scholarly journals In-hospital mortality in patients with acute limb ischemia over a 12-year period in the Brazilian public health-care system

2021 ◽  
Vol 20 ◽  
Author(s):  
João Henrique Fonseca do Nascimento ◽  
André Gusmão Cunha ◽  
André Bouzas de Andrade ◽  
Monique Magnavita Borba da Fonseca Cerqueira
Keyword(s):  
Public Health ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Public Health Problem ◽  
Secondary Data ◽  
Limb Ischemia ◽  
Public Health Care ◽  
Acute Limb Ischemia ◽  
Atypical Manifestations ◽  
Icd 10

Abstract Background Arterial diseases represent a severe public health problem in the 21st century. Although men have a higher overall prevalence, reports have suggested that women may exhibit atypical manifestations, be asymptomatic, and have hormonal peculiarities, resulting in worse outcomes and severe emergencies, such as acute limb ischemia (ALI). Objectives To analyze the morbidity and mortality profile of ALI emergencies in Brazil between 2008 and 2019. Methods An ecological study was carried out with secondary data from SIH/SUS, using ICD-10 code I.74 The proportions of emergency hospital admissions and in-hospital mortality rates (HMR) by gender, ethnicity, and age were extracted from the overall figures. P<0.05 was considered significant. Results From 2008 to 2019, there were 195,567 urgent hospitalizations due to ALI in Brazil, 111,145 (56.8%) of which were of men. Women had a higher HMR (112:1,000 hospitalizations) than men (85:1,000 hospitalizations) (p<0.05), and a higher chance of death (OR=1.36; p<0.05). Furthermore, mean survival was significantly higher among men (8,483/year versus 6,254/year; p<0.05). Stratified by ethnicity, women who self-identified as white (OR=1.44; p<0.05), black (OR=1.33; p<0.05), and brown (RR=1.25; p <0.05) had greater chances of death than men in the same ethnicity categories. Moreover, women over the age of 50 years had a higher chance of death, with a progressive increment in risk as age increased. Conclusions There was a trend to worse prognosis in ALI emergencies associated with women, especially in older groups. The literature shows that the reasons for these differences are still poorly investigated and more robust studies of this relevant disease in the area of vascular surgery are encouraged.

scholarly journals Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

2020 ◽  
Vol 109 (12) ◽  
pp. 1540-1548 ◽  
Author(s):  
Moritz Seiffert ◽  
Fabian J. Brunner ◽  
Marko Remmel ◽  
Götz Thomalla ◽  
Ursula Marschall ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Insurance ◽  
Hospital Admissions ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
St Segment Elevation ◽  
Admission Rates ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Health Insurance Claims

Abstract Aims The first reports of declining hospital admissions for major cardiovascular emergencies during the COVID-19 pandemic attracted public attention. However, systematic evidence on this subject is sparse. We aimed to investigate the rate of emergent hospital admissions, subsequent invasive treatments and comorbidities during the COVID-19 pandemic in Germany. Methods and results This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for acute myocardial infarction, acute limb ischemia, aortic rupture, stroke or transient ischemic attack (TIA) between January 1, 2019, and May 31, 2020, were included. Admission rates per 100,000 insured, invasive treatments and comorbidities were compared from January–May 2019 (pre-COVID) to January–May 2020 (COVID). A total of 115,720 hospitalizations were included in the current analysis (51.3% females, mean age 72.9 years). Monthly admission rates declined from 78.6/100,000 insured (pre-COVID) to 70.6/100,000 (COVID). The lowest admission rate was observed in April 2020 (61.6/100,000). Administration rates for ST-segment elevation myocardial infarction (7.3–6.6), non-ST-segment elevation myocardial infarction (16.8–14.6), acute limb ischemia (5.1–4.6), stroke (35.0–32.5) and TIA (13.7–11.9) decreased from pre-COVID to COVID. Baseline comorbidities and the percentage of these patients treated with interventional or open-surgical procedures remained similar over time across all entities. In-hospital mortality in hospitalizations for stroke increased from pre-COVID to COVID (8.5–9.8%). Conclusions Admission rates for cardiovascular and cerebrovascular emergencies declined during the pandemic in Germany, while patients’ comorbidities and treatment allocations remained unchanged. Further investigation is warranted to identify underlying reasons and potential implications on patients’ outcomes. Graphic abstract

Burden of hospitalisation among older people in the Brazilian public health system: a big data analysis from 2009 to 2015

2019 ◽  
Vol 73 (6) ◽  
pp. 537-543 ◽  
Author(s):  
Roger Daglius Dias ◽  
Jacson Venancio de Barros
Keyword(s):  
Public Health ◽  
Hospital Mortality ◽  
Older People ◽  
Health System ◽  
Hospital Admissions ◽  
Public Health System ◽  
Average Length ◽  
Admission Rate ◽  
Older Population ◽  
Icu Admission

BackgroundThe world’s population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older (>60 years) compared with non-older population, as well as the epidemiology of these hospital admissions.MethodsUsing the Brazilian Unified Health System (known as ‘Sistema Único de Saúde’ (SUS)), an analysis of all hospital admissions of adult patients in the SUS from 2009 to 2015 was undertaken. The following indicators were used: hospital admission rate, intensive care unit (ICU) admission rate, average length of hospital and ICU stay, hospital mortality and average reimbursement per hospitalisation.ResultsA total of 61 958 959 admissions during the 7-year period, were analysed, encompassing 17 893 392 (28.9%) older patients. Elderly represent 15% (n=21 294 950) of the Brazilian adult population, but are responsible for 29% (n=17 893 392) of hospitalisations, 52% (n=1 731 299) of ICU admissions and 66% (n=1 885 291) of hospital mortality. Among the adults, elderly represents 39% of the total reimbursement made related to admission/hospitalisation. For 2009 to 2015, while the older population increased 27%, ICU admission rate increased 20%; the average length of ICU stay was 12% higher in 2015 (6.5 days) compared with 2009 (5.8 days); and the hospital mortality increased from 9.8% to 11.2%.ConclusionThese findings illustrate the current panorama of the burden due to hospitalisation of older people in the Brazilian public health system, and evidence the consolidation of the epidemiological transition toward the predominance of non-communicable diseases as the main cause of hospitalisation among the elderly in Brazil.

scholarly journals Hospital Admissions Related to Tuberculosis in Brazil: Epidemiological and Economic Profile, from the Public Health Care Perspective

2013 ◽  
Vol 16 (7) ◽  
pp. A347
Author(s):  
L.M. Amaral ◽  
R.A. Fernandes ◽  
M. Takemoto ◽  
J.F. Vasconcellos ◽  
L.C. Haas ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Hospital Admissions ◽  
Public Health Care ◽  
The Public ◽  
Economic Profile

scholarly journals The impact of asthma in Brazil: a longitudinal analysis of data from a Brazilian national database system

2017 ◽  
Vol 43 (3) ◽  
pp. 163-168 ◽  
Author(s):  
Thiago de Araujo Cardoso ◽  
Cristian Roncada ◽  
Emerson Rodrigues da Silva ◽  
Leonardo Araujo Pinto ◽  
Marcus Herbert Jones ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admissions ◽  
Indirect Costs ◽  
Mortality Rates ◽  
Absolute Number ◽  
Public Health Care ◽  
National Database ◽  
Hospitalization Costs ◽  
The Absolute ◽  
The Impact

ABSTRACT Objective: To present official longitudinal data on the impact of asthma in Brazil between 2008 and 2013. Methods: This was a descriptive study of data collected between 2008 and 2013 from an official Brazilian national database, including data on asthma-related number of hospitalizations, mortality, and hospitalization costs. A geographical subanalysis was also performed. Results: In 2013, 2,047 people died from asthma in Brazil (5 deaths/day), with more than 120,000 asthma-related hospitalizations. During the whole study period, the absolute number of asthma-related deaths and of hospitalizations decreased by 10% and 36%, respectively. However, the in-hospital mortality rate increased by approximately 25% in that period. The geographic subanalysis showed that the northern/northeastern and southeastern regions had the highest asthma-related hospitalization and in-hospital mortality rates, respectively. An analysis of the states representative of the regions of Brazil revealed discrepancies between the numbers of asthma-related hospitalizations and asthma-related in-hospital mortality rates. During the study period, the cost of asthma-related hospitalizations to the public health care system was US$ 170 million. Conclusions: Although the numbers of asthma-related deaths and hospital admissions in Brazil have been decreasing since 2009, the absolute numbers are still high, resulting in elevated direct and indirect costs for the society. This shows the relevance of the burden of asthma in middle-income countries.

scholarly journals Neutrophil-to-lymphocyte ratio associated with an increased risk of mortality in patients with critical limb ischemia

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252030
Author(s):  
Min-I. Su ◽  
Cheng-Wei Liu
Keyword(s):  
Hospital Mortality ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Neutrophil To Lymphocyte Ratio ◽  
Major Adverse Cardiovascular Events ◽  
Acute Limb Ischemia ◽  
Male Body ◽  
Lymphocyte Ratio ◽  
Increased Risk ◽  
Related Mortality

Purpose Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI. Materials and methods We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs). Results Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075–13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292–6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008–1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998–1.057, P = 0.073) mortality but not in-hospital mortality or MACEs. Conclusion CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

scholarly journals Effect of Acute Limb Ischemia on the Mortality of Patients with Extracorporeal Membrane Oxygenation Established by Femoral Vein-Arterial Catheterization and Analysis of Related Risk Factors

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xiang Li ◽  
Guang Chen ◽  
Sheng Zhang ◽  
Xinting Zheng ◽  
Wenjun Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Risk Factor ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Cardiopulmonary Failure ◽  
Va Ecmo ◽  
Associated Risk Factors

Extracorporeal membrane oxygenation (ECMO) is a common treatment for cardiopulmonary failure. Although it can effectively reduce the mortality of patients with cardiopulmonary failure, it still has a high mortality rate, such as acute limb ischemia (ALI), stroke, liver and kidney failure, and other related complications and related causes of death. This study aims to explore the impact of ALI on the mortality of VA-ECMO patients in hospital and 6 months after discharge and analyze the occurrence of ALI and related factors that affect the mortality of VA-ECMO in hospital and 6 months after discharge. The results showed that the smoking history was an independent risk factor for ALI, and age, diabetes, cardiac arrest, first time of ECMO, and hyperbilirubinemia were associated risk factors for in-hospital mortality. Cardiac arrest and ALI were associated risk factors for mortality at 6 months after discharge. Although ALI is not significantly associated with VA-ECMO in-hospital mortality, it is a risk factor for mortality at 6 months after discharge, and medical personnel should therefore strive to reduce and avoid ALI.

Abstract 182: Changing Risk Factor Profile Among Middle-aged Adults Hospitalized For Stroke, United States 2007-2016

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Quanhe Yang ◽  
Mary G George ◽  
Cathleen Gillespie ◽  
Robert Merritt
Keyword(s):  
Public Health ◽  
Linear Trend ◽  
Public Health Problem ◽  
Younger Adults ◽  
Effective Prevention ◽  
Lipid Disorder ◽  
Polynomial Coefficients ◽  
Icd 10 ◽  
Middle Aged Adults ◽  
Increasing Trends

Introduction: Previous studies reported increasing trends in stroke hospitalizations among adults 35-64 years. Methods: We used data from the National Inpatient Sample to identify stroke hospitalizations (principal ICD-9-CM/ICD-10-CM codes) among adults aged 35-64 years from 2007 through 2016. Four major risk factors (RFs) (hypertension, diabetes, lipid disorder, and tobacco use) were identified using secondary codes for each hospitalization. We used relative percent change (RPC) to assess the changes in prevalence between 2007-08 and 2015-16. Orthogonal polynomial coefficients were calculated by the method of Fisher and Yates for linear trend testing. Results: Approximately 2.4 million stroke hospitalizations occurred during 2007-2016. The prevalence of having all 4 RFs among stroke hospitalizations nearly doubled, from 3.6% in 2007-08 to 7.0% in 2015-16 (p <0.001 for trend, Table), prevalence of any 3 RFs increased from 21.4% in 2007-08 to 29.3% in 2015-16 (RPC 37%, p<0.001). There was a small but significant decrease in the prevalence of only 2 RFs (RPC of -2%, p=0.004). Stroke hospitalizations with only 1 RF decreased by 15-39% (p<0.001), and the prevalence of not having any RFs decreased by 37% (p<0.001). The most prevalent RF triad was hypertension, diabetes, and lipid disorder (11.8% in 2007-08, and 16.9% in 2015-16, RPC of 44%), and the most common RF dyad was hypertension and lipid disorder (RPC of 1%). Conclusions: Our findings have important implications for younger adults. Regardless of stroke etiology, younger adults are increasingly at higher risk for stroke from preventable and treatable traditional RFs. This growing public health problem will require clinicians, healthcare systems, and public health efforts to implement more effective prevention strategies to address the rising prevalence of multiple co-existing RFs among this population.

scholarly journals Factors associated with hospital admissions due to hypertension

2018 ◽  
Vol 16 (3) ◽  
Author(s):  
Rosimery Cruz de Oliveira Dantas ◽  
João Paulo Teixeira da Silva ◽  
Davidson Cruz de Oliveira Dantas ◽  
Ângelo Giuseppe Roncalli
Keyword(s):  
Primary Care ◽  
Information System ◽  
Linear Regression ◽  
Arterial Hypertension ◽  
Hospital Admissions ◽  
Descriptive Analysis ◽  
Secondary Data ◽  
Icd 10 ◽  
Essential Arterial Hypertension ◽  
Sensitive Conditions

ABSTRACT Objective: To study the temporality of hospital admissions due to arterial hypertension and its associated factors. Methods: An ecological study with secondary data on hospital admissions due to essential arterial hypertension – ICD 10, from the Hospital Information System, the Mortality Information System and and the Primary Care Information System, between 2010 and 2015. Descriptive analysis using means, proportions and linear regression. Results: We recorded 493,299 hospitalizations due to arterial hypertension from 2010 to 2015, with an average annual progressive cost decrease of −7.76% and −24.21%. Of the patients admitted, 59.2% were women, 60.2% were non-white and 54.7% were older than 60 years. The mean length of stay was 4.2 days, and the hospitalization cost was R$307.60. The multiple linear regression variables that remained significant were the percentage of admissions due to primary care-sensitive conditions, the per capita income and the City Human Development Index. Conclusion: Hospital admissions due to arterial hypertension have an impact on the percentage of admissions due to primary care- sensitive conditions. Intensifying primary care activities, raising-awareness among professionals to the importance of integrated care, and investing in social development are crucial to change the reality of hypertension in terms of its control and complications.

scholarly journals Tuberculosis in a township in southern Bahia: epidemiological and operational indicators

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
Jesus GAS ◽  
M R Silva ◽  
M L Miranda ◽  
I M Reis
Keyword(s):  
Public Health ◽  
Information System ◽  
Health Problem ◽  
Control Strategies ◽  
Public Health Problem ◽  
Secondary Data ◽  
Control Program ◽  
Important Public Health Problem ◽  
Important Public Health ◽  
Treatment Abandonment

Abstract Tuberculosis is an important public health problem of global magnitude. Although it has had diagnostic and therapeutic support for decades, its control requires attention in several points from the health system. In this context, epidemiological and operational indicators allow evaluating the effectiveness of the Tuberculosis Control Program. A retrospective epidemiological study was conducted with a quantitative approach, referring to the period from 2014 to 2018, in the township of Ilhéus, using secondary data from the Information System of Notifiable Diseases of the State Secretariate of Bahia (SINAN/SESAB). During the analyzed period, 678 cases of tuberculosis were identified in the information system, with an average annual incidence coefficient of 71.32 cases/100,000 inhabitants and a mortality coefficient with an average of 4.45 deaths/100,000 inhabitants. The test rate of these HIV patients was 56.64%. Regarding the directly observed treatment (DOT), the annual average was 10.19% cases that underwent this follow-up, with a reduction of 28.57% of cases in 2014 followed up with DOT for only 8.11% of cases in 2018. Regarding the closure situation, in 2018 there was a higher proportion of individuals who presented cure (77.61%), lower proportion of treatment abandonment (18.30%), as well as a lower number of cases with closure due to death (2.99%). Thus, it is perceived that tuberculosis in the township of Ilhéus presents values far from what is recommended and remains an important public health problem. In view of this scenario, highlights the importance of decentralization of the service, with its management guided by the evaluation of indicators and the consolidation of primary health care. Key messages This study is relevant because it allows the assessment of the tuberculosis profile. The analysis of the indicators makes it possible to adopt appropriate prevention and control strategies.

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