A population-based matched cohort study examining the mortality and costs of patients with community-onset Clostridium difficile infection identified using emergency department visits and hospital admissions

BACKGROUNDHigh-quality cost estimates for hospital-acquired Clostridium difficile infection (CDI) are vital evidence for healthcare policy and decision-making.OBJECTIVETo evaluate the costs attributable to hospital-acquired CDI from the healthcare payer perspective.METHODSWe conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with CDI (those with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada code A04.7) from January 1, 2003, through December 31, 2010, in Ontario, Canada. Infected subjects were matched to uninfected subjects (those without the code A04.7) on age, sex, comorbidities, geography, and other variables, and followed up through December 31, 2011. We stratified results by elective and nonelective admissions. The main study outcomes were up-to-3-year costs, which were evaluated in 2014 Canadian dollars.RESULTSWe identified 28,308 infected subjects (mean annual incidence, 27.9 per 100,000 population, 3.3 per 1,000 admissions), with a mean age of 71.5 years (range, 0–107 years), 54.0% female, and 8.0% elective admissions. For elective admission subjects, cumulative mean attributable 1-, 2-, and 3-year costs adjusted for survival (undiscounted) were $32,151 (95% CI, $28,192–$36,005), $34,843 ($29,298–$40,027), and $37,171 ($30,364–$43,415), respectively. For nonelective admission subjects, the corresponding costs were $21,909 ($21,221–$22,609), $26,074 ($25,180–$27,014), and $29,944 ($28,873–$31,086), respectively.CONCLUSIONSHospital-acquired CDI is associated with substantial healthcare costs. To the best of our knowledge, this study is the first CDI costing study to present longitudinal costs. New strategies may be warranted to mitigate this costly infectious disease.Infect Control Hosp Epidemiol 2016;37:1068–1078

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Unplanned index hospital admissions among new older high-cost health care users in Ontario: a population-based matched cohort study

CMAJ Open ◽

10.9778/cmajo.20180185 ◽

2019 ◽

Vol 7 (3) ◽

pp. E537-E545 ◽

Cited By ~ 2

Author(s):

Sergei Muratov ◽

Justin Lee ◽

Anne Holbrook ◽

J. Michael Paterson ◽

Jason R. Guertin ◽

...

Keyword(s):

Health Care ◽

Cohort Study ◽

Hospital Admissions ◽

Population Based ◽

Matched Cohort ◽

Matched Cohort Study ◽

Index Hospital

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206 – Increased Emergency Department Visits and Hospitalizations for Infectious Diseases in Patients with Elderly-Onset Inflammatory Bowel Disease: A Population-Based Matched Cohort Study

Gastroenterology ◽

10.1016/s0016-5085(19)36887-8 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-42-S-43 ◽

Cited By ~ 1

Author(s):

Ellen Kuenzig ◽

Sanjay K. Murthy ◽

Therese A. Stukel ◽

Geoffrey C. Nguyen ◽

Gilaad Kaplan ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Emergency Department ◽

Cohort Study ◽

Infectious Diseases ◽

Bowel Disease ◽

Population Based ◽

Emergency Department Visits ◽

Matched Cohort ◽

Elderly Onset ◽

Inflammatory Bowel

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Faculty Opinions recommendation of Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733524969.793548255 ◽

2018 ◽

Author(s):

Andie Lee

Keyword(s):

Staphylococcus Aureus ◽

Cohort Study ◽

Clostridium Difficile ◽

Population Based ◽

Penicillin Allergy ◽

Matched Cohort ◽

Matched Cohort Study

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Use of health services in the last year of life and cause of death in people with intellectual disability: a retrospective matched cohort study

BMJ Open ◽

10.1136/bmjopen-2017-020268 ◽

2018 ◽

Vol 8 (2) ◽

pp. e020268 ◽

Cited By ~ 8

Author(s):

Kate Brameld ◽

Katrina Spilsbury ◽

Lorna Rosenwax ◽

Helen Leonard ◽

James Semmens

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Intellectual Disability ◽

Cause Of Death ◽

Western Australia ◽

Hospital Admissions ◽

Average Length ◽

Matched Cohort ◽

Matched Cohort Study ◽

Covariate Balance

ObjectiveTo describe the cause of death together with emergency department presentations and hospital admissions in the last year of life of people with intellectual disability.MethodA retrospective matched cohort study using de-identified linked data of people aged 20 years or over, with and without intellectual disability who died during 2009 to 2013 in Western Australia. Emergency department presentations and hospital admissions in the last year of life of people with intellectual disability are described along with cause of death.ResultsOf the 63 508 deaths in Western Australia from 2009 to 2013, there were 591 (0.93%) decedents with a history of intellectual disability. Decedents with intellectual disability tended to be younger, lived in areas of more social disadvantage, did not have a partner and were Australian born compared with all other decedents. A matched comparison cohort of decedents without intellectual disability (n=29 713) was identified from the general population to improve covariate balance.Decedents with intellectual disability attended emergency departments more frequently than the matched cohort (mean visits 3.2 vs 2.5) and on average were admitted to hospital less frequently (mean admissions 4.1 vs 6.1), but once admitted stayed longer (average length of stay 5.2 days vs 4.3 days). People with intellectual disability had increased odds of presentation, admission or death from conditions that have been defined as ambulatory care sensitive and are potentially preventable. These included vaccine-preventable respiratory disease, asthma, cellulitis and convulsions and epilepsy.ConclusionPeople with intellectual disability were more likely to experience potentially preventable conditions at the end of their lives. This indicates a need for further improvements in access, quality and coordination of healthcare to provide optimal health for this group.

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