Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

2020 ◽  
pp. 000313482096006
Author(s):  
William Q. Duong ◽  
Areg Grigorian ◽  
Cyrus Farzaneh ◽  
Jeffry Nahmias ◽  
Theresa Chin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Outcomes ◽  
Risk Of Death ◽  
Hospital Access ◽  
Risk Of Mortality ◽  
Sex Disparities ◽  
Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

scholarly journals High-dose opioid utilization and mortality among individuals initiating hemodialysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matthew Daubresse ◽  
G. Caleb Alexander ◽  
Deidra C. Crews ◽  
Dorry L. Segev ◽  
Krista L. Lentine ◽  
...  
Keyword(s):  
United States ◽  
Cumulative Incidence ◽  
The United States ◽  
High Dose ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Average Percentage ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background Individuals undergoing hemodialysis in the United States frequently report pain and receive three-fold more opioid prescriptions than the general population. While opioid use is appropriate for select patients, high-dose utilization may contribute to an increased risk of death due to possible accumulation of opioid metabolites. Methods We studied high-dose opioid utilization (≥120 morphine milligram equivalents [MME] per day) among adults initiating hemodialysis in the United States between 2007 and 2014 using national registry data. We calculated the cumulative incidence (%) of high-dose utilization and depicted trends in the average percentage of days individuals were exposed to opioids. We used adjusted Cox proportional hazards models to identify which opioid doses were associated with mortality. Results Among 327,344 adults undergoing hemodialysis, the cumulative incidence of high-dose utilization was 14.9% at 2 years after initiating hemodialysis. Among patients with ≥1 opioid prescription during follow-up, the average percentage of days exposed to high-dose utilization increased from 13.9% in 2007 to 26.1% in 2014. Compared to 0MME per day, doses < 60MME were not associated with an increased risk of mortality, but high-dose utilization was associated with a 1.63-fold (95% CI, 1.57, 1.69) increased risk of mortality. The risk of mortality associated with opioid dose was highest in the first year after hemodialysis initiation. Conclusions The risk of mortality associated with opioid utilization among individuals on hemodialysis increases as doses exceed 60MME per day and is greatest during periods of high-dose utilization. Patients and clinicians should carefully weigh the risks and benefits of opioid doses exceeding 60MME per day.

Volunteers: An Effective Medium for Delivering Therapeutic Lifestyle Interventions

2021 ◽  
pp. 089011712110625
Author(s):  
Lillian M. Kent ◽  
Paul M. Rankin ◽  
Darren P. Morton ◽  
Rebekah M. Rankin ◽  
Roger L. Greenlaw ◽  
...  
Keyword(s):  
United States ◽  
Chronic Disease ◽  
Lifestyle Modification ◽  
Density Lipoprotein ◽  
Blood Lipid ◽  
The United States ◽  
Analysis Of Covariance ◽  
Health Improvement ◽  
Improvement Program ◽  
Blood Lipid Profile

Purpose Lifestyle modification programs have been shown to effectively treat chronic disease. The Coronary Health Improvement Program has been delivered by both paid professional and unpaid volunteer facilitators. This study compared participant outcomes of each mode in the United States. Design Pre-/post-analysis of CHIP interventions delivered between 1999 and 2012. Setting Professional-delivered programs in Rockford Illinois 1999-2004 and volunteer-delivered programs across North America 2005-2012. Subjects Adults ≥21 years (professional programs N = 3158 34.3% men, mean age = 54.0 ± 11.4 years; volunteer programs N = 7115 33.4% men, mean age = 57.4 ± 13.0 years). Measures Body mass index, blood pressure (systolic and diastolic), blood lipid profile (total cholesterol, high-density lipoprotein, triglycerides, low-density lipoprotein), and fasting plasma glucose. Analysis Analysis of Covariance, with adjustment for age, gender, BMI change and baseline biometric and effect sizes. Results The professional-delivered programs achieved significantly greater reductions in BMI (.4%, P < .001) and HDL (1.9%, P < .001) and the volunteer-delivered programs achieved greater reductions in SBP (1.4%, P < .001), DBP (1.1%, P < .001), TC (1.4%, P = .004), LDL (2.3%, P < .001), TG (4.0%, P = .006), and FPG (2.7%, P < .001). However, the effect size differences between the groups were minimal (Cohen’s d .1-.2). Conclusions Lifestyle modification programs have been shown to effectively treat chronic disease. The Complete Health Improvement Program (CHIP) lifestyle intervention has been delivered by both paid professional and unpaid volunteer facilitators. This study compared selected chronic disease biometric outcomes of participants in each mode in the United States. It found volunteer-delivered programs do not appear to be any less effective than programs delivered by paid professionals, which is noteworthy as volunteers may provide important social capital in the combat of chronic disease.

scholarly journals Older Adults in the United States and COVID-19: A Qualitative Study of Perceptions, Finances, Coping, and Emotions

2021 ◽  
Vol 9 ◽  
Author(s):  
R. Turner Goins ◽  
Elizabeth Anderson ◽  
Hannah Minick ◽  
Heather Daniels
Keyword(s):  
Mental Health ◽  
United States ◽  
Older Adults ◽  
News Media ◽  
Emotional Health ◽  
The United States ◽  
Stress Appraisal ◽  
Risk Of Death ◽  
Increased Risk ◽  
Precautionary Measures

Introduction: Older adults have the poorest coronavirus (COVID-19) prognosis with the highest risk of death due to complications, making their COVID-19 experiences particularly important. Guided by the stress-appraisal-coping theoretical model, we sought to understand COVID-related perceptions and behaviors of older adults residing in the United States.Materials and Methods: We used convenience sampling to recruit persons with the following inclusion criteria: Aged ≥ 65 years, English fluency, and U.S. residency. Semi structured in-depth interviews were conducted remotely and audio recorded between April 25, 2020 and May 7, 2020. Interviews were professionally transcribed with a final study sample of 43. A low-inference qualitative descriptive design was used to provide a situated understanding of participants' life experiences using their naturalistic expressions.Results: The mean age of participants was 72.4 ± 6.7. Slightly over half were female (55.8%), 90.6% were White, and 18.6% lived alone. The largest percentages of participants resided in a rural area (27.9%) or small city (25.6%). We identified four themes, including (1) risk perception, (2) financial impact, (3) coping, and (4) emotions. Most participants were aware of their greater risk for poor COVID-19 outcomes but many did not believe in their increased risk. Financial circumstances because of the pandemic varied with largely no financial impacts, while others reported negative impacts and a few reported positive impacts. Coping was problem- and emotion-focused. Problem-focused coping included precautionary efforts and emotion-focused coping included creating daily structure, pursuing new and/or creative activities, connecting with others in new ways, and minimizing news media exposure. Overall, emotional health was negatively affected by the pandemic although some participants reported positive emotional experiences.Conclusions: Perceiving themselves as high risk for COVID-19 complications, older adults used precautionary measures to protect themselves from contracting the virus. The precautionary measures included social isolation, which can negatively affect mental health. Older adults will need to be resourceful and draw on existing resources to cope, such as engaging in creative activities and new strategies to connect with others. Our findings underscore the importance of the preservation of mental health during extended periods of isolation by taking advantage of low-to-no-cost existing resources.

scholarly journals The Impact of Antihypertensive Drugs on the Number and Risk of Death, Stroke and Myocardial Infarction in the United States

2006 ◽  
Author(s):  
Genia Long ◽  
David Cutler ◽  
Ernst Berndt ◽  
Jimmy Royer ◽  
Andrée-Anne Fournier ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Antihypertensive Drugs ◽  
The United States ◽  
Risk Of Death ◽  
The Impact

Socioeconomic and Health Disparities Among Pediatric Trauma Patients in the United States

2021 ◽  
Author(s):  
Katherine A. Kelly ◽  
Pious D. Patel ◽  
Hannah Phelps ◽  
Chevis Shannon ◽  
Harold N. Lovvorn
Keyword(s):  
United States ◽  
Health Disparities ◽  
Pediatric Trauma ◽  
The United States ◽  
Trauma Patients

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.

Severity of Illness Scoring Systems in Critical Care

2015 ◽  
Author(s):  
Mark T. Keegan
Keyword(s):  
United States ◽  
Critical Care ◽  
Organ Failure ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
The United States ◽  
Prognostic Models ◽  
Fourth Generation ◽  
Risk Of Death ◽  
Predicted Risk

Critical care consumes about 4% of national health expenditure and 0.65% of United States gross domestic product. There are approximately 94,000 critical care beds in the United States, and provision of critical care services costs approximately $80 billion per year. The enormous costs and the heterogeneity of critical care have led to scrutiny of patient outcomes and cost-effectiveness by a variety of governmental and nongovernmental organizations; furthermore, individual critical care practitioners and their hospitals should evaluate the care delivered. This review discusses scoring systems in medicine, critical care systems, development, validation, performance, and customization of the models, adult intensive care unit (ICU) prognostic models, model use, limitations, prognostic models in trauma care, perioperative scoring systems, assessment of organ failure, severity of illness and organ dysfunction scoring in children, and future directions. Figures show the distribution of predicted risk of death using two different prediction models among a population of patients who ultimately are observed to either live or die, a comparison of  “expected” deaths (based on the expectation that the predicted probability from the model is correct) to observed deaths within each of the 10 deciles of predicted risk, the importance of disease in the risk of death equation,  and the revised Rapaport-Teres graph for ICUs in the Project IMPACT validation set. Tables list three main ICU prognostic models, study characteristics and performance of the fourth-generation prognostic models, variables included in the fourth-generation prognostic models, potential uses of adult ICU prognostic models, variables included in the calculation of the organ failure scores, and sequential organ failure assessment. This review contains 4 highly rendered figures, 6 tables, and 293 references

Operating Room Blood Delivery Turnaround Time

2002 ◽  
Vol 126 (8) ◽  
pp. 909-914 ◽  
Author(s):  
David A. Novis ◽  
Richard C. Friedberg ◽  
Stephen W. Renner ◽  
Frederick A. Meier ◽  
Molly K. Walsh
Keyword(s):  
United States ◽  
Operating Room ◽  
Median Time ◽  
The United States ◽  
Blood Bank ◽  
Blood Component ◽  
Blood Components ◽  
Improvement Program ◽  
Delivery Times ◽  
Blood Banks

Abstract Objectives.—To determine the normative distribution of time elapsed for blood bank personnel to fill nonscheduled operating room (OR) blood component orders in hospital communities throughout the United States, and to examine hospital blood bank practices associated with faster blood component delivery times. Design.—Participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data prospectively on the times elapsed for blood bank personnel to fill nonscheduled emergent orders from hospital ORs for red blood cell (RBC) products, fresh frozen plasma (FFP), and platelets (PLTs). Participants also completed questionnaires describing their hospitals' and blood banks' laboratory and transfusion practices. Setting and Participants.—Four hundred sixty-six public and private institutions located in 48 states in the United States (n = 444), Canada (n = 9), Australia (n = 8), the United Kingdom (n = 4), and Spain (n = 1). Main Outcome Measures.—The median time elapsed between requests for blood components by OR personnel and the retrieval of those components by blood component transport personnel, and the median time elapsed between requests for blood components by OR personnel and the arrival of those components in ORs. Results.—Participants submitted data on 12 647 units of RBCs, FFP, and PLTs. The median aggregate request-to-retrieval turnaround times (TATs) for RBCs, FFP, and PLTs ranged from 30 to 35 minutes, and the median aggregate request-to-arrival TATs for RBCs, FFP, and PLTs ranged from 33 to 39 minutes. Most of the TAT was consumed by events occurring prior to, rather than after release of components from blood banks. Shorter prerelease TATs were associated with having surgical schedules that listed patients' names and procedures available to blood bank personnel prior to surgeries, and having adequate clotted specimens in the blood bank and completed type-and-screen procedures performed before requests for blood components were submitted to blood banks. Among the fastest-performing 10% of participants (90th percentile and above), request-to-retrieval TATs ranged from 12 to 24 minutes for the 3 blood components, whereas among the slowest-performing 10% of participants (10th percentile and below), request-to-retrieval TATs ranged from 63 to 115 minutes for the 3 components. Median TATs ranged from 33 to 37 minutes for the 3 components. Institutions with TATs in the fastest-performing 25th percentile more frequently stored cross-matched RBCs in the OR daily, stocked PLTs for unexpected surgical use, stored PLTs in or near the OR, and had laboratory rather than nonlaboratory personnel deliver components to the OR than did those institutions with TATs in the slowest-performing 25th percentile. Conclusions.—Hospital blood bank personnel can deliver blood components to the OR in slightly longer than 30 minutes, measured from the time that those units are requested by OR personnel. Practices aimed at saving time before components are released from blood banks will be more efficient in reducing overall TAT than those practices aimed at saving time after components are released from blood banks. Specific practices associated with shorter blood delivery TATs included providing blood bank personnel with access to the names of surgical patients potentially requiring blood components, having pretransfusion testing completed on those patients prior to surgery, having ample blood products on hand, and having laboratory personnel control blood product delivery.

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