Health disparities experienced by Black Americans with multiple myeloma in the United States: A population-based study.

e18512 Background: Multiple Myeloma (MM) is the most common hematologic malignancy in Black Americans. Incidence and death rates for MM in Black Americans are more than double those in Whites. Our study aimed to evaluate trends of all cause in-hospital mortality among Black Americans with MM and to investigate characteristics of MM-related hospitalizations. Methods: We conducted a retrospective cross-sectional study of hospitalizations in adult patients with MM during 2008-2017 using the National Inpatient Sample (NIS), the largest all-payer inpatient care database in the US. We used joinpoint regression to assess temporal trends in the national incidence of in-hospital death. We conducted adjusted survey logistic regression to generate adjusted odds ratios to measure the likelihood of in-hospital death among MM related hospitalizations. Results: Admissions related to MM constituted 0.32% of all hospitalizations in the study period (913,967 out of 285,876,821). The prevalence of MM related hospitalizations was higher in Black Americans when compared with Whites (476.0 vs 305.6 per 100,000 hospitalizations, p <0.01). In-hospital mortality with MM was higher in older patients, males, those belonging to lowest zip code quartile, and who self-paid for their treatment. Average Annual Percent Change (AAPC) showed a statistically significant decline of in-hospital mortality among all MM patients except Black Americans who had the highest inpatient mortality in 2016 and 2017. Black Americans received less autologous stem cell transplantation (ASCT) (2.8% vs. 3.8%, p <0.01), more blood product transfusions (23.0% vs. 21.1%, p <0.01), less palliative care consultation (4.0% vs. 4.6%, p <0.01), less chemotherapy (10.8% vs. 11.2%, p <0.01), and more intensive care utilization (5.3% vs. 4.3%, p <0.01), when compared with Whites. Adjusted association between race/ethnicity and various outcomes confirmed observed differences [Table]. Conclusions: Black Americans with MM had the slowest improvement and highest inpatient mortality in recent years. Data suggests higher disease burden, more frequent hospitalizations, delay in accessing care and lower utilization of supportive care measures compared with White MM patients. Data highlight disparities in MM care for Black Americans necessitating a clarion call for urgent changes in health care systems.[Table: see text]

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978. Disease Associations and Outcomes in Hospitalized Patients with Non-Cutaneous Mucormycosis: Data from the National Inpatient Sample

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1172 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S580-S580

Author(s):

Mark White

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Myelodysplastic Syndrome ◽

Hematologic Malignancy ◽

The United States ◽

Solid Organ ◽

Medical Conditions ◽

National Inpatient Sample ◽

Inpatient Mortality ◽

Cutaneous Mucormycosis

Abstract Background Data regarding comorbidities and hospital outcomes among patients with non-cutaneous mucormycosis is primarily derived from case reports and single institution series. This study was undertaken to define the prevalence of this condition among adult inpatients in the United States and to measure the frequency of comorbid illnesses and outcomes of inpatients with mucormycosis. Methods The 2016 National Inpatient Sample was used to identify a cohort of patients with a hospital diagnosis of non-cutaneous mucormycosis. Patients with mucormycosis and comorbid medical illnesses were identified by ICD-10 codes. The impact of disease site and comorbid illness on inpatient mortality was measured. Results A cohort of 95 adults with non-cutaneous mucormycosis was identified and included patients with pulmonary (n=53), rhinocerbral (n=25), disseminated (n=17), and gastrointestinal (n=4) mucormycosis. The prevalence of non-cutaneous mucormycosis was 15.7 cases per million admissions. Frequently associated medical conditions included diabetes mellitus (45.3%), hematologic malignancy (34.7%), hematopoietic stem cell transplant (6.3%), long term use of systemic steroids (6.3%), myelodysplastic syndrome (6.3%), solid organ transplant (5.3%), non-hematologic malignancy (4.2%), and iron overload disorders (2.1%). The median age of adults hospitalized with non-cutaneous mucormycosis was 53.2 years (range 18-83); patients were predominantly male (78.9%) and Caucasian (51.8%). The median length of stay for this cohort was 20 days (range 1-190) with a median total hospital cost of &323, 470 (range &2,401-&1,958,259) and an in-hospital mortality rate of 20%. The inpatient mortality rate was increased with underlying myelodysplastic syndrome (p=0.003) but not by other associated medical conditions or by site of disease. Conclusion Non-cutaneous mucormycosis is associated with a high in-hospital mortality rate and should be considered in patients with suggestive clinical presentations and underlying diabetes or conditions associated immunosuppression. Prompt recognition and tissue confirmation of this diagnosis leading to early surgical intervention and systemic antifungal therapy may improve outcomes. Disclosures All Authors: No reported disclosures

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Characteristics and comparative clinical outcomes of prisoner versus non-prisoner populations hospitalized with COVID-19

Scientific Reports ◽

10.1038/s41598-021-85916-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ahmed M. Altibi ◽

Bhargava Pallavi ◽

Hassan Liaqat ◽

Alexander A. Slota ◽

Radhika Sheth ◽

...

Keyword(s):

Hospital Mortality ◽

Clinical Outcomes ◽

Regression Models ◽

Cox Regression ◽

The United States ◽

Hospital Death ◽

Inpatient Mortality ◽

Mortality Hazard ◽

Henry Ford ◽

Mortality Hazard Ratio

AbstractPrisons in the United States have become a hotbed for spreading COVID-19 among incarcerated individuals. COVID-19 cases among prisoners are on the rise, with more than 143,000 confirmed cases to date. However, there is paucity of data addressing clinical outcomes and mortality in prisoners hospitalized with COVID-19. An observational study of all patients hospitalized with COVID-19 between March 10 and May 10, 2020 at two Henry Ford Health System hospitals in Michigan. Clinical outcomes were compared amongst hospitalized prisoners and non-prisoner patients. The primary outcomes were intubation rates, in-hospital mortality, and 30-day mortality. Multivariable logistic regression and Cox-regression models were used to investigate primary outcomes. Of the 706 hospitalized COVID-19 patients (mean age 66.7 ± 16.1 years, 57% males, and 44% black), 108 were prisoners and 598 were non-prisoners. Compared to non-prisoners, prisoners were more likely to present with fever, tachypnea, hypoxemia, and markedly elevated inflammatory markers. Prisoners were more commonly admitted to the intensive care unit (ICU) (26.9% vs. 18.7%), required vasopressors (24.1% vs. 9.9%), and intubated (25.0% vs. 15.2%). Prisoners had higher unadjusted inpatient mortality (29.6% vs. 20.1%) and 30-day mortality (34.3% vs. 24.6%). In the adjusted models, prisoner status was associated with higher in-hospital death (odds ratio, 2.32; 95% confidence interval (CI), 1.33 to 4.05) and 30-day mortality (hazard ratio, 2.00; 95% CI, 1.33 to 3.00). In this cohort of hospitalized COVID-19 patients, prisoner status was associated with more severe clinical presentation, higher rates of ICU admissions, vasopressors requirement, intubation, in-hospital mortality, and 30-day mortality.

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Comparative Clinical Outcomes and Mortality in Prisoner and Non-Prisoner Populations Hospitalized with COVID-19: A Cohort from Michigan

10.1101/2020.08.08.20170787 ◽

2020 ◽

Author(s):

Ahmed M Altibi ◽

Pallavi Bhargava ◽

Hassan Liaqat ◽

Alexander A. Slota ◽

Radhika Sheth ◽

...

Keyword(s):

Hospital Mortality ◽

Clinical Outcomes ◽

Regression Models ◽

Cox Regression ◽

The United States ◽

Hospital Death ◽

Inpatient Mortality ◽

Mortality Hazard ◽

Henry Ford ◽

Mortality Hazard Ratio

Background: Prisons in the United States have become a hotbed for spreading Covid-19 among incarcerated individuals. Covid-19 cases among prisoners are on the rise, with more than 46,000 confirmed cases to date. However, there is paucity of data addressing clinical outcomes and mortality in prisoners hospitalized with Covid-19. Methods: An observational study of all patients hospitalized with Covid-19 between March 10 and May 10, 2020 at two Henry Ford Health System hospitals in Michigan. Clinical outcomes were compared amongst hospitalized prisoners and non-prisoner patients. The primary outcomes were intubation rates, in-hospital mortality, and 30-day mortality. Multivariable logistic regression and Cox-regression models were used to investigate primary outcomes. Results: Of the 706 hospitalized Covid-19 patients (mean age 66.7 +/- 16.1 years, 57% males, and 44% black), 108 were prisoners and 598 were non-prisoners. Compared to non-prisoners, prisoners were more likely to present with fever, tachypnea, hypoxemia, and markedly elevated inflammatory markers. Prisoners were more commonly admitted to the intensive care unit (ICU) (26.9% vs. 18.7%), required vasopressors (24.1% vs. 9.9%), and intubated (25.0% vs. 15.2%). Prisoners had higher unadjusted inpatient mortality (29.6% vs. 20.1%) and 30-day mortality (34.3% vs. 24.6%). In the adjusted models, prisoner status was associated with higher in-hospital death (odds ratio, 1.95; 95% confidence interval (CI), 1.07 to 3.57) and 30-day mortality (hazard ratio, 1.92; 95% CI, 1.24 to 2.98). Conclusions: In this cohort of hospitalized Covid-19 patients, prisoner status was associated with more severe clinical presentation, higher rates of ICU admissions, vasopressors requirement, intubation, in-hospital mortality, and 30-day mortality.

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National Temporal Trends in Hospitalization and Inpatient Mortality in Patients with Pulmonary Sarcoidosis in the United States between 2007 - 2018

CHEST Journal ◽

10.1016/j.chest.2021.07.2166 ◽

2021 ◽

Author(s):

Shehabaldin Alqalyoobi ◽

Shu-Yi Liao ◽

Waqas Qureshi ◽

Ogugua Ndili Obi

Keyword(s):

United States ◽

Temporal Trends ◽

The United States ◽

Pulmonary Sarcoidosis ◽

Inpatient Mortality

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Abstract 14759: Burden of Intracranial Hemorrhage in Patients With Acute Myocardial Infarction in the United States, 2000-2017

Circulation ◽

10.1161/circ.142.suppl_3.14759 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sri Harsha Patlolla ◽

Saraschandra Vallabhajosyula

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Length Of Stay ◽

Hospital Mortality ◽

Intracranial Hemorrhage ◽

Temporal Trends ◽

The United States ◽

Circulatory Support ◽

White Race ◽

Hospitalization Costs

Introduction: There is a paucity of contemporary data on the burden of intracranial hemorrhage (ICH) complicating acute myocardial infarction (AMI). Methods: The National Inpatient Sample database (2000 to 2017) was used to evaluate in-hospital burden of ICH in adult (>18 years) AMI admissions. In-hospital mortality, hospitalization costs, length of stay, and measure of functional ability were the outcomes of interest. The discharge destination along with use of tracheostomy and percutaneous endoscopic gastrostomy (PEG) were used to estimate functional burden. Results: Of a total 11,622,528 AMI admissions, 23,422 (0.2%) had concomitant ICH. Compared to those without, admissions with ICH were on average older, female, of non-White race, with greater comorbidities, and higher rates of arrhythmias (all p<0.001). Female sex, non-White race, ST-segment-elevation AMI presentation, use of fibrinolytics, mechanical circulatory support and invasive mechanical ventilation were identified as individual predictors of ICH. The AMI admissions with ICH received less frequent coronary angiography (46.9% vs. 63.8%), percutaneous coronary intervention (22.7% vs. 41.8%), and coronary artery bypass grafting (5.4% vs. 9.2%) as compared to those without (all p<0.001). ICH was associated with a significantly higher in-hospital mortality (41.4% vs. 6.1%; adjusted OR 5.65 [95% CI 5.47-5.84]; p<0.001), and adjusted temporal trends showed a steady decrease in in-hospital mortality over the 18-year period (Figure 1A). AMI-ICH admissions also had longer hospital length of stay, higher hospitalization costs, and greater use of PEG (all p<0.001). In AMI-ICH survivors (N=13, 689), 81.3% had a poor functional outcome indicating severe morbidity and temporal trends revealed a slight increase over the study period (Figure 1B). Conclusions: ICH causes a substantial burden in AMI due to associated higher in-hospital mortality, resource utilization, and poor functional outcomes.

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Using Data Analytics to Predict Hospital Mortality in Sepsis Patients

International Journal of Healthcare Information Systems and Informatics ◽

10.4018/ijhisi.2019070104 ◽

2019 ◽

Vol 14 (3) ◽

pp. 40-57

Author(s):

Yazan Alnsour ◽

Rassule Hadidi ◽

Neetu Singh

Keyword(s):

Hospital Mortality ◽

Predictive Model ◽

Health Care Providers ◽

Prediction Models ◽

Predictive Analytics ◽

Area Under The Curve ◽

The United States ◽

Hospital Death ◽

Care Providers ◽

Chi Square

Predictive analytics can be used to anticipate the risks associated with some patients, and prediction models can be employed to alert physicians and allow timely proactive interventions. Recently, health care providers have been using different types of tools with prediction capabilities. Sepsis is one of the leading causes of in-hospital death in the United States and worldwide. In this study, the authors used a large medical dataset to develop and present a model that predicts in-hospital mortality among Sepsis patients. The predictive model was developed using a dataset of more than one million records of hospitalized patients. The independent predictors of in-hospital mortality were identified using the chi-square automatic interaction detector. The authors found that adding hospital attributes to the predictive model increased the accuracy from 82.08% to 85.3% and the area under the curve from 0.69 to 0.84, which is favorable compared to using only patients' attributes. The authors discuss the practical and research contributions of using a predictive model that incorporates both patient and hospital attributes in identifying high-risk patients.

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In-hospital mortality following carotid endarterectomy

Neurology ◽

10.1212/wnl.51.2.440 ◽

1998 ◽

Vol 51 (2) ◽

pp. 440-447 ◽

Cited By ~ 16

Author(s):

Douglas J. Lanska ◽

Richard J. Kryscio

Keyword(s):

Hospital Mortality ◽

Carotid Endarterectomy ◽

Surgical Complications ◽

Surgical Complication ◽

The United States ◽

Population Based ◽

Third Party ◽

Hospital Death ◽

Stepwise Logistic Regression ◽

Secondary Procedure

Objectives: To determine population-based estimates of in-hospital mortality following carotid endarterectomy (CEA) and identify potential risk factors for in-hospital death.Methods: Data from the Healthcare Cost and Utilization Project (HCUP-3) were analyzed for the year 1993. Nationally representative estimates of risk were calculated by age, sex, race, income, census region, hospital location (urban versus rural), teaching status of hospital, number of hospital beds, hospital ownership, third-party payer, principal procedure, and presence of surgical complications. Multivariate models were developed using stepwise logistic regression and a logit model fit by generalized estimating equations.Results: There were 228 deaths among 18,510 CEAs performed in 17 states of the United States in 1993, yielding an estimated in-hospital mortality rate of 1.2%. Multivariate analysis showed that age, principal procedure, and presence of any surgical complication were significant predictors of in-hospital mortality increased with increasing age (from 0.9% in those younger than 65 years to 1.7% in those age 75 and older) and was markedly higher with CEA performed as a secondary procedure (6.1% versus 0.9%) or with any surgical complication (5.9% versus 0.9%).Conclusions: Increasing age, CEA performed as a secondary procedure, and surgical complications are important predictors of in-hospital mortality following CEA.

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Ethnic Disparities in AL Amyloidosis Outcomes Among Hospitalized Patients in the United States

Blood ◽

10.1182/blood-2021-147060 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4110-4110

Author(s):

Samer Al Hadidi ◽

Deepa Dongarwar ◽

Hamisu Salihu ◽

Carolina Schinke ◽

Sharmilan Thanendrarajan ◽

...

Keyword(s):

Palliative Care ◽

Health Disparities ◽

Hospital Mortality ◽

Conflicts Of Interest ◽

The United States ◽

Hospital Death ◽

Al Amyloidosis ◽

Type I ◽

Care Services ◽

Palliative Care Services

Abstract INTRODUCTION Health disparities in immunoglobulin light chain (AL) amyloidosis have not been well described. We aimed to assess if health disparities between non-Hispanic (NH)-Whites, NH-Blacks and Hispanics exist and to describe differences between different ethnic/racial groups. METHODS We conducted a retrospective cross-sectional analysis of in-patient AL amyloidosis hospitalizations from 2016 to 2018 using the Nationwide Inpatient Sample (NIS), a database which provides nationally representative information on hospitalizations in the U.S. The studied period was chosen to capture data from the ICD-10-CM codes to avoid misclassification of AL amyloidosis which was grouped with other cases of ATTR amyloidosis in the ICD-9-CM coding system. All hospitalizations in adults (age ≥18 years) were included. The exposure for the study was the occurrence of AL amyloidosis in the discharge records. Outcomes were [1] in-hospital death [2] chemotherapy use; [3] intensive care unit (ICU) utilization; [4] palliative care consultation. The analysis for this study was performed using R program version 3.5.1; a 5% type I error rate for all hypothesis tests (two-sided) was assumed. RESULTS Admissions related to AL amyloidosis constituted 0.03% of all hospitalizations in the study period (25,470 of 90,869,381). The prevalence of AL amyloidosis related hospitalizations was higher in NH-Blacks when compared with NH-Whites (42.8 vs.28.1 per 100,000 hospitalizations). AL amyloidosis related in-hospital mortality rate was higher in NH-Whites and Hispanics when compared to NH-Blacks (6.6%% and 6.2% vs. 4.9%). In-hospital mortality with AL amyloidosis was higher in older patients, males and those who self-paid for their treatment. Utilization of ICU care was more common in NH-Blacks when compared to NH-Whites (6% vs. 4.8%). Hispanics had the lowest inpatient chemotherapy use (1.7% vs. 2.9%). Multivariable adjusted association between race/ethnicity and various outcomes showed a trend towards lower in-hospital mortality in NH-Blacks when compared to NH-Whites (OR: 0.76, 95% CI: 0.55-1.05, p=0.09) and lower utilization of palliative care services in NH-Blacks when compared with NH-Whites (OR: 0.61, 95% CI: 0.42-0.88, p=0.01). Despite very low numbers of transplant related admissions, such admissions occurred only in NH-Whites. CONCLUSIONS Our findings highlight disparities in AL amyloidosis care for NH-Blacks and Hispanics. NH-Blacks tend to have lower in-hospital mortality with higher utilization of ICU care, nevertheless, they receive the lowest palliative care services. Despite the higher utilization of ICU care, data suggest possible superior outcomes of AL amyloidosis in NH-Blacks when compared to NH-Whites. Disclosures No relevant conflicts of interest to declare.

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Pregnancy-Related Acute Kidney Injury in the United States: Clinical Outcomes and Health Care Utilization

American Journal of Nephrology ◽

10.1159/000505894 ◽

2020 ◽

Vol 51 (3) ◽

pp. 216-226 ◽

Cited By ~ 4

Author(s):

Silvi Shah ◽

Karthikeyan Meganathan ◽

Annette L. Christianson ◽

Kathleen Harrison ◽

Anthony C. Leonard ◽

...

Keyword(s):

Health Care ◽

Acute Kidney Injury ◽

Health Care Utilization ◽

Clinical Outcomes ◽

Kidney Injury ◽

The United States ◽

Care Utilization ◽

Inpatient Mortality ◽

Factors Associated ◽

Race Ethnicity

Background: Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied. Methods: Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15–49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations. Results: Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95% CI 1.89–2.55) than in 2006; in older women aged 36–40 years (OR 1.49; 95% CI 1.36–1.64) and 41–49 years (OR 2.12; 95% CI 1.84–2.45) than in women aged 20–25 years; in blacks (OR 1.52; 95% CI 1.40–1.65) and Native Americans (OR 1.45; 95% CI 1.10–1.91) than in whites, and in diabetic women (OR 4.43; 95% CI 4.04–4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95% CI 10.47–17.42) and CV events (OR 9.74; 95% CI 9.08–10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447). Conclusion: The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.

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