Prevalence-adjusted trends in U.S. healthcare spending on colorectal cancer, 1996-2016.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18819-e18819
Author(s):  
Igor Stukalin ◽  
Newaz Shubidito Ahmed ◽  
Adam Michael Fundytus ◽  
Siddharth Singh ◽  
Christopher Ma
Keyword(s):  
Colorectal Cancer ◽  
Inpatient Care ◽  
Temporal Trends ◽  
Age Groups ◽  
Healthcare Spending ◽  
Annual Percent Change ◽  
The Us ◽  
Intensity Of Care ◽  
Per Capita ◽  
Global Burden Of Diseases

e18819 Background: Colorectal cancer is rising in prevalence and associated with high healthcare costs. We estimated trends in the US healthcare spending in patients with colorectal cancer between 1996 and 2016. Methods: We used data on national healthcare spending developed by the Institute for Health Metrics and Evaluations for the Disease Expenditure Project. Corresponding US age-specific prevalence of colon cancer was estimated from the Global Burden of Diseases Study. Prevalence-adjusted, temporal trends in the US healthcare spending in patients with colorectal cancer, stratified by age groups ( < 20, 20-44, 45-64, >65) and by type of care (ambulatory, inpatient, emergency department, pharmaceutical prescriptions, nursing care and government administration) were estimated using joinpoint regression, expressed as annual percent change (APC) with 95% confidence intervals. Results: Overall, annual US healthcare spending on colorectal cancer increased from $8.85 billion (95% CI $8.17 billion, $9.53 billion) in 1996 to $10.5 billion (95% CI $9.35 billion, $11.7 billion) in 2016, with total costs increasing by 0.9%/year (95% CI 0.1%, 1.6%). After adjusting for colorectal cancer prevalence, the absolute per capita spending decreased from $8848 to $8427 and there has been no significant change over time (APC 0.3%, 95% CI, -0.2%, 0.8%). However, spending in patients > 65 decreased significantly by 1.3%/year (95% CI -2.2%, -0.5%). Inpatient care was the largest contributor to total colorectal cancer-related expenditures: in 2016, 65.9% (95% CI 59.5%, 71.0%) and 19.7% (95% CI 14.8%, 25.8%) of the total cost were spent on inpatient care and ambulatory care, respectively. Between 1996-2016, increases in the price and intensity of care (defined by the cost per encounter) was the largest positive driver of changing healthcare spending, accounting for $5.02 billion ($2.60, $7.33 billion). Conclusions: After adjusting for rising prevalence, US healthcare spending on colorectal cancer has not changed significantly since 1996, while the per capita cost continues to decrease, primarily in patients > 65 years old. Inpatient care accounts for the majority of colorectal cancer-related expenditures.

Prevalence-adjusted trends in U.S. healthcare spending on upper gastrointestinal cancers, 1996 to 2016.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16064-e16064
Author(s):  
Igor Stukalin ◽  
Newaz Shubidito Ahmed ◽  
Adam Michael Fundytus ◽  
Siddharth Singh ◽  
Christopher Ma
Keyword(s):  
Gastric Cancer ◽  
Esophageal Cancer ◽  
Stomach Cancer ◽  
Inpatient Care ◽  
Healthcare Spending ◽  
Gastrointestinal Cancers ◽  
The Us ◽  
Capita Spending ◽  
Per Capita ◽  
Upper Gastrointestinal

e16064 Background: Upper gastrointestinal cancers are rising in prevalence and associated with high healthcare costs. We estimated trends in the US healthcare spending in patients with esophageal and stomach cancer between 1996 and 2016. Methods: We used data on national healthcare spending developed by the Institute for Health Metrics and Evaluations Disease Expenditure Project. Corresponding prevalence of esophageal and stomach cancer was estimated from the Global Burden of Diseases Study. Prevalence-adjusted, temporal trends in the US healthcare spending in patients with upper gastrointestinal cancer, stratified by age and setting of care (ambulatory, inpatient, emergency department, pharmaceutical prescriptions, nursing care and government administration) were calculated using joinpoint regression, expressed as annual percent change (APC) with 95% confidence intervals. Results: Overall, annual US healthcare spending on esophageal cancer increased from $0.76 billion (95% CI 0.68-0.86) in 1996 to $1.06 billion (95% CI 0.88-1.29) in 2016, although after adjusting for increasing prevalence, there was a significant decrease in per capita spending of -0.4%/year (95% CI -0.7%, -0.1%). Annual US healthcare spending on stomach cancer increased from $1.23 billion (95% CI $1.14 billion - $1.34 billion) in 1996 to $1.49 billion (95% CI $1.20 billion - $2.03 billion) in 2016. Per capita spending increased by 1.8%/year (95% CI 1.4%, 2.1%) between 1996 and 2011, followed by a decrease in gastric cancer-related per capita spending after 2011 (APC -4.4%/year [95% CI -5.8%, -2.9%]). Inpatient care was the largest contributor to total cost of both cancers between 1996-2016: 61.9% for esophageal cancer and 73.1% in gastric cancer in 2016. The rising price and intensity of care (defined as the cost per encounter) was the largest driver of change from 1996-2016 for both cancers, accounting for $0.28 billion (95% CI 0.12-0.41) for esophageal cancer and $0.95 billion (95% CI 0.41-1.39) for stomach cancer. Conclusions: After adjusting for rising prevalence, US per capita healthcare spending on esophageal cancer has decreased significantly since 1996, while per capita spending on gastric cancer has remained stable. Inpatient care was the most significant contributor to costs for both cancers over the time period studied.

scholarly journals Age period cohort analysis in cancers associated with overweight and obesity in Ireland

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Colette O'Neill ◽  
Conan Donnelly
Keyword(s):  
Colorectal Cancer ◽  
Cohort Analysis ◽  
Temporal Trends ◽  
Age Groups ◽  
Overweight And Obesity ◽  
Sufficient Evidence ◽  
International Agency ◽  
Cancer Type ◽  
Annual Percent Change ◽  
Cancer Types

AbstractThe Central Statistics Office (CSO) in Ireland report that 62% of adults were overweight or obese in 2017(1). In 2019, the latest data from the national longitudinal study “Growing Up in Ireland” showed that 15% of five-year olds were overweight and 5% were obese(2). According to WHO projections, Ireland may have the highest prevalence of overweight and obesity in Europe by 2030(3). The International Agency for Research on Cancer (IARC) state there is sufficient evidence for a cancer preventative effect of the absence of excess body fatness for 13 different cancer sites(4). Recent USA based research showed that the risk of developing an obesity-related cancer seems to be increasing in a stepwise manner in successively younger birth cohorts(5), therefore we aimed to investigate trends in the age of obesity related cancer diagnosis.National Cancer Registry Ireland (NCRI) data was obtained for 25 to 84 year olds between 1997 and 2016 for several cancer types and 5-year intervals were constructed to categorise age (25–29, 30–34 etc.) and year of diagnosis (1997–2001, 2002–2006 etc.). An age-period-cohort model was fitted to each cancer type, resulting in estimated temporal trends in incidence (expressed as annual percent change (APC) per year) and significance of the trend across age groups was tested using a Wald test(5).Analysis of NCRI data reflect significantly increasing incidence of colorectal cancer with decreasing age in Ireland (n = 40703, p = 0.00). Despite the limitation of low numbers for several cancer sites in younger age groups, similar trends were observed for a number of cancer types including thyroid and cervical cancer (p < 0.05). Although other factors (such as early detection) may contribute to these observations, addressing the large increase in incidence of obesity and colorectal cancer among young adults is essential. Research to identify exposure to modifiable risk factors, including nutrition and physical activity, throughout life in Ireland is necessary to examine potential determinants of such trends.

scholarly journals A vastag- és végbéldaganat okozta országos epidemiológiai és egészségbiztosítási betegségteher Magyarországon

2021 ◽  
Vol 162 (Supplement-1) ◽  
pp. 14-21
Author(s):  
Zsuzsanna Kívés ◽  
Dóra Endrei ◽  
Diána Elmer ◽  
Tímea Csákvári ◽  
Luca Fanni Kajos ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Insurance ◽  
Inpatient Care ◽  
Age Groups ◽  
International Classification Of Diseases ◽  
Cost Driver ◽  
Insurance Fund ◽  
Insurance Cost ◽  
Care Utilisation ◽  
Classification Of Diseases

Összefoglaló. Bevezetés: Magyarországon a vastag- és a végbéldaganat mindkét nem esetében a harmadik leggyakoribb daganatos megbetegedés és a második leggyakoribb halálok. Célkitűzés: Elemzésünk célja volt a vastag- és végbéldaganat okozta éves epidemiológiai és egészségbiztosítási betegségteher meghatározása Magyarországon. Adatok és módszerek: Az adatok a Nemzeti Egészségbiztosítási Alapkezelő (NEAK) finanszírozási adatbázisából származnak, és a 2018. évet fedik le. A daganat típusait a Betegségek Nemzetközi Osztályozása (BNO, 10. revízió) szerinti C18-as, C19-es, C20-as, C21-es, D010–D014-es és D12-es kóddal azonosítottuk. Meghatároztuk az éves betegszámokat korcsoportos és nemek szerinti bontásban, a prevalenciát 100 000 lakosra, az éves egészségbiztosítási kiadásokat valamennyi ellátási formára és daganattípusra vonatkozóan. Eredmények: A vastag- és végbéldaganatok kezelésére a NEAK 21,7 milliárd Ft-ot (80,2 millió USD; 68,0 millió EUR) költött 2018-ban. A költségek 58,0%-át az aktívfekvőbeteg-szakellátás költségei teszik ki. Az összköltségek megoszlása szerint a legmagasabb költségek a férfiaknál (4,98 milliárd Ft) és a nőknél (3,25 milliárd Ft) is a 65–74 éves korcsoportban figyelhetők meg. A legnagyobb betegszámot a járóbeteg-szakellátás esetében találtuk: 88 134 fő, ezt a háziorvosi ellátás (55 324 fő) és a CT, MRI (28 426 fő) követte. A vastagbél rosszindulatú daganata esetében az egy betegre jutó aktívfekvőbeteg-kassza alapján az éves egészségbiztosítási kiadás 1,206 millió Ft (4463 USD/3782 EUR) volt a férfiak és 1,260 millió Ft (4661 USD/3950 EUR) a nők esetében. Következtetés: Hazánkban az aktívfekvőbeteg-szakellátás bizonyult a fő költségtényezőnek, mely magában foglalja az onkoterápiás gyógyszeres költségeket is. Orv Hetil. 2021; 162(Suppl 1): 14–21. Summary. Introduction: Colorectal cancer is the third most common type of cancer and the second most common cause of mortality in Hungary in both sexes. Objective: The aim of our study was to determine the annual epidemiological disease burden and health insurance cost of colorectal cancer in Hungary. Data and methods: Data were derived from the financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. Types of cancer were identified with the following codes of the International Classification of Diseases, 10th revision: C18, C19, C20, C21, D010–D014, D12. The data analysed included annual patient numbers according to age groups and sex, prevalence of care utilisation per 100 000 population, and annual health insurance costs for all types of care and all cancer types. Results: In 2018, NHIFA spent 21.7 billion HUF (80.2 million USD, 68.0 million EUR) on the treatment of colorectal cancer. 58.0% of the costs was spent on acute inpatient care. Regarding total costs, the highest costs were found in the 65–74 age group in both men (4.98 billion HUF) and women (3.25 billion HUF). The highest patient numbers were in outpatient care: 88 134 patients, general practice care (55 324 patients) and CT, MRI (28 426 patients). The annual health care treatment cost per patient was 1.206 million HUF (4463 USD/3782 EUR) in men and 1.260 million HUF (4661 USD/3950 EUR) in women. Conclusion: Acute inpatient care, including the costs of oncotherapeutic pharmaceuticals, was found to be the major cost driver in Hungary. Orv Hetil. 2021; 162(Suppl 1): 14–21.

scholarly journals MORTALITY RISK OF COLORECTAL CANCER IN BRAZIL FROM 1980 TO 2013

2016 ◽  
Vol 53 (2) ◽  
pp. 76-83 ◽  
Author(s):  
Ronaldo Coimbra OLIVEIRA ◽  
Marco Antônio Vasconcelos RÊGO
Keyword(s):  
Colorectal Cancer ◽  
Cancer Mortality ◽  
Statistical Tests ◽  
Age Groups ◽  
Developed Countries ◽  
Mortality Rates ◽  
Significance Level ◽  
Risk Of Death ◽  
The Us ◽  
Colorectal Cancer Mortality

ABSTRACT Background - Colorectal cancer is one of the most common cancer worldwide, and variation in its mortality rates indicates the importance of environmental factors in its occurrence. While trend studies have indicated a reduction in colorectal cancer mortality rates in most developed countries, the same trends have not been observed in developing countries. Moreover, trends may differ when analyzed by age and sex. Objective - The present study aimed to analyze the trends in risk of colorectal cancer death in Brazil based on sex and age group. Methods - Death records were obtained from the Mortality Information System of the Ministry of Health. The risk of death and the average annual percent changes (AAPC) in the mortality rates were estimated using joinpoint analysis of long-term trends from 1980 to 2013. All of the statistical tests were two-sided and had a significance level of 5%. Results - Colorectal cancer mortality rates were found to have increased in the last 15 years for both sexes and for all age ranges. The rate ratio (RR) was statistically higher at ages 70 to 79 for men (RR: 1.37; 95% CI: 1.26; 1.49) compared to women (RR: 1.14; 95% CI: 1.06; 1.24). Increases in AAPC were observed in both sexes. Although men presented higher percent changes (AAPC: 1.8; 95% CI: 1.1; 2.6) compared to women (AAPC: 1.2; 95% CI: 0.4; 2.0), this difference was not statistically significant. Growth trends in mortality rates occurred in all age groups except for in women over 70. Conclusion - Unlike Europe and the US, Brazil has shown increases in death rates due to colorectal cancer in the last three decades; however, more favorable trends were observed in women over 70 years old. The promotion of healthier lifestyles in addition to early diagnosis and improved treatment should guide the public health policies targeting reductions in colorectal cancer.

Survival from Acute Lymphoblastic Leukemia (ALL) in Adult Patients in the United States and Sweden: Evidence of Recent Improvement

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 938-938
Author(s):  
Edgren Gustaf ◽  
Magnus Björkholm ◽  
Per Bernell ◽  
Helene Hallböök ◽  
Paul W Dickman
Keyword(s):  
Temporal Trends ◽  
Age Groups ◽  
Relative Survival ◽  
The United States ◽  
Adult Patients ◽  
Survival Ratio ◽  
The Us ◽  
Seer Data ◽  
Pediatric All ◽  
End Results

Abstract Introduction The improvement in pediatric ALL survival rates observed since the 1970xs has been achieved through a series of carefully conducted randomized controlled, multi-institutional clinical trials. Alas, despite more precise risk stratification and widespread implementation of aggressive treatment protocols results in adults (including young adults) lag behind those in children. For example, a recent study estimated the overall 5-year relative survival of adult ALL patients diagnosed in 2002-06 in Germany and the United States (US) at 43.4% and 35.5%, respectively. While survival was better in younger patients, with 5-year relative survival ratios of 59.2% (Germany) and 54.9% (US) in patients aged 15-24 years, the lack of curative treatment for the majority of adult patients is obvious. In recognition of a recent shift of the treatment for younger adult ALL patients in Sweden, with increasing use of pediatric protocols up to age 45 as well as introduction of imatinib for patients with Philadelphia-positive ALL, we compared the overall and age specific relative survival of adult ALL patients in Sweden and the US Surveillance, Epidemiology and End Results (SEER) database with emphasis on temporal trends. Methods We used data from the SEER 9 database (which covers approximately 9% of the US population) and the nationwide Swedish cancer register to determine the survival of adults (aged 18-84) diagnosed with ALL in the period 1980-2011. To improve comparability with Sweden, the SEER data were restricted to whites (82% of all patients). We studied temporal trends in relative survival for four predefined age groups: 18-29, 30-44, 45-64, and 65-84 years at diagnosis. Relative survival was estimated using flexible parametric models with year of diagnosis modelled as a restricted cubic spline with 3 degrees of freedom. Separate models were fitted for Sweden and the SEER data, each containing age, year, and an age by year interaction. The effects of age and year were allowed to be non-proportional. Model goodness of fit was assessed by comparing the model-based estimates of relative survival to empirical (life table) estimates. Because patients diagnosed in 2010 could only be followed up until the end of 2011, the estimates of 5-year relative survival for these patients are based on statistical prediction. We therefore also compared 1-year survival, which could be directly estimated. Results Our analysis included 3,539 and 1,391 patients with ALL in the US and Sweden, respectively. The mean ages were similar in the two countries, 48.1 (US) and 51.6 (Sweden); as was the distribution in the four age groups. In both countries we saw a trend towards better survival in patients diagnosed in recent years, as well as an age gradient with better relative survival for younger patients. However, a larger temporal improvement was noted in patients younger than 45 years at diagnosis in Sweden than in the US (p<0.05). Strikingly, in Sweden the 5-year RSR of patients aged 18-29 at diagnosis improved from 0.56 (95% CI, 0.43-0.66) for those diagnosed in 2000 to 0.82 (95% CI, 0.63-0.92) for those diagnosed in 2010. The corresponding estimates for the SEER data were 0.51 (95% CI, 0.44-0.57) and 0.53 (95% CI, 0.39-0.65) for patients diagnosed in 2000 and 2010, respectively. Similar results were seen for patients age 30-45 at diagnosis. Conclusions The survival of adult patients with ALL has improved gradually in both the US and Sweden during the past decades. The most dramatic improvement was seen in patients age 18-29 and 30-44 years diagnosed in the most recent years in Sweden, with 5-year relative survival of 82% and 66%, respectively. As we lack detailed clinical data including information on treatment and supportive care, we are unable to confidently identify what factors account for the important differences in survival between the two countries. However, the widespread and standardized implementation of a pediatric ALL protocol adapted for adults in Sweden seems a likely success factor. Figure 1 One and 5-year relative survival ratios by year of diagnosis and age at diagnosis for Sweden and the US SEER data Footnote: RSR denotes relative survival ratio; SEER denotes Surveillance, Epidemiology and End Results. Figure 1. One and 5-year relative survival ratios by year of diagnosis and age at diagnosis for Sweden and the US SEER data. / Footnote: RSR denotes relative survival ratio; SEER denotes Surveillance, Epidemiology and End Results. Disclosures No relevant conflicts of interest to declare.

Incidence patterns of early onset colon cancer by race and stage in the US.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18168-e18168
Author(s):  
Nishi Shah ◽  
Ana Acuna-Villaorduna ◽  
Sanjay Goel
Keyword(s):  
Colon Cancer ◽  
American Indians ◽  
Early Onset ◽  
Age Groups ◽  
Young Patients ◽  
Cancer Registries ◽  
Age Group ◽  
Annual Percent Change ◽  
Percent Change ◽  
The Us

e18168 Background: Several studies show that incidence of colorectal cancer is increasing among young individuals. However, information on incidence of early onset colon cancer by race and stage is lacking. Methods: We analyzed incidence of colon cancer using National Program of Cancer Registries database which covers 99% of the US population. We identified colon cancer using ICD-O-3 code 8000-9049, 9056-9139, 9141-9589, along with the variable for site from cecum to sigmoid colon for years 2001 to 2015. SEER*Stat was used to calculate age-adjusted rates, trends and annual percent change. Results: Age adjusted incidence rate for colon is 31.2 cases per 100,000 among the entire population. Incidence in the age group of 15-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, 80+ years is 2.4, 14.3, 39.8, 86, 165.8, 232.3 per 100,000 respectively. The distribution of colon cancer by race for age groups is listed in table. When evaluating the incidence trend in each race for early onset colon cancer, the trend shows a rise in whites for both age groups (Annual Percent Change [APC] 3.4%, 1.5% for 15-39 years, 40-49 years of age respectively, p < 0.05). The trend in blacks on the other hand shows a rise of 1.2% (p < 0.05) in 15-39 years of age and a small but statistically significant decrease in incidence in 40-49 years of 0.5% (p < 0.05). In Asian Pacific Islanders (API) and American-Indians or Alaskan Natives (AI), the trend is not significant for either age groups. In the age groups above 50 years, the trend shows a decrease in incidence of colon cancer in all races. The rise in incidence for colon cancer in 15-39 years age group appears higher in localized disease as compared to metastatic disease (6.5% vs 2.8% for localized vs distant site of disease). Conclusions: This study highlights differences in incidence of early onset colon cancer among young patients by race and stage. Although there have been more cases of early onset colon cancers in blacks, the rise in incidence is higher in whites. With colonoscopy, there has been decrease in incidence of colon cancer for patients > 50 years for all races and stages. [Table: see text]

scholarly journals Trends in the Utilization of Radiation Therapy (XRT) Among Patients with Non-Hodgkin's Lymphoma (NHL) in the United States (US)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4765-4765
Author(s):  
Vivek Kumar ◽  
Taimur Sher ◽  
Prakash Vishnu ◽  
Vivek Roy ◽  
Anne M Hazen ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Age Groups ◽  
The United States ◽  
Significant Decline ◽  
P Value ◽  
Significant Heterogeneity ◽  
Cell Transplant ◽  
Annual Percent Change ◽  
The Us ◽  
Facility Level

Abstract Background: The treatment of NHL has witnessed a paradigm shift over time, with targeted immunotherapy, stem cell transplant (SCT) among others. Historically, XRT was used quite frequently for the management of NHL but with advent of better systemic therapy, its utilization has changed. Trends and patterns of care for XRT use have never been formally reported. Methods: We identified patients with NHL diagnosis in the National Cancer Database (NCDB) between years 2004 and 2015. Demographic, clinical, facility level, initial treatment and outcome data were collected. The utilization of XRT in diffuse large B-cell (DLBCL) and non-DLBCL NHL were analyzed separately by univariate and multivariate analyses. To analyze the trends in the rates of XRT, we applied segmented linear regression to calculate the average annual percent change (AAPC) and 95% confidence Interval (CI) with a 'p' value. AAPC and CIs were calculated using the segmented package in R studio v1.1.49. Rest of the analyses was conducted using StataCorp version 15.1. Results: A total of 133,182 DLBCL and 204,933 non-DLBCL patients were identified. Among patients with DLBCL, 27,895 (20.9%) patients received RT. The rate of XRT declined from 25% in 2004 to 18.4% in 2015 with estimated AAPC of -0.59% (95%CI: -0.70- -0.49), p= 0.03 (Figure 1). In a subgroup analysis, a similar decline in the rate of XRT was evident across all the age groups, combined stages I and II vs stages III and IV and nodal vs extra nodal DLBCL (Table 1). Among non DLBCL, 33,369 (16.3%) patients received XRT. There was a statistically significant decline in the rate of XRT from 18.03% in 2004 to 16.3% in 2014 with an AAPC of -0.26 (95%CI: -0.38- -0.14) p <0.001 (Figure 1). On the subgroup analysis, the utilization of XRT declined across all the studied subgroups except among patients aged 80 years and above (Table 1). On multivariate analysis, several demographic, clinical and facility level factors were found to be significantly associated with XRT utilization in NHL (Table 2). In particular, older age groups, racial/ethnic minorities, advanced stages, higher Charlson comorbidity scores and diagnosis in the more recent calendar years were associated with lesser chances of receiving RT. Extranodal DLBCL had lower utilization while extranodal non-DLBCL had increased XRT utilization. Conclusion: There has been a significant decline in the utilization of XRT among patients with NHL (DLBCL and non-DLBCL) in the US since 2004, likely due to introduction of practice changing systemic therapeutics. There is still significant heterogeneity noted in practice patterns regarding utilization of XRT across the US. Having more standardized guidelines will help streamline delivery of evidence-based patient care. Disclosures Ailawadhi: Celgene: Consultancy; Janssen: Consultancy; Amgen: Consultancy; Takeda: Consultancy; Pharmacyclics: Research Funding.

Abstract 270: Temporal Trends in Heart Failure Mortality in an Integrated Healthcare Delivery System, California and the US, 2001-2017

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Matthew Mefford ◽  
Zimin Zhuang ◽  
Zhi Liang ◽  
Wansu Chen ◽  
Heather Watson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Temporal Trends ◽  
Healthcare Delivery ◽  
Mortality Rates ◽  
Healthcare Delivery System ◽  
Kaiser Permanente ◽  
Annual Percent Change ◽  
The Us ◽  
State Death ◽  
Us Census

Background: In recent years declines in the rate of mortality attributable to cardiovascular diseases have slowed and mortality attributable to heart failure (HF) has increased. Objective: To examine secular trends in mortality with HF as the underlying cause in Kaiser Permanente Southern California (KPSC), California, and the US among adults 45 years of age and older from 2001 and 2017. Methods: KPSC mortality rates with HF as an underlying cause from 2001 to 2017 were derived through linkage with California State death files and were compared with rates in California and the US. Rates were age-standardized to the 2000 US Census population. Trends were examined overall and among men and women, separately, using best-fit Joinpoint regression models. Average annual percent change (AAPC) and 95% confidence intervals (CI) were calculated for the overall study period, and within earlier (2001-2011) and later (2011-2017) time periods. Results: Between 2001-2017, age-adjusted mortality rates with HF as the underlying cause were lower comparing KPSC to California and the US. In KPSC, rates increased from 23.9 to 44.7 per 100,000 person-years (PY) in KPSC, representing an AAPC of 1.3% (95% CI 0.0%, 2.6%). (Table) During the same time period, HF mortality rates in California also increased from 33.9 to 46.5 per 100,000 PY (AAPC 1.5%, 95% CI 0.3%, 2.7%), while remaining unchanged in the US at 57.9 per 100,000 PY in 2001 and 2017 (AAPC 0.0%, 95% CI -0.5%, 0.5%). AAPCs were not statistically different comparing KPSC to both California and the US (all p > 0.05). Between 2001-2011, rates of HF mortality increased in KPSC (AAPC 1.3%, 95% CI 0.0, 2.6), non-significantly increased in California (AAPC 0.2%, 95% CI -0.8%, 1.2%) and decreased in the US (AAPC -2.1%, 95% CI -2.7%, -1.5%). Between 2011-2017, rates of HF mortality increased in KPSC (AAPC 1.3%, 95% CI 0.0%, 2.6%), California (AAPC 3.7%, 95% CI 1.0%, 6.5%), and the US (AAPC 3.6%, 95% CI 2.4%, 4.8%) except among KPSC women (AAPC 0.3% [95% CI -1.6%, 2.2%]). Conclusion: Despite increases in HF mortality after 2011, rates of HF mortality were lower among KPSC compared to California and the US. Given the mortality burden of HF at older age, there is a need to improve HF prevention, treatment and management efforts earlier in life.

scholarly journals Temporal trends in heart failure mortality in an integrated healthcare delivery system, California, and the US, 2001–2017

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthew T. Mefford ◽  
Zimin Zhuang ◽  
Zhi Liang ◽  
Wansu Chen ◽  
Sandra Y. Koyama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Temporal Trends ◽  
Healthcare Delivery ◽  
Mortality Rates ◽  
Healthcare Delivery System ◽  
Kaiser Permanente ◽  
Related Factors ◽  
Annual Percent Change ◽  
The Us ◽  
State Death

Abstract Background In recent years, decreases in mortality rates attributable to cardiovascular diseases have slowed but mortality attributable to heart failure (HF) has increased. Methods Between 2001–2017, trends in age-adjusted mortality with HF as an underlying cause for Kaiser Permanente Southern California (KPSC) members were derived through linkage with state death files and compared with trends among California residents and the US. Average annual percent change (AAPC) and 95% confidence intervals (CI) were calculated using Joinpoint regression. Analyses were repeated examining HF as a contributing cause of death. Results In KPSC, the age-adjusted HF mortality rates were comparable to California but lower than the US, increasing from 23.9 per 100,000 person-years (PY) in 2001 to 44.7 per 100,000 PY in 2017, representing an AAPC of 1.3% (95% CI 0.0%, 2.6%). HF mortality also increased in California from 33.9 to 46.5 per 100,000 PY (AAPC 1.5%, 95% CI 0.3%, 2.7%), while remaining unchanged in the US at 57.9 per 100,000 PY in 2001 and 2017 (AAPC 0.0%, 95% CI − 0.5%, 0.5%). Trends among KPSC members ≥ 65 years old were similar to the overall population, while trends among members 45–64 years old were flat between 2001–2017. Small changes in mortality with HF as a contributing cause were observed in KPSC members between 2001 and 2017, which differed from California and the US. Conclusion Lower rates of HF mortality were observed in KPSC compared to the US. Given the aging of the US population and increasing prevalence of HF, it will be important to examine individual and care-related factors driving susceptibility to HF mortality.

Trends in U.S. Health Care Spending on Inflammatory Bowel Diseases, 1996-2016

2021 ◽  
Author(s):  
Siddharth Singh ◽  
Alexander S Qian ◽  
Nghia H Nguyen ◽  
Stephanie K M Ho ◽  
Jiyu Luo ◽  
...  
Keyword(s):  
Health Care ◽  
Confidence Interval ◽  
Inflammatory Bowel Diseases ◽  
Temporal Trends ◽  
Age Groups ◽  
Care Utilization ◽  
Health Care Spending ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Global Burden Of Diseases

Abstract Background Inflammatory bowel diseases (IBD) are rising in prevalence and are associated with high health care costs. We estimated trends in U.S. health care spending in patients with IBD between 1996 and 2016. Methods We used data on national health care spending developed by the Institute for Health Metrics and Evaluations for the Disease Expenditure Project. We estimated corresponding U.S. age-specific prevalence of IBD from the Global Burden of Diseases Study. From these 2 sources, we estimated prevalence-adjusted, temporal trends in U.S. health care spending in patients with IBD, stratified by age groups (&lt;20 years, 20-44 years, 45-64 years, ≥65 years) and by type of care (ambulatory, inpatient, emergency department [ED], pharmaceutical prescriptions, and nursing care), using joinpoint regression, expressed as an annual percentage change (APC) with 95% confidence intervals. Results Overall, annual U.S. health care spending on IBD increased from $6.4 billion (95% confidence interval, 5.7-7.4) in 1996 to $25.4 billion (95% confidence interval, 22.4-28.7) in 2016, corresponding to a per patient increase in annual spending from $5714 to $14,033. Substantial increases in per patient spending on IBD were observed in patients aged ≥45 years. Between 2011 and 2016, inpatient and ED care accounted for 55.8% of total spending and pharmaceuticals accounted for 19.9%, with variation across age groups (inpatient/ED vs pharmaceuticals: ages ≥65 years, 57.6% vs 11.2%; ages 45-64 years, 49.5% vs 26.9%; ages 20-44 years, 59.2% vs 23.6%). Conclusions Even after adjusting for rising prevalence, U.S. health care spending on IBD continues to progressively increase, primarily in middle-aged and older adults, with unplanned health care utilization accounting for the majority of costs.

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