality in the US has declined in recent decades. However, little is known about stroke morbidity. Using the National Hospital Discharge Survey data from 1988 to 1997, we examined the change in stroke hospitalization and case-fatality in the US. During the 10 years, age-adjusted stroke hospitalization rate increased 22% (from 381 to 463/100,000, p=0.048). By regions, stroke hospitalization rates overall were 641, 600, 562 and 438 for the South, Midwest, Northeast, and West respectively (p<0.05), and were increased in all regions during the 10 years. Overall, 58% of stroke hospitalizations were due to ischemic stroke, 13% due to hemorrhagic stroke, and 29% were classified as other stroke. The hospitalization rates were 74.8 and 332.4 per 100,000 respectively for hemorrhagic and ischemic strokes and the increase rate in 10 years were 13.5% (p=0.214) and 31.5% (p=0.044) respectively. During 10 years, stroke patients with diabetes, hypertension and congestive heart failure increased 17.4% (p=0.17), 34% (p=0.05), and 31% (p=0.091) respectively. The average length of hospital stay reduced from 11.1 to 6.2 days (decrease of 44.1%), with an average annual percentage decrease of 6.1% (p=0.012). Although the total number of patients hospitalized for stroke increased during this period, the total person-days in hospital decreased 22% (p=006). In-hospital death among stroke decreased steadily from 12.7% to 7.6% (decrease of 40%, p=0.04). In-hospital case-fatality was estimated by stratifying patients on age, gender, region, type of stroke, and other co-morbidity. Case-fatality rate was substantially higher among patients with hemorrhagic than ischemic stroke (28.0% vs 5.8%, p<0.01); among patients with congestive heart failure than those without (17.9% vs 8.5%). In addition, patients of old age (≥75 years), men, those living in the Northeast had higher case-fatality rates than those younger, women and living in elsewhere. In conclusion, the declining of age-adjusted stroke mortality in the US has not been found to be related to the decrease in incidence. However, the observed reduction in hospital case-fatality might contribute to the decline of stroke mortality.

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COVID-19 Symptoms and Deaths Among Health Care Workers in the United States

10.21203/rs.3.rs-599870/v1 ◽

2021 ◽

Author(s):

Shao Lin ◽

Xinlei Deng ◽

Wangjian Zhang ◽

Ian Ryan ◽

Kai Zhang ◽

...

Keyword(s):

Health Care ◽

Health Care Workers ◽

Temporal Trends ◽

The United States ◽

Outcome Variable ◽

Shortness Of Breath ◽

Medical Conditions ◽

Older Individuals ◽

Care Workers ◽

The Us

Abstract Background: While most COVID-19 research has focused on older individuals with multi-comorbidities, few studies have assessed the predictors of fatality among health care workers (HCWs). This study evaluated if demographics and COVID-19 symptomatology predicted COVID-19 fatality and the temporal trends and spatial distribution among HCWs.Methods: We used a case-control design to compare HCW deaths related to COVID-19 (laboratory-confirmed) with three control groups (i.e., Non-HCW deaths, HCW non-deaths, and non-HCW non-deaths). Patient-level data with 33 variables, including COVID-19 confirmed cases, deaths, demographics, and various specific COVID symptoms reported by all states in the US, have been obtained from the Restricted Access Dataset by the US CDC since January 2020. A logistic regression model was used by regressing the outcome variable against each predictor while controlling for gender, age group, race, and ethnicity.Results: The percentages of 50-69 years old, Hispanics (8.7%), Black (32%), and Asian (23.1%) in HCW death were significantly higher than in their respective controls. The fatality and all severe indicators were higher among the deaths than non-deaths, but not different for HCWs than non-HCWs. Significantly increased risks for deaths were observed with pre-existing medical conditions (RR: 7.24, 95% CI: 5.40-9.70), shortness of breath (RR: 5.73, 95% CI:4.50-7.31), fever (RR:3.52, 95% CI: 2.71-4.56), cough (RR:2.02, 95% CI: 1.54-2.65), and diarrhea (RR: 1.57, 95% CI:1.20-2.05). Conclusion: Older and minority HCWs experienced relatively higher COVID-19 fatality. Severe symptoms are similarly prevalent among HCW deaths and non-HCW deaths. Pre-existing medical conditions, shortness of breath and fever symptoms may be critical COVID indicators for HCWs.

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Abstract WMP50: Age-Specific Female-Male Disparities in Endovascular Thrombectomy Use for Acute Ischemic Stroke in the United States

Stroke ◽

10.1161/str.51.suppl_1.wmp50 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Hamidreza Saber ◽

Amytis Towfighi ◽

David S Liebeskind ◽

Jeffrey L Saver

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Age Groups ◽

Reperfusion Therapy ◽

The United States ◽

National Inpatient Sample ◽

Endovascular Thrombectomy ◽

Age Related ◽

The Us ◽

Age And Sex

Introduction: Studies have suggested sex-related and age-related variations in frequency of reperfusion therapy, but have been limited by constrained geographic scope, data from before the modern thrombectomy era, and incomplete exploration of sex-related differences in discrete age ranges. We therefore analyzed sex-, age-, and sex-age interaction in the frequency of endovascular thrombectomy (EVT) for acute ischemic stroke in the US National Inpatient Sample. Methods: In the National Inpatient Sample , we identified all adult ischemic stroke EVT hospitalizations from 2010-2016, using ICD-9-CM and ICD-10-CM codes. Patient age was categorized as: <50y, 50-59y, 60-69y, 70-79y and ≥80ys. Rates of use of EVT were assessed standardized to the 2010 US Census population. Results: Among 50,573 EVT hospitalizations, 50.1% were female. The number of EVTs increased from 4091 in 2010 to 12,875 in 2016. Over the entire 7y time period, a sex-age interaction was noted: 49% in <50y; 37% in 50-59y; 35% in 60-69y; 53% in 70-79y; and 66% in ≥80y. This sex-age interaction was present as well for EVT rates per 100,000 individuals in the population, with the total ratio of female to male rate of EVT per 100,000: 0.93 for in <50y; 0.52 in 50-59y; 0.58 in 60-69y; 0.91 in 70-79y; and 1.1 in ≥80y. EVT utilization rates increased substantially over time in both men and women in all age groups. However, the ratio of women to men per 100,000 receiving EVT changed for only one age range, decreasing among <50y from 0.98 in 2010 to 0.79 in 2016 (P<0.05). Conclusion: While half of all endovascular thrombectomies in the US are performed in women, there are major age-related sex-specific variations in EVT rates, with rates of EVT much lower among women than men in 50-70 age group. Determinants of these age-specific female-male disparities in EVT treatment merit detailed investigation. Figure: Age- and sex-specific female to male thrombectomy utilization rates.

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2006 Prevalence Estimate of Idiopathic Thrombocytopenic Purpura (ITP) in the United States.

Blood ◽

10.1182/blood.v108.11.3955.3955 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3955-3955 ◽

Cited By ~ 1

Author(s):

Anne C. Deitz ◽

Samantha A. St. Laurent ◽

Monica G. Kobayashi ◽

Susan A. Hall ◽

Maurille A. Feudjo-Tepie

Keyword(s):

Managed Care ◽

The Elderly ◽

The United States ◽

Population Based ◽

Older Individuals ◽

Diagnosis Code ◽

Number Of Patients ◽

Fatal Hemorrhage ◽

Platelet Disorder ◽

The Us

Abstract ITP is a rare but serious platelet disorder. It has been associated with fatal hemorrhage and reduced life expectancy (Cohen et al., Arch Intern Med, 2000). The incidence of ITP has been reported in two population-based studies in Europe (Neylon et al., Br J Haem, 2003; Frederiksen and Schmidt, Blood, 1999). However, there are no recent high quality studies that we are aware of regarding the burden of this disease (i.e., prevalence) in the US by gender and age group, and so we undertook this study in IHCIS (Integrated Healthcare Information Services), a US managed care database comprised of over 38 million patients from 30 health plans. ICD-9 code 287.3 (primary thrombocytopenia) was used as a proxy for an ITP diagnosis. Patients were required to have at least one diagnosis code in 2004 and a second diagnosis code in 2003, 2004 or 2005 to help minimize rule-out diagnoses. Continuous enrolment for a defined period of time also was required. Projected 2006 cases were obtained by multiplying the 2004 prevalence proportions by July 1, 2006 US population estimates (http://www.census.gov/ipc/www/usinterimproj). The projected number of patients with ITP in the US in 2006 was estimated to be 85,000 to 108,000, depending on the stringency of the inclusion criteria (i.e., whether the second occurrence of 287.3 in a patient record had to be within six months of the first). Slightly more of these cases were among women (56%) compared to men, and adults were diagnosed more frequently than those aged 0–15. This is the first study to estimate US prevalence counts using a managed care population, which includes both inpatients and outpatients. However, there are several limitations: ICD-9 code 287.3 is not exclusive to ITP. Segal et al. (Am J Hem, 2004) reported that sensitivity and specificity based on a single occurrence of this code was 100% and 89%, respectively, among inpatients, and 84% and 66%, respectively, among outpatients; our study required two code occurrences. Our estimate also assumes that the prevalence rate has remained constant from 2004 to present. Lastly, Frederiksen and Schmidt reported that the incidence of ITP was higher among older individuals. Therefore, we may be under-estimating the true prevalence of this disease in the general population because the elderly are somewhat under-represented in the IHCIS database.

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Caring for Older Patients With Cancer: Estimates of the Prevalence, Burden, and Unmet Needs of Caregivers in the United States

Innovation in Aging ◽

10.1093/geroni/igaa057.2412 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 690-690

Author(s):

Erin Kent

Keyword(s):

Family Caregivers ◽

Older Patients ◽

Unmet Needs ◽

The United States ◽

Population Based ◽

Data Sources ◽

Behavioral Risk ◽

Ripple Effect ◽

The Us ◽

National Trends

Abstract In 2020, ~1.8 million Americans are expected to be newly diagnosed with cancer, with approximately 70% of cases diagnosed over the age of 65. Cancer can have a ripple effect, impacting not just patients themselves, but their family caregivers. This presentation will provide an overview of the estimates of the number of family caregivers caring for individuals with cancer in the US, focusing on older patients, from several population-based data sources: Caregiving in the US 2020, the Health Information National Trends Survey (HINTS, 2017-2019), the Behavioral Risk Factors Surveillance System (BRFSS, 2015-2019), and the National Health and Aging Trends (NHATS) Survey. The presentation will compare features of the data sources to give a comprehensive picture of the state of cancer caregiving. In addition, the presentation will highlight what is known about the experiences of cancer caregivers, including caregiving characteristics, burden, unmet needs, and ideas for improving support for family caregivers.

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Disparities in the Use of Intravenous t-PA among Ischemic Stroke Patients: Population-based Recent Temporal Trends

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2019.01.013 ◽

2019 ◽

Vol 28 (5) ◽

pp. 1243-1251 ◽

Cited By ~ 1

Author(s):

Mohammad A. Faysel ◽

Jonathan Singer ◽

Caroline Cummings ◽

Dimitre G. Stefanov ◽

Steven R. Levine

Keyword(s):

Ischemic Stroke ◽

Temporal Trends ◽

Population Based ◽

Stroke Patients

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Abstract 123: A Comparison of In-Hospital Acute Myocardial Infarction Management Between Portugal and the United States: 2000 - 2010

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.123 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Mariana F Lobo ◽

Vanessa Azzone ◽

Luis Azevedo ◽

Armando Teixeira-Pinto ◽

Jose Pereira Miguel ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

The United States ◽

Billing Data ◽

Cross Sectional ◽

Medical Technologies ◽

Hospitalization Rates ◽

The Us ◽

International Comparative

Objectives: Because inter- and intra-country variations in the adoption of medical technologies exist, international comparative studies provide an opportunity to infer technology effectiveness. Few studies have characterized recent trends in acute myocardial infarction (AMI) management between countries. Methods: Repeated cross-sectional observational cohorts of hospitalized adults aged ≥20 years discharged between January 2000 and December 2010. We identified new AMI hospitalizations using a US national 20% inpatient sample and a 100% inpatient sample in all Portuguese public sector hospitals. Age, sex, comorbidities, and median length of stay (interquartile range [IQR]) were determined. Annual age-sex adjusted hospitalization rates (HR) for AMI, in-hospital procedures, and in-hospital mortality were directly standardized to the 2010 US population. Intra-country (2010 relative to 2000) and inter-country in 2010 (Portugal [PT] relative to US) rate ratios [RR] were estimated. Findings: We identified 1476808 AMI US hospitalizations and 126314 Portugal hospitalizations between 2000 and 2010. Portuguese patients were more male, younger, and had fewer comorbidities compared to US patients (Table). The age-sex adjusted AMI HR decreased from 21 per 1000 person-years to 15 in the US (RR=0.70; 95% CI = [0.70, 0.71]) but increased in PT (14 to 15 per 1000, RR = 1.17 [1.14, 1.21]). While crude procedure rates were uniformly lower in PT, only CABG rates differed after standardization (2010: RR=0.19 [0.14, 0.26]). PCI use increased annually in both countries and decreased for CABG in the US only (102 to 79, RR=0.77 [0.73, 0.81]). Standardized in-hospital mortality decreased within-country (US: 44 to 29 per 1000, RR= 0.65 [0.60, 0.72]; PT: 93 to 62 per 1000, RR= 0.67 [0.44, 1.00]). In 2010, PT mortality was twice that in the US. Conclusions: AMI hospitalization rates and use of medical technologies are higher in the US compared to Portugal. However, standardized rates reveal only CABG surgery rates differ significantly between the two countries. Outcomes, measured by hospital mortality and LOS, are generally better in the U.S. Inter-country disparities may be a consequence of differential use of technologies, differences in AMI epidemiology, patient risk, or quality of hospital billing data.

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Body Mass Index and Depressive Symptoms: Testing for Adverse and Protective Associations in Two Twin Cohort Studies

Twin Research and Human Genetics ◽

10.1017/thg.2016.14 ◽

2016 ◽

Vol 19 (4) ◽

pp. 306-311 ◽

Cited By ~ 7

Author(s):

Markus Jokela ◽

Venla Berg ◽

Karri Silventoinen ◽

G. David Batty ◽

Archana Singh-Manoux ◽

...

Keyword(s):

Body Mass Index ◽

Depressive Symptoms ◽

Cohort Studies ◽

Body Mass ◽

Genetic Model ◽

The United States ◽

Population Based ◽

The Us ◽

Mz Twins ◽

Pair Analysis

Studies have suggested both adverse and protective associations of obesity with depressive symptoms. We examined the contribution of environmental and heritable factors in this association. Participants were same-sex twin pairs from two population-based twin cohort studies, the Older Finnish Twin Cohort (n = 8,215; mean age = 44.1) and the US Midlife Development in the United States (MIDUS; n = 1,105; mean age = 45.1). Body mass index (BMI) was calculated from self-reported height and weight. Depressive symptoms were assessed using Beck's Depression Inventory (BDI; Finnish Twin Cohort), and by negative and positive affect scales (MIDUS). In the Finnish Twin Cohort, higher BMI was associated with higher depressive symptoms in monozygotic (MZ) twins (B = 2.01, 95% CI = 1.0, 3.0) and dizygotic (DZ) twins (B = 1.17, 0.5, 1.9) with BMI >22. This association was observed in within-pair analysis in DZ twins (B = 1.47, CI = 0.4, 2.6) but not in within-pair analysis of MZ twins (B = 0.03, CI = -1.9, 2.0). Consistent with the latter result, a bivariate genetic model indicated that the association between higher BMI and higher depressive symptoms was largely mediated by genetic factors. The results of twin-pair analysis and bivariate genetic model were replicated in the MIDUS sample. These findings suggest an association between obesity and higher depressive symptoms, which is largely explained by shared heritable biological mechanisms.

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