Epidemiology and Factors Affecting Mortality of Hospitalized Patients with Disseminated Intravascular Coagulation in the United States

Introduction Disseminated Intravascular Coagulation (DIC) is a systemic coagulopathy which leads to widespread thrombosis and hemorrhage and ultimately results in multiorgan dysfunction. DIC usually occurs as a complication of illnesses like severe sepsis, malignancies, trauma, acute pancreatitis, burns, and obstetrical complications. The prognosis and mortality of DIC depend on the etiology, however, the mortality of DIC is known to be on the higher side. The aim of the study is to analyze if gender, race, regional differences have any association with the mortality of hospitalized patients with DIC. Method The National Inpatient Sample database from the Healthcare Cost and Utilization Project (HCUP) for the year 2016 was queried for data. We identified hospital admissions for DIC with the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code D65. The data was analyzed with STATA 16.0 version and univariate and multivariate analysis were performed. We studied the characteristics of all such hospitalizations for the year 2016 and the factors associated with the in-hospital mortality rate (MR) of DIC. We used length of stay, cost of stay as an outcome to determine if gender, race, and location play a role in the mortality. Results A total of 8704 admissions were identified with a diagnosis of DIC during the year 2016. The mean age for admission was found to be 56.48± 0.22. The percentage of admissions in females and males did not have a notable difference (50.57% vs 49.43%). The disease specific MR for DIC was 47.7%. Admission during weekend vs weekdays did not carry a statistically significant difference in terms of MR. Females with DIC were less likely to die in the hospital when compared to males with DIC (OR= 0.906, CI 0.82 - 0.99, p= 0.031). Interestingly, African Americans (AA) with DIC admissions were found to have 24% more risk of dying when compared to Caucasians admitted with DIC (OR= 1.24, CI 1.10 - 1.39, P= 0.00), Native Americans (NA) has 67% more risk of dying when compared to Caucasians (OR= 1.67, CI 1.03 - 2.69, p= 0.035). The mortality rate of NA, AA, Caucasians with DIC was found to be 57%, 52%, 47% respectively. The MR was found to be highest in hospitals of the northeast region (52%), then hospitals in the south (47%), followed by west and mid-west (46%), p= 0.000. Patients admitted to west and mid-west were 24% less likely to die when compared to patients admitted to northeast region hospitals (OR= 0.76, p= 0.001). The average length of stay and cost of stay were also less in west and mid-west regions when compared to north east. The difference in outcomes persisted after adjusting for age, gender, race, hospital division, co-morbid conditions. Conclusion Our study demonstrated that African Americans and Native Americans with DIC have high risk of dying in the hospital. Also, there exists a difference between the mortality rate, length and cost of stay among different regions in the United States. More research is needed to elucidate the factors that might be impacting the location-based variation in mortality. Disclosures No relevant conflicts of interest to declare.

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Epidemiology and regional variation in the mortality of patients admitted with prostate cancer in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.69 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 69-69

Author(s):

Arya Mariam Roy ◽

Manojna Konda ◽

Akshay Goel ◽

Rashmi Verma

Keyword(s):

Prostate Cancer ◽

United States ◽

African Americans ◽

Mortality Rate ◽

Length Of Stay ◽

Malignant Neoplasm ◽

The United States ◽

Principal Diagnosis ◽

Significant Difference ◽

Age Of Diagnosis

69 Background: Prostate cancer is one of the most common cancers in men and one of the leading causes of death among men of all races worldwide. Prostate cancer prevalence and mortality vary substantially by race, ethnicity and geography. The reason behind the disparity is unclear, however, access to screening and treatment, variation in exposure to risk factors, genetic susceptibility, lifestyle practices are the suggested factors that affect the disparity. Methods: We conducted a retrospective analysis of the National Inpatient Sample Database for the year 2016. Patients who were admitted with a principal diagnosis of Malignant Neoplasm of Prostate (MNP) were identified using ICD-10 codes. The epidemiology, racial disparities and regional variations in the mortality of prostate cancer, trend in the cost and length of stay were studied. Results: A total of 39,853 hospitalizations were identified with a principal diagnosis of MNP. The prevalence of MNP was found to be 0.56% with mean age of diagnosis 71.36 ± 0.55. The prevalence of prostate cancer was found to be highest in African Americans (0.65%), followed by Caucasians (0.60%). The disease-specific mortality rate for MNP was 3.45% (n=1,375). African Americans (AA) had 32% more risk of dying with prostate cancer when compared to all the other groups (OR= 1.322, P= 0.001, 95% CI= 1.14-1.52). Caucasians had 25% less chance of dying and Hispanic had 28% less chance of dying with prostate cancer when compared to AA (OR= 0.755, P= 0.001, CI= 0.65-0.87 vs OR= 0.72, P= 0.016, CI= 0.56- 0.94). Those who admitted to West were 22% more likely to die and those admitted to Northeast were 18% more likely to die when compared to Midwest and south regions (OR= 1.22, P= 0.037, CI= 1.01- 1.47 vs OR= 1.18, P= 0.062, CI= 0.91-1.4). The length of stay and also cost of stay were found to be highest for African American population. Conclusions: The prevalence, mortality of prostate cancer, cost and length of inpatient stay were highest among African Americans. There was a statistically significant difference in the mortality rate of prostate cancer based on the hospital regions in the United States. More studies are needed to better understand the reasons behind the regional difference.

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Poor Survival for US Pacific Islander Cancer Patients: Evidence From the Surveillance, Epidemiology, and End Results Database: 1991 to 2004

Journal of Clinical Oncology ◽

10.1200/jco.2007.13.8271 ◽

2007 ◽

Vol 25 (36) ◽

pp. 5738-5741 ◽

Cited By ~ 44

Author(s):

William B. Goggins ◽

Grace K.C. Wong

Keyword(s):

United States ◽

African Americans ◽

Native Americans ◽

Cancer Survival ◽

The United States ◽

Native Hawaiians ◽

Targeted Interventions ◽

Female Breast ◽

Cause Specific Survival ◽

End Results

Purpose Although racial and ethnic differences in cancer survival in the United States have been studied extensively, little is known about cancer survival in US Pacific Islanders (PIs), a fast-growing and economically disadvantaged minority group. Methods Using data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries, we compared cause-specific and all-cause survival for female breast, prostate, lung, colorectal, stomach and liver cancer for Native Hawaiians, Samoans, other PIs (including Tongans, Guamanians, and others), African Americans, and Native Americans with non-Hispanic whites using Cox proportional hazards models. Separate models were fitted adjusting for demographic factors only and demographic and disease severity variables. Results Among all groups, Samoans were the most likely to present with advanced disease and had the worst cause-specific survival for all sites considered. Samoans had particularly poor results (adjusted for demographic variables only) for female breast (relative risk [RR] = 3.05; 95% CI, 2.31 to 4.02), colorectal (RR = 1.82; 95% CI, 1.37 to 2.41) and prostate (RR = 4.82; 95% CI, 3.38 to 6.88) cancers. Native Hawaiians and other PIs also had significantly worse cause-specific survival than did non-Hispanic whites for most sites, but generally had better survival than African Americans or Native Americans. Conclusion Much of the survival disadvantage for PI groups appears to be a result of late diagnosis, and thus targeted interventions have much potential to reduce cancer mortality in this group. More research is needed to find explanations for the particularly poor cancer survival for Samoans in the United States.

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Interactions with Asians in Higher Education: Beyond Multicultural Myths

Multicultural Learning and Teaching ◽

10.1515/mlt-2019-2029 ◽

2019 ◽

Vol 14 (2) ◽

Author(s):

Festus E. Obiakor

Keyword(s):

Higher Education ◽

United States ◽

African Americans ◽

Native Americans ◽

Linguistically Diverse ◽

The United States ◽

Culturally And Linguistically Diverse ◽

Model Minorities ◽

Critical Issues ◽

Education Today

AbstractOne of the critical issues in education today is how to help all students to maximize their fullest potential. Achieving this goal seems to be difficult for many people who come from culturally and linguistically diverse (CLD) backgrounds. At all levels, they endure direct and indirect disenfranchisements, disadvantages, and disillusionments, especially if they learn differently, are racially different, demonstrate different behavioral patterns, have different personal idiosyncrasies, or come from different countries. Despite these apparent impediments, Asians are viewed by many as “model” minorities when compared to African Americans, Latinos, and Native Americans. This view has continued to affect how Asians view themselves and how the society as a whole views them. Coming originally from Nigeria to the United States, I have had myriad interactions with Asians as student, professor, scholar, leader, and professional. In this article, I share my experiences with Asians and how these experiences have exposed multicultural realities and myths.

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The Impact of BMI on Adult Blunt Trauma Outcomes

The American Surgeon ◽

10.1177/000313481908501229 ◽

2019 ◽

Vol 85 (12) ◽

pp. 1354-1362

Author(s):

Rahman Barry ◽

Milad Modarresi ◽

Rodrigo Aguilar ◽

Jacqueline Sanabria ◽

Thao Wolbert ◽

...

Keyword(s):

United States ◽

Mortality Rate ◽

Length Of Stay ◽

Blunt Trauma ◽

Nationwide Inpatient Sample ◽

The United States ◽

Mortality Rates ◽

Hospital Length Of Stay ◽

Obese Patients ◽

The Impact

Traumatic injuries account for 10% of all mortalities in the United States. Globally, it is estimated that by the year 2030, 2.2 billion people will be overweight (BMI ≥ 25) and 1.1 billion people will be obese (BMI ≥ 30). Obesity is a known risk factor for suboptimal outcomes in trauma; however, the extent of this impact after blunt trauma remains to be determined. The incidence, prevalence, and mortality rates from blunt trauma by age, gender, cause, BMI, year, and geography were abstracted using datasets from 1) the Global Burden of Disease group 2) the United States Nationwide Inpatient Sample databank 3) two regional Level II trauma centers. Statistical analyses, correlations, and comparisons were made on a global, national, and state level using these databases to determine the impact of BMI on blunt trauma. The incidence of blunt trauma secondary to falls increased at global, national, and state levels during our study period from 1990 to 2015, with a corresponding increase in BMI at all levels ( P < 0.05). Mortality due to fall injuries was higher in obese patients at all levels ( P < 0.05). Analysis from Nationwide Inpatient Sample database demonstrated higher mortality rates for obese patients nationally, both after motor vehicle collisions and mechanical falls ( P < 0.05). In obese and nonobese patients, regional data demonstrated a higher blunt trauma mortality rate of 2.4% versus 1.2%, respectively ( P < 0.05) and a longer hospital length of stay of 4.13 versus 3.26 days, respectively ( P = 0.018). The obesity rate and incidence of blunt trauma secondary to falls are increasing, with a higher mortality rate and longer length of stay in obese blunt trauma patients.

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Forgiveness: An Interview

PMLA ◽

10.1632/003081202x62006 ◽

2002 ◽

Vol 117 (2) ◽

pp. 278-295 ◽

Cited By ~ 10

Author(s):

Julia Kristeva ◽

Alison Rice

Keyword(s):

United States ◽

South Africa ◽

African Americans ◽

Native Americans ◽

The United States ◽

Julia Kristeva ◽

Japanese Americans ◽

The Holocaust ◽

Aboriginal Children

This interview with julia kristeva, conducted on 25 april 2000, focuses on forgiveness, a topic that is receiving considerable attention worldwide. Numerous nations around the globe have recently extended apologies to specific groups of people, including South Africa, to victims of apartheid; Britain, to the Maori people; Australia, to stolen aboriginal children; the United States, to Native Americans, Japanese Americans, and African Americans; and Germany, to victims of the Holocaust. This remarkable international proliferation of requests for forgiveness for wrongdoing and of attempts to make amends has not escaped the attention of prominent literary critics and philosophers.

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The Underrepresentation of Minorities and Non-Generalizability of Breast Cancer Clinical Trials?

10.31219/osf.io/bgu9c ◽

2021 ◽

Author(s):

Joseph Angel De Soto

Keyword(s):

Breast Cancer ◽

United States ◽

Clinical Trials ◽

African Americans ◽

Native Americans ◽

Ethnic Minorities ◽

Minority Groups ◽

The United States ◽

Cancer Clinical Trials ◽

High Death

Introduction This year 43,000 women will die from breast cancer in the United States. African Americans and Native Americans though less likely to get breast cancer, once diagnosed they are much more likely to die from breast cancer. This increased death rate may in part be due to the non-generalizability of breast cancer clinical trials. In this study, we evaluate the participation of ethnic minorities from breast cancer clinical trials. Methodology In this study, fifty-six breast cancer clinical trials completed in the last ten years in the United States were evaluated for the inclusion of ethnic minorities in the breast cancer clinical trials. Results Only 21% of breast cancer clinical trials include information on ethnicity in the methodology while only 7% provided any information on the effect or toxicity of the therapeutic intervention in minority groups while 100% report the results for Whites. Though Whites only make up 60.1% of the population, they were 87.5% of the clinical trial participants while African Americans were 6.2%, Hispanics 3.1%, Asians 2.9% and Native Americans were 0.2% of the participants. Conclusion Racial minorities have been underrepresented in breast cancer clinical trials which may contribute to unnecessarily high death rates in these groups while suggesting limited generalizability of breast cancer clinical trials.

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Afrocentrism and the Peopling of the Americas

Ethnic Studies Review ◽

10.1525/esr.1996.19.2-3.129 ◽

1996 ◽

Vol 19 (2-3) ◽

pp. 129-140

Author(s):

Gabriel Haslip-Viera

Keyword(s):

United States ◽

Native American ◽

African Americans ◽

Native Americans ◽

Human Development ◽

Black People ◽

The United States ◽

Western Hemisphere ◽

Peopling Of The Americas ◽

Late Nineteenth

This essay focuses on a theory of human development that has been promoted aggressively by a group of Afrocentrists in recent years - that the Western Hemisphere was first populated by “Africoids” or “Black” people who came to the Americas by way of Asia and the Bering Straits with little or no change in their physical or racial characteristics. As discussed in this article, the theory has no support in the evidence collected by scientists in various fields. The essay focuses on the basic claims and methods used by the Afrocentrists to support their theory, including their misuse or misinterpretation of mostly outdated scholarship produced in Europe and the United States during the late nineteenth and early twentieth centuries. A brief concluding section makes reference to the potential repercussions of this theory on relations between African Americans, Native Americans and Latinos of Native American and part Native American background.

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Representations of Native Americans in Adamic’s Writing on (New) Immigrants

Two Homelands ◽

10.3986/dd.2020.1.02 ◽

2020 ◽

Author(s):

Ksenija Šabec

Keyword(s):

United States ◽

African Americans ◽

Native Americans ◽

Nation Building ◽

The United States ◽

American Identity ◽

New Immigrants ◽

European Immigrants ◽

Interethnic Relationships

This article presents an overview of the attention Louis Adamic dedicated to Native Americans in various written works and public engagements and compares it with his writing on new immigrants in the light of his understanding of the importance of the preservation of immigrants’ identity and issues of integration and nation-building as they relate to American identity. The article also explores the views on interculturaland interethnic relationships in the United States that Adamic drew on in his treatment of Native Americans. Three works in particular will be analyzed: My America (1938), From Many Lands (1940), and A Nation of Nations (1945). The main finding is that Adamic does not deal as extensively with issues related to indigenous Americans as he does with those related to European immigrants. Nevertheless, Adamic does notcompletely neglect “the Indian story”. In some of his works, most extensively in A Nation of Nations, he specifically compares this story to the (problematic) position of African Americans in an American space that was colonized either “by sword or by book”.

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Toxic Spiders of the United States: A Case Report and Discussion

Journal of Pharmacy Practice ◽

10.1177/089719000001300309 ◽

2000 ◽

Vol 13 (3) ◽

pp. 210-213

Author(s):

Philip R. Fuller

Keyword(s):

United States ◽

Case Report ◽

Disseminated Intravascular Coagulation ◽

Surgical Intervention ◽

Horse Serum ◽

The United States ◽

Systemic Effects ◽

Black Widow ◽

Intravascular Coagulation ◽

Systemic Reactions

Although there are over 20,000 species of spiders in the United States serious complications from envenomation is restricted to only two genera: Loxoceles species (i.e., brown recluse type spiders) and Latrodectus species (i.e., black widow type spiders). Loxoceles species venom is primarily cyto/hemo toxic. It produces local necrotic lesions and occasionally systemic reactions including disseminated intravascular coagulation. Latrodectus species venom is primarily neurotoxic with little more than local erythema at the bite site, but with serious systemic effects from paresthesias to paralysis. A horse serum derived antivenin is available for Latrodectus envenomation while surgical intervention is often necessary for large necrotic lesions associated with Loxoceles envenomation.

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The Jacobs Siblings’ Black Hemispheric Geographies

Transamerican Sentimentalism and Nineteenth-Century US Literary History ◽

10.1093/oso/9780198862338.003.0005 ◽

2020 ◽

pp. 136-171

Author(s):

Maria A. Windell

Keyword(s):

United States ◽

New York ◽

North Carolina ◽

African Americans ◽

Native Americans ◽

The United States ◽

The North ◽

East West

The fourth chapter highlights the hemispheric imaginaries and sentimental skepticism of Harriet A. Jacobs’s Incidents in the Life of a Slave Girl (1862) and John S. Jacobs’s speeches and writings. The siblings challenge the North–South mapping of US slavery, instead embedding it in an East–West, antiracist, anti-imperial mapping that makes explicit the transamerican pressures shaping the dispossession of African Americans, Native Americans, and Mexicans. Their writings move not only along familiar abolitionist routes from South to North and the United States to Britain but also from North Carolina and New York to Florida, Haiti, Jamaica, California, and Mexico. As the foreclosure of Harriet’s journey to California at the end of Incidents suggests, however, transamerican sentimentalism here struggles to sustain even localized moments of connection. The Jacobs siblings’ writings highlight the challenges that complicate potential multiethnic, transnational alliances.

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