Patient Health Outcomes following Dialysis Facility Closures in the United States

2021 ◽  
Vol 32 (10) ◽  
pp. 2613-2621
Author(s):  
Jingbo Niu ◽  
Maryam K. Saeed ◽  
Wolfgang C. Winkelmayer ◽  
Kevin F. Erickson
Keyword(s):  
United States ◽  
Health Outcomes ◽  
The United States ◽  
Content Type ◽  
Rate Difference ◽  
Risk Of Death ◽  
Increased Risk ◽  
Dialysis Facility ◽  
Matched Comparison ◽  
Hospital Days

BackgroundOngoing changes to reimbursement of United States dialysis care may increase the risk of dialysis facility closures. Closures may be particularly detrimental to the health of patients receiving dialysis, who are medically complex and clinically tenuous.MethodsWe used two separate analytic strategies—one using facility-based matching and the other using propensity score matching—to compare health outcomes of patients receiving in-center hemodialysis at United States facilities that closed with outcomes of similar patients who were unaffected. We used negative binomial and Cox regression models to estimate associations of facility closure with hospitalization and mortality in the subsequent 180 days.ResultsWe identified 8386 patients affected by 521 facility closures from January 2001 through April 2014. In the facility-matched model, closures were associated with 9% higher rates of hospitalization (relative rate ratio [RR], 1.09; 95% confidence interval [95% CI], 1.03 to 1.16), yielding an absolute annual rate difference of 1.69 hospital days per patient-year (95% CI, 0.45 to 2.93). Similarly, in a propensity-matched model, closures were associated with 7% higher rates of hospitalization (RR, 1.07; 95% CI, 1.00 to 1.13; P=0.04), yielding an absolute rate difference of 1.08 hospital days per year (95% CI, 0.04 to 2.12). Closures were associated with nonsignificant increases in mortality (hazard ratio [HR], 1.08; 95% CI, 1.00 to 1.18; P=0.05 for the facility-matched comparison; HR, 1.08; 95% CI, 0.99 to 1.17; P=0.08 for the propensity-matched comparison).ConclusionsPatients affected by dialysis facility closures experienced increased rates of hospitalization in the subsequent 180 days and may be at increased risk of death. This highlights the need for effective policies that continue to mitigate risk of facility closures.

scholarly journals Older Adults in the United States and COVID-19: A Qualitative Study of Perceptions, Finances, Coping, and Emotions

2021 ◽  
Vol 9 ◽  
Author(s):  
R. Turner Goins ◽  
Elizabeth Anderson ◽  
Hannah Minick ◽  
Heather Daniels
Keyword(s):  
Mental Health ◽  
United States ◽  
Older Adults ◽  
News Media ◽  
Emotional Health ◽  
The United States ◽  
Stress Appraisal ◽  
Risk Of Death ◽  
Increased Risk ◽  
Precautionary Measures

Introduction: Older adults have the poorest coronavirus (COVID-19) prognosis with the highest risk of death due to complications, making their COVID-19 experiences particularly important. Guided by the stress-appraisal-coping theoretical model, we sought to understand COVID-related perceptions and behaviors of older adults residing in the United States.Materials and Methods: We used convenience sampling to recruit persons with the following inclusion criteria: Aged ≥ 65 years, English fluency, and U.S. residency. Semi structured in-depth interviews were conducted remotely and audio recorded between April 25, 2020 and May 7, 2020. Interviews were professionally transcribed with a final study sample of 43. A low-inference qualitative descriptive design was used to provide a situated understanding of participants' life experiences using their naturalistic expressions.Results: The mean age of participants was 72.4 ± 6.7. Slightly over half were female (55.8%), 90.6% were White, and 18.6% lived alone. The largest percentages of participants resided in a rural area (27.9%) or small city (25.6%). We identified four themes, including (1) risk perception, (2) financial impact, (3) coping, and (4) emotions. Most participants were aware of their greater risk for poor COVID-19 outcomes but many did not believe in their increased risk. Financial circumstances because of the pandemic varied with largely no financial impacts, while others reported negative impacts and a few reported positive impacts. Coping was problem- and emotion-focused. Problem-focused coping included precautionary efforts and emotion-focused coping included creating daily structure, pursuing new and/or creative activities, connecting with others in new ways, and minimizing news media exposure. Overall, emotional health was negatively affected by the pandemic although some participants reported positive emotional experiences.Conclusions: Perceiving themselves as high risk for COVID-19 complications, older adults used precautionary measures to protect themselves from contracting the virus. The precautionary measures included social isolation, which can negatively affect mental health. Older adults will need to be resourceful and draw on existing resources to cope, such as engaging in creative activities and new strategies to connect with others. Our findings underscore the importance of the preservation of mental health during extended periods of isolation by taking advantage of low-to-no-cost existing resources.

scholarly journals 370. Comparing Trends and Outcomes among HIV-Infected vs. HIV Uninfected Patients with Tuberculosis: A 5-Year Experience Within the Florida Department of Health in Hillsborough County

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S194-S194
Author(s):  
Shylah M Moore-Pardo ◽  
Anteneh Addisu ◽  
Tea Reljic ◽  
Sadaf Aslam ◽  
Beata Casanas
Keyword(s):  
United States ◽  
The United States ◽  
Homeless Persons ◽  
Sputum Smear ◽  
Foreign Born ◽  
Female Ratio ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Difference ◽  
Hiv Negative

Abstract Background Although the rate of tuberculosis (TB) has significantly declined in the United States, elimination has plateaued. Florida is one of the states with the greatest number of cases. The majority of cases occur in foreign-born individuals. Human immunodeficiency virus (HIV) is also a major contributor. HIV-TB coinfection leads to reciprocal interactions with significant clinical impact. We aim to compare the risk factors, clinical findings, and outcomes among HIV-infected vs. HIV uninfected patients. Methods A retrospective cohort study of TB cases over a 5 year period (2012–2017) was conducted. All patients with HIV co-infection with age- and gender-matched HIV negative controls were included. The diagnosis of TB was made via clinical, microbiological, radiological, and/or PCR based methods. SPSS was used for statistical data analysis. Results A total of 411 TB cases were identified and 66 patients (33 HIV-infected plus 33 HIV un-infected) were eligible for inclusion. The median age was 49 years (range 22–70). The male to female ratio was 21:12 and 50% of patients had TB symptoms; the rest had abnormal imaging or lab finding. Cases were confirmed via positive sputum smear, culture, or PCR (Figures 1–3). Only 11 patients were lost to follow-up, thus 83.3% completed therapy. A total of 5 persons died (Table 1). Conclusion The rate of HIV-TB coinfection in the United States was 5.3% in 2018; higher among injection drugs users, homeless persons, inmates, and alcoholics. In our study, the rate of HIV-TB coinfection was slightly higher (8%). The difference was not statistically significant in regards to foreign born, homelessness, and incarceration. Only 3 patients admitted to injection drug use and 9 used alcohol (all HIV negative). Traditionally, HIV-TB coinfected patients have extra-pulmonary TB with higher rates of negative sputum and are at increased risk of death. In our cohort, the difference was statistically significant (P = 0.009) only for cavitary TB (predominated in HIV un-infected) but no difference in outcomes was observed between the two groups. These findings suggest changing trends in HIV-TB coinfection which may be partly related to our setting and demographics but may be attributed to better access to care and antiretroviral therapy at large. Disclosures All authors: No reported disclosures.

Increased Risk of Death for Patients on the Waitlist for Liver Transplant Residing at Greater Distance From Specialized Liver Transplant Centers in the United States

2016 ◽  
Vol 100 (10) ◽  
pp. 2146-2152 ◽  
Author(s):  
Luca Cicalese ◽  
Ali Shirafkan ◽  
Kristofer Jennings ◽  
Daria Zorzi ◽  
Cristiana Rastellini
Keyword(s):  
United States ◽  
Liver Transplant ◽  
The United States ◽  
Risk Of Death ◽  
Increased Risk

scholarly journals Secondary organic aerosol association with cardiorespiratory disease mortality in the United States

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Havala O. T. Pye ◽  
Cavin K. Ward-Caviness ◽  
Ben N. Murphy ◽  
K. Wyat Appel ◽  
Karl M. Seltzer
Keyword(s):  
United States ◽  
Secondary Organic Aerosol ◽  
Carbon Sources ◽  
Organic Aerosol ◽  
The United States ◽  
County Level ◽  
Risk Of Death ◽  
Predictive Algorithms ◽  
Increased Risk ◽  
The U.S

AbstractFine particle pollution, PM2.5, is associated with increased risk of death from cardiorespiratory diseases. A multidecadal shift in the United States (U.S.) PM2.5 composition towards organic aerosol as well as advances in predictive algorithms for secondary organic aerosol (SOA) allows for novel examinations of the role of PM2.5 components on mortality. Here we show SOA is strongly associated with county-level cardiorespiratory death rates in the U.S. independent of the total PM2.5 mass association with the largest associations located in the southeastern U.S. Compared to PM2.5, county-level variability in SOA across the U.S. is associated with 3.5× greater per capita county-level cardiorespiratory mortality. On a per mass basis, SOA is associated with a 6.5× higher rate of mortality than PM2.5, and biogenic and anthropogenic carbon sources both play a role in the overall SOA association with mortality. Our results suggest reducing the health impacts of PM2.5 requires consideration of SOA.

scholarly journals High-dose opioid utilization and mortality among individuals initiating hemodialysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matthew Daubresse ◽  
G. Caleb Alexander ◽  
Deidra C. Crews ◽  
Dorry L. Segev ◽  
Krista L. Lentine ◽  
...  
Keyword(s):  
United States ◽  
Cumulative Incidence ◽  
The United States ◽  
High Dose ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Average Percentage ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background Individuals undergoing hemodialysis in the United States frequently report pain and receive three-fold more opioid prescriptions than the general population. While opioid use is appropriate for select patients, high-dose utilization may contribute to an increased risk of death due to possible accumulation of opioid metabolites. Methods We studied high-dose opioid utilization (≥120 morphine milligram equivalents [MME] per day) among adults initiating hemodialysis in the United States between 2007 and 2014 using national registry data. We calculated the cumulative incidence (%) of high-dose utilization and depicted trends in the average percentage of days individuals were exposed to opioids. We used adjusted Cox proportional hazards models to identify which opioid doses were associated with mortality. Results Among 327,344 adults undergoing hemodialysis, the cumulative incidence of high-dose utilization was 14.9% at 2 years after initiating hemodialysis. Among patients with ≥1 opioid prescription during follow-up, the average percentage of days exposed to high-dose utilization increased from 13.9% in 2007 to 26.1% in 2014. Compared to 0MME per day, doses < 60MME were not associated with an increased risk of mortality, but high-dose utilization was associated with a 1.63-fold (95% CI, 1.57, 1.69) increased risk of mortality. The risk of mortality associated with opioid dose was highest in the first year after hemodialysis initiation. Conclusions The risk of mortality associated with opioid utilization among individuals on hemodialysis increases as doses exceed 60MME per day and is greatest during periods of high-dose utilization. Patients and clinicians should carefully weigh the risks and benefits of opioid doses exceeding 60MME per day.

scholarly journals Ependymoma, NOS and anaplastic ependymoma incidence and survival in the United States varies widely by patient and clinical characteristics, 2000-2016

2020 ◽  
Vol 7 (5) ◽  
pp. 549-558
Author(s):  
Rebecca L Achey ◽  
Sierra Vo ◽  
Gino Cioffi ◽  
Haley Gittleman ◽  
Julia Schroer ◽  
...  
Keyword(s):  
United States ◽  
African American ◽  
Survival Data ◽  
Lower Incidence ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Subtotal Resection ◽  
Anaplastic Ependymoma ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background Ependymoma is a rare CNS tumor arising from the ependymal lining of the ventricular system. General differences in incidence and survival have been noted but not examined on a comprehensive scale for all ages and by histology. Despite the rarity of ependymomas, morbidity/mortality associated with an ependymoma diagnosis justifies closer examination. Methods Incidence data were obtained from the Central Brain Tumor Registry of the United States in collaboration with the Centers for Disease Control and Prevention and the National Cancer Institute, and survival data from Surveillance Epidemiology and End Results, from 2000 to 2016 for anaplastic ependymoma and ependymoma, not otherwise specified (NOS). Age-adjusted incidence rates (IRs) per 100 000 person-years were analyzed by age, sex, race, and location. Survival analysis was performed with Kaplan-Meier curves and multivariable Cox proportional hazards models. Results Incidence of anaplastic ependymoma was highest in ages 0 to 4 years. African American populations had lower incidence but had a 78% increased risk of death compared to white populations (hazard ratio [HR]: 1.78 [95% CI, 1.30-2.44]). Incidence was highest for anaplastic ependymoma in the supratentorial region. Adults (age 40+ years) had almost twice the risk of death compared to children (ages 0-14 years) (HR: 1.97 [95% CI, 1.45-2.66]). For ependymoma, NOS, subtotal resection had a risk of mortality 1.86 times greater than gross total resection ([HR: 1.86 [95% CI, 1.32-2.63]). Conclusions African American populations experienced higher mortality rates despite lower incidence compared to white populations. Extent of resection is an important prognostic factor for survival. This highlights need for further evaluation of treatment patterns and racial disparities in the care of patients with ependymoma subtypes.

scholarly journals Inhibitors and mortality in persons with nonsevere hemophilia A in the United States

2020 ◽  
Vol 4 (19) ◽  
pp. 4739-4747
Author(s):  
Ming Y. Lim ◽  
Dunlei Cheng ◽  
Michael Recht ◽  
Christine L. Kempton ◽  
Nigel S. Key
Keyword(s):  
United States ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Hemophilia A ◽  
Epidemiological Data ◽  
The United States ◽  
Early Age ◽  
Risk Of Death ◽  
Increased Risk

Abstract Although persons with nonsevere hemophilia A (NSHA) account for about one-half of the hemophilia A population, epidemiological data in this subset of individuals are scarce. We set out to describe the clinical characteristics of persons with NSHA with inhibitors, and to determine mortality rates, predictors of mortality, and primary causes of death in persons with NSHA in the United States over a 9-year period (2010-2018). We queried the American Thrombosis and Hemostasis Network dataset (ATHNdataset) for information on demographics, inhibitor status, and date and cause of death. A total of 6624 persons with NSHA (86.0% men; 14.0% women) were observed for an average of 8.5 years; total 56 119 person-years . The prevalence of inhibitors was 2.6% (n = 171), occurring at a median age of 13 years. At the end of follow-up, 136 persons died at a median age of 63 years; an age-adjusted mortality rate of 3.3 deaths per 1000 person-years. Three deaths occurred in inhibitor participants. Presence of inhibitors was not associated with increased mortality risk (hazard ratio [HR], 0.7, 95% confidence interval [CI], 0.2-2.3). Factors independently associated with increased risk of death (HR, 95% CI) were the following: age (10-year increase) (2.1, 2.0-2.4); male (2.6, 1.0-6.4); hepatitis C (2.2, 1.5-3.1); and HIV (3.6, 2.2-6.0). The most common primary cause of death was malignancy (n = 27, 20.0%). In persons with NSHA, the development of inhibitors occurred at an early age and was not associated with increased mortality.

scholarly journals Induced Abortion and the Increased Risk of Maternal Mortality

2020 ◽  
Vol 87 (3) ◽  
pp. 302-310
Author(s):  
Patrick J. Marmion ◽  
Ingrid Skop
Keyword(s):  
United States ◽  
Maternal Mortality ◽  
Health Care Providers ◽  
Ethnic Disparities ◽  
The United States ◽  
Induced Abortion ◽  
Standards Of Care ◽  
Care Providers ◽  
Risk Of Death ◽  
Increased Risk

After years of failure to obtain accurate statistics on maternal mortality, the United States noted a sharp increase in its maternal mortality rate with widening racial and ethnic disparities. The 2016 report shocked the nation by documenting a 26 percent increase in maternal mortality from 18.8/100,000 live births in 2000 to 23.8 in 2014. Suggested etiologies of this increase included artifact as a result of improved maternal death surveillance, incorrect use of ICD- 10 codes, healthcare disparities, lack of family support and other social barriers, substance abuse and violence, depression and suicide, inadequate preconception care, patient noncompliance, lack of standardized protocols for handling obstetric emergencies, failure to meet expected standards of care, aging of the pregnant patient cohort with associated increase in chronic diseases and cardiovascular complications, and lack of a comprehensive national plan. While some of the increase in maternal mortality may be a result of improved data collection, pregnancy-related deaths are occurring at a higher rate in the United States than in other developed countries. Some have suggested that the increased maternal mortality is due to limiting women’s access to legal abortion. In order to discover effective strategies to improve pregnancy outcomes, maternal mortality must be investigated in an unbiased manner. This review explores the relationship between legal-induced abortion and maternal mortality. Summary: In Finland, where epidemiologic record linkage has been validated, the risk of death from legal induced abortion is reported to be almost four times greater than the risk of death from childbirth. It is difficult to do this comparison in the United States not only because prior induced abortion history is often not recorded for a pregnancy-related death but also because less than one-quarter of the states require health care providers to report abortion deaths for investigation. These omissions are important because mortality risk in pregnancies subsequent to abortion is increased due to abortion-induced morbidities such as preterm birth and abnormal placentation. Legal induced abortion is a root cause of the racial and ethnic disparity noted in maternal mortality. In the United States, the death rate from legal induced abortion performed at 18 weeks gestation is more than double that observed for women experiencing vaginal delivery.

Abstract 4957: Racial Differences in Waitlist Mortality in Children Listed for Heart Transplant in the United States in the Current Era

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tajinder P Singh ◽  
Kimberlee Gauvreau ◽  
Ravi Thiagarajan ◽  
Gary Piercy ◽  
Christopher Almond
Keyword(s):  
United States ◽  
Racial Differences ◽  
Heart Transplant ◽  
Household Income ◽  
The United States ◽  
Solid Organ ◽  
White Children ◽  
Risk Of Death ◽  
Increased Risk ◽  
Waitlist Mortality

Disparities in access and utilization of solid organ transplantation in racial minorities are well known in adults but not children. We assessed racial differences in waitlist mortality in children listed for heart transplant (HT) in the United States (US) in the current era. Data from the United Network of Organ Sharing for all US children<18 years of age listed for primary HT during 1999 –2006 were analyzed. Clinical variables were defined at the time of listing. Race was defined as reported by HT centers. Multivariable Cox proportional hazards modeling was used to determine the relationship between race and waitlist mortality. Of 3299 listed children, 1913 (58%) were White, 657 (20%) were Black, 519 (16%) were Hispanic, 109 (3%) were Asian and the remaining 101 (3%) were defined as “Other”. The racial groups were similar with respect to distribution of listing status, percent patients on hemodynamic support and those with pre-formed antibodies >10%. Black and Hispanic children lived in areas with lower median household income ($33,352, $37,516, and $43,077 for Black, Hispanic and White children respectively, P<0.001) and were more likely to have Medicaid insurance compared to White children (58%, 59% and 24% respectively, P<0.001). Waitlist mortality was 14% for White, 19% for Black, 21% for Hispanic, 17% for Asian and 27% for “Other” children. After controlling for age, cardiac diagnosis, listing status, hemodyamic support and creatinine clearance, Black (hazard ratio HR 1.6, 95% confidence interval CI 1.3–1.9, P<0.001), Hispanic (HR 1.5, CI 1.2–1.9, P=0.001), Asian (HR, 2.1, CI 1.3–3.3, P=0.003) and “Other” children (HR 2.3, CI 1.5–3.4, P<0.001) were all at higher risk for waitlist mortality compared to White children. After adjusting additionally for insurance and area household income, the risk of death remained higher for all nonwhite races (HR 1.4 for Black, 1.4 for Hispanic, 2.3 for Asian and 2.2 for “Other” children, P<0.01 for all). Nonwhite children listed for heart transplant have higher waitlist mortality compared to White children after controlling for clinical risk factors. Socioeconomic variables explain only a small fraction of this increased risk.

Pertussis Deaths: Report of 23 Cases in the United States, 1992 and 1993

PEDIATRICS ◽  
1996 ◽  
Vol 97 (5) ◽  
pp. 607-612
Author(s):  
Naomi Wortis ◽  
Peter M. Strebel ◽  
Melinda Wharton ◽  
Barbara Bardenheier ◽  
Iain R. B. Hardy
Keyword(s):  
United States ◽  
Disease Control ◽  
Pertussis Vaccine ◽  
Disease Onset ◽  
The United States ◽  
Risk Of Death ◽  
Young Infants ◽  
Increased Risk ◽  
Control And Prevention ◽  
Centers For Disease Control

Objective. To characterize pertussis deaths and to identify possible risk factors and prevention strategies. Methods. A retrospective review of all deaths attributed to pertussis with disease onset during 1992 and 1993 reported to the Centers for Disease Control and Prevention. Hospital discharge summaries and autopsy reports were reviewed, and additional clinical information was provided by physicians involved in the care of the children. Results. During 1992 and 1993, 23 deaths attributed to pertussis were reported to the Centers for Disease Control and Prevention. Cultures for Bordetella pertussis were positive in 18 (90%) of the 20 cases in which it was performed. Twenty (87%) of the 23 children who died were younger than 1 year of age, and 18 (78%) of the children had received no doses of pertussis vaccine. Among 20 children for whom gestational ages were known, 12 (60%) were born at 36 weeks' gestation or earlier; in contrast, 10.7% of live births in the United States in 1992 were at 36 weeks' gestation or earlier. The median age of mothers whose children had fatal pertussis was 20 (range, 14 to 37) years in the 15 cases in which ages were known, compared with the national median age of 26.3 years in 1992. Pneumonia was a complication in all but 1 (96%) of the cases. Seizures occurred in 4 cases (17%), and acute encephalopathy occurred in 3 cases (13%). Conclusions. Pertussis continues to cause serious illness and death in the United States, particularly among infants who are not vaccinated. Preterm delivery and young maternal age may place infants at increased risk of death because of pertussis. Under the current pertussis vaccination schedule, three fourths of the infants who died were too young to have received three doses of pertussis vaccine, the minimum number of doses considered necessary for adequate protection against clinical pertussis. Additional strategies to prevent deaths caused by pertussis in young infants, such as starting infant vaccination at an earlier age and booster doses to adolescents and adults, need to be evaluated.

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