Hospitalization trends and outcomes for adults with metastatic cancers in the United States: 2004-2013.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18111-e18111
Author(s):  
Oladimeji Akinboro ◽  
Odunayo Olorunfemi ◽  
Daniel Pomerantz ◽  
Stephen Jesmajian ◽  
Gbolahan Ogunbayo ◽  
...  
Keyword(s):  
United States ◽  
Hospital Mortality ◽  
Metastatic Cancer ◽  
The United States ◽  
Population Based ◽  
Policy Implications ◽  
Teaching Hospitals ◽  
Hospitalization Rates ◽  
Complications Of Surgery ◽  
The Impact

e18111 Background: Metastatic cancer accounts for 90% of cancer deaths. However, the impact of metastatic cancer on hospitalization patterns and in-hospital mortality is unknown. We sought to examine trends in hospitalizations and mortality among adults with metastatic cancers in the United States. Methods: We obtained data from the National Inpatient Sample for hospitalized adults, aged ≥18 years, with metastatic cancer listed as a discharge diagnosis from 2004 to 2013. We estimated and trended the following: i) proportion of hospitalized adults with metastatic cancers; ii) leading causes of hospitalization for adults with metastatic cancer; and iii) in-hospital mortality among adults with metastatic cancer. Independent associations of in-hospital mortality with age, gender, race/ethnicity, payment source, and hospital type were examined with multivariable logistic regression. Survey weights were applied in estimating the population-based rates, odds ratios, and confidence intervals (CI). Results: 3.0% (95% CI 2.9-3.1%) and 3.2% (95% CI 3.0-3.3%) of hospitalized adults had metastatic cancers in 2004 and 2013, respectively ( P for trend 0.07). The leading causes of hospitalization from 2004 to 2013 were: maintenance chemotherapy/radiotherapy – 3.5% (95% CI 3.2-3.8%); pneumonia – 3.2% (95% CI 3.1-3.3%); complications of surgery, medical care, devices, and implants – 2.8% (95% CI 2.8-2.9%); fluid/electrolyte abnormalities – 2.4% (95% CI 2.4-2.5%); and heart failure/pulmonary circulation diseases – 2.2% (95% CI 2.1-2.2%). In-hospital mortality for patients with metastatic cancer declined from 10.3% (95% CI 9.9-10.7%) in 2004 to 8.1% (95% CI 7.8-8.3%) in 2013 ( P for trend < 0.01). Higher odds of in-hospital mortality were consistently seen each year with increasing age, non-Hispanic blacks, self-payment, and admissions at hospitals other than urban teaching hospitals. Conclusions: The relative hospitalization rates for adults with metastatic cancer remain stable. Significant declines in in-hospital mortality for these patients are noted but disparities are seen for certain groups. The economic burden and policy implications of these findings for end-of-life care warrant further investigation.

Population-Based Analysis of Firearm Injuries among Young Children in the United States, 2010–2015

2019 ◽  
Vol 85 (5) ◽  
pp. 449-455 ◽  
Author(s):  
Alan Cook ◽  
David Hosmer ◽  
Laurent Glance ◽  
Bindu Kalesan ◽  
Jordan Weinberg ◽  
...  
Keyword(s):  
United States ◽  
Young Children ◽  
Hospital Mortality ◽  
Gunshot Wounds ◽  
The United States ◽  
Population Based ◽  
Older Children ◽  
Firearm Injuries ◽  
One Year ◽  
The Impact

Firearm violence in the United States knows no age limit. This study compares the survival of children younger than five years to children and adolescents of age 5–19 years who presented to an ED for gunshot wounds (GSWs) in the United States to test the hypothesis of higher GSW mortality in very young children. A study of GSW patients aged 19 years and younger who survived to reach medical care was performed using the Nationwide ED Sample for 2010–2015. Hospital survival and incidence of fatal and nonfatal GSWs in the United States were the study outcomes. A multilevel logistic regression model estimated the strength of association among predictors of hospital mortality. The incidence of ED presentation for GSW is as high as 19 per 100,000 population per year. Children younger than five years were 2.7 times as likely to die compared with older children (15.3% vs 5.6%). Children younger than one year had the highest hospital mortality, 33.1 per cent. The mortality from GSW is highest among the youngest children compared with older children. This information may help policy makers and the public better understand the impact of gun violence on the youngest and most vulnerable Americans.

Adoption: Transracial and Intercountry

2019 ◽  
Author(s):  
Rowena Fong ◽  
Ruth G. McRoy ◽  
Amy Griffin ◽  
Catherine LaBrenz
Keyword(s):  
United States ◽  
Identity Formation ◽  
Challenging Behaviors ◽  
The United States ◽  
Social Work Practice ◽  
Policy Implications ◽  
Practice Research ◽  
Adoptive Families ◽  
Transracial Adoptions ◽  
The Impact

A history of transracial and intercountry adoptions in the United States is briefly provided as well as highlights trends, demographics, practices, and policies that have evolved as families have become more diverse. The current prevalence of intercountry and transracial adoptions in the United States is examined as well as the impact of policy changes in the United States and abroad on rates of intercountry adoption. Additionally, the challenges that have emerged for children adopted transracially and from abroad, as well as for their adoptive families, are reviewed. These include navigating ethnic and racial identity formation, cultural sensitivity, and challenging behaviors. Finally, future directions for social work practice, research, and policy are explored, and implications are provided for social workers intervening with families who have adopted children transracially or internationally. Specifically, adoption-competent professionals should also integrate cultural humility and competence into their therapeutic work with adoptive children and families. Implications for research in the conclusion focus on expanding prior studies on intercountry and transracial adoptions to incorporate racial and ethnic groups underrepresented in the literature. Policy implications include increasing access and funding for post-adoption services for all adoptive families.

Continued Evidence of the Impact of Rotavirus Vaccine in Children Less Than 3 Years of Age From the United States New Vaccine Surveillance Network: A Multisite Active Surveillance Program, 2006–2016

2020 ◽  
Author(s):  
Mary Allen Staat ◽  
Daniel C Payne ◽  
Natasha Halasa ◽  
Geoffrey A Weinberg ◽  
Stephanie Donauer ◽  
...  
Keyword(s):  
United States ◽  
Disease Burden ◽  
The United States ◽  
Population Based ◽  
Surveillance Program ◽  
Surveillance Network ◽  
Rotavirus Vaccination ◽  
Ed Visits ◽  
The Impact ◽  
Vaccine Surveillance

Abstract Background Since 2006, the New Vaccine Surveillance Network has conducted active, population-based surveillance for acute gastroenteritis (AGE) hospitalizations and emergency department (ED) visits in 3 United States counties. Trends in the epidemiology and disease burden of rotavirus hospitalizations and ED visits were examined from 2006 to 2016. Methods Children &lt; 3 years of age hospitalized or visiting the ED with AGE were enrolled from January 2006 through June 2016. Bulk stool specimens were collected and tested for rotavirus. Rotavirus-associated hospitalization and ED visit rates were calculated annually with 2006–2007 defined as the prevaccine period and 2008–2016 as the postvaccine period. Rotavirus genotype trends were compared over time. Results Over 11 seasons, 6954 children with AGE were enrolled and submitted a stool specimen (2187 hospitalized and 4767 in the ED). Comparing pre- and postvaccine periods, the proportion of children with rotavirus dramatically declined for hospitalization (49% vs 10%) and ED visits (49% vs 8%). In the postvaccine era, a biennial pattern of rotavirus rates was observed, with a trend toward an older median age. G1P[8] (63%) was the predominant genotype in the prevaccine period with a significantly lower proportion (7%) in the postvaccine period (P &lt; .001). G2P[4] remained stable (8% to 14%) in both periods, whereas G3P[8] and G12P[8] increased in proportion from pre- to postvaccine periods (1% to 25% and 17% to 40%), respectively. Conclusions The epidemiology and disease burden of rotavirus has been altered by rotavirus vaccination with a biennial disease pattern, sustained low rates of rotavirus in children &lt; 3 years of age, and a shift in the residual genotypes from G1P[8] to other genotypes.

Policy Implications

2018 ◽  
pp. 295-306
Author(s):  
Kevin A. Sabet ◽  
Ken C. Winters
Keyword(s):  
United States ◽  
Federal Government ◽  
The United States ◽  
Policy Implications ◽  
United States Government ◽  
United States Department ◽  
Government Accountability ◽  
Department Of Justice ◽  
Pros And Cons ◽  
The Impact

This chapter reviews policy implications associated with legalizing marijuana for medical and recreational purposes. The authors discuss the current landscape and attitudes toward marijuana use and review the enforcement polices of the federal government, including the impact of policies within the United States Department of Justice and the United States Government Accountability Office. The chapter also examines the expanding marijuana industry and warns against the growth of ‘Big Marijuana’ and the industry’s ability to influence policy. Finally, after reviewing the important pros and cons of legalizing this drug, the authors offer several guidelines for states to optimize care when legalization is implemented.

A Dynamic Model of Rational Addiction with Stockpiling and Learning: An Empirical Examination of E-cigarettes

2020 ◽  
Vol 66 (12) ◽  
pp. 5886-5905
Author(s):  
Jialie Chen ◽  
Vithala R. Rao
Keyword(s):  
United States ◽  
Structural Model ◽  
The United States ◽  
Policy Implications ◽  
Future Research ◽  
The European Union ◽  
Empirical Examination ◽  
Cigarette Taxes ◽  
Smoking Behaviors ◽  
The Impact

Current regulations on e-cigarettes are minimal compared with cigarette regulations, despite their growing popularity globally. Advocates of e-cigarettes claim that they aid in ceasing smoking habits. However, leaving e-cigarettes unregulated has raised growing health concerns. Policymakers in several countries, including the United States and those in Europe, are considering and experimenting with policy interventions. To evaluate current policies and implement potential regulations on e-cigarettes, policymakers must understand the impact of e-cigarettes on consumers’ smoking behaviors. To address this issue, we construct a dynamic structural model that incorporates consumers’ purchases and consumption behaviors of both cigarettes and e-cigarettes. The results from our proposed model indicate that consumption of e-cigarettes promotes, rather than counteracts, smoking. This is because the less costly e-cigarettes incentivize consumers to build their addiction to nicotine, which, in return, increases future consumption of both cigarettes and e-cigarettes. This finding calls for regulations on e-cigarettes. We then conduct counterfactual analyses to evaluate two policy regulations on e-cigarettes: (1) e-cigarette taxes and (2) price regulation. Because both of these policies have been discussed extensively in both the United States and many countries in the European Union, results of our policy simulations address these policy debates. We find that both are effective in reducing overall consumption of cigarettes and e-cigarettes. We also examine the role of consumers’ heterogeneity on the simulation results as well as the policy implications. We conclude with future research directions, such as inclusion of social influence and cross-selling marketing. This paper was accepted by Matthew Shum, marketing.

1390 THE IMPACT OF URETEROSCOPY ON THE RATE OF SECONDARY BLADDER CANCER IN THE UNITED STATES: A POPULATION-BASED ASSESSMENT

2011 ◽  
Vol 185 (4S) ◽  
Author(s):  
Max Kates ◽  
Gina Badalato ◽  
Olga Yeshchina ◽  
Neda Sadeghi ◽  
James McKiernan
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
The United States ◽  
Population Based ◽  
The Impact

scholarly journals The Impact of Winter Months on Patients with Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE), a Retrospective Analysis of Hospital Outcomes in the United States (US) from 1998-2011

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4451-4451
Author(s):  
Danielle Krol ◽  
Parshva Patel ◽  
Konstantine Halkidis ◽  
Gaurav Varma ◽  
Ravindra Sangitha ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
The United States ◽  
Mortality Rates ◽  
Teaching Hospitals ◽  
Hospital Outcomes ◽  
North Central ◽  
Increased Risk ◽  
The Us ◽  
The Impact

Abstract Background: DVT and PE are common complications in hospitalized patients. Many hospitals have implemented EMR-based protocols to identify patients who could benefit from prophylactic anticoagulation, because of the increased morbidity, mortality, and cost associated with thrombotic disease. Several groups have sought to characterize the potential seasonal and winter variation in the incidence of DVT and PE, with several international studies supporting a so called "Winter effect" (Damnjanović et al., Hippokratia 2013); however, no study has demonstrated a "Winter effect" on patients within the US (Stein et al., Am J Cardiol 2004). Objective: (1) To compare mortality rates and length of stay (LOS) in hospitals by month to identify a "Winter effect" in patients diagnosed with either DVT or PE; and (2) characterize other factors that might influence mortality and LOS, using the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Methods: The NIS was queried from 1998-2011. Inclusion criteria were a diagnosis of DVT (ICD-9 453.4X, 453.8X) and/or PE (ICD-9 415.1X) in patients aged 18 years or more. The sample was weighted to approximate the full inpatient population of the United States over the period of interest. Admission data was then analyzed to compare mortality rates over those years by month. Demographics, Charlson Comorbidity Index (CCI), length of stay, hospital region, and admission type (emergent/urgent versus elective admissions) were assessed. Linear and logistic models were generated for complex survey design to assess predictors of mortality and LOS. Results: A total of 1,449,113 DVT/PE cases were identified in the NIS (weighted n = 7,150,613). 54.7% of admission were for females, 56.4% were white, and 49% of admissions were at a teaching facility. Mortality over the 12 months was 6.4% and was noted to be higher in four months: November (6.52%), December (6.9%), January (6.94%), and February (6.93%), as indicated in the graph below. A similar trend was noted on a regional basis with higher mortality noted in winter months for all hospital regions (Northeast, Midwest or North Central, South, and West). No significant trend was noted in DVT/PE hospitalization rates between regions over 12 months (p=0.7674). Mortality in the total cohort was found to be significantly higher in December, OR 1.10 (95% CI: 1.06-1.14), p<0.0001; January, OR 1.11 (95% CI: 1.08-1.15), p<0.0001; and February, OR 1.11 (95% CI: 1.07-1.15), p<0.0001 compared to June (Table 1). Mortality was significantly lower in the Midwest or North Central, OR 0.78 (95% CI: 0.72-0.83), p<0.0001; and West, OR 0.80 (95% CI: 0.73-0.87), p<0.0001 compared to the Northeast. Mortality was also significantly higher in teaching hospitals than in nonteaching hospitals (OR 1.16 [95% CI: 1.10-1.22], p<0.0001), with mortality higher in teaching hospitals in all months. Length of stay was also significantly increased in the winter months. Similar results were noted in the subgroups of patients greater than age 80 or with a CCI score of 2 or more. Conclusion: This national study identified an increased risk of mortality and increased LOS associated with hospitalizations for DVT/PE during the winter months (December, January, and February), supporting the existence of a "Winter effect" on hospital outcomes. Our data differs from previous reports on seasonal variation in DVT/PE in the US because of the database used (Bekkers et al., Clin Orthop Relat Res 2014). Since no regional variation was shown, decreased activity or cold temperature is unlikely to be the cause of this phenomenon. Alternative explanations should be sought. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

COViD-19: We're All in This Together – Some More Than Others

2021 ◽  
Vol 36 (8) ◽  
pp. 358-360
Author(s):  
Chris Alderman
Keyword(s):  
United States ◽  
Health Care ◽  
Minority Groups ◽  
Premature Mortality ◽  
The United States ◽  
Adverse Outcomes ◽  
Developed Economies ◽  
Hospitalization Rates ◽  
The Impact ◽  
Significant Disease

It has long been apparent that gross disparities exist in health care in the United States, and, indeed, other nations with fully developed economies. All kinds of markers point to these inequities, with measures such as overall life expectancy, hospitalization rates, premature mortality, adverse outcomes associated with medical and surgical treatment, infant mortality, and the impact of many significant disease types higher and more impactful among minority groups and those of the most modest economic means. This is not new. Are there pointers to what might underpin the disparities in outcomes among the different minority groups?

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