scholarly journals National Hospitalization Trends and the Role of Preventable Hospitalizations among Centenarians in the United States (2000–2009)

Author(s):  
Sylvia E. Twersky ◽  
Adam Davey

Increases in life expectancy mean that an unprecedented number of individuals are reaching centenarian status, often with complex health concerns. We analyzed nationally representative hospital admissions data (200–2009) from the National Inpatient Study (NIS) for 52,618 centenarians (aged 100–115 years, mean age 101.4). We predicted length of stay (LOS) via negative binomial models and total inflation adjusted costs via fixed effects regression analysis informed by descriptive data. We also identified hospitalizations due to ambulatory care-sensitive conditions defined by AHRQ Prevention Quality Indicators. Mean LOS decreased from 6.1 to 5.1 days, while over the same time period the mean total adjusted charges rose from USD 13,373 to USD 25,026 in 2009 dollars. Black, Hispanic, Asian, or other race centenarians had higher cost stays compared to White, but only Black and Hispanic centenarians had significantly greater mean length of stay. Comorbidities predicted greater length of stay and higher costs. Centenarians admitted on weekends had higher costs but shorter length of stay. In total, 29.4% of total costs were due to potentially preventable hospitalizations for total charges (2000–2009) of USD 341.8M in 2009 dollars. Centenarian hospitalizations cost significantly more than hospitalization for any other group of elderly in the U.S.

2013 ◽  
Vol 25 (1) ◽  
pp. 65-77 ◽  
Author(s):  
Sara R. Jaffee ◽  
Caitlin McPherran Lombardi ◽  
Rebekah Levine Coley

AbstractMarried men engage in significantly less antisocial behavior than unmarried men, but it is not clear whether this reflects a causal relationship. Instead, the relationship could reflect selection into marriage whereby the men who are most likely to marry (men in steady employment with high levels of education) are the least likely to engage in antisocial behavior. The relationship could also be the result of reverse causation, whereby high levels of antisocial behavior are a deterrent to marriage rather than the reverse. Both of these alternative processes are consistent with the possibility that some men have a genetically based proclivity to become married, known as an active genotype–environment correlation. Using four complementary methods, we tested the hypothesis that marriage limits men's antisocial behavior. These approaches have different strengths and weaknesses and collectively help to rule out alternative explanations, including active genotype–environment correlations, for a causal association between marriage and men's antisocial behavior. Data were drawn from the in-home interview sample of the National Longitudinal Study of Adolescent Health, a large, longitudinal survey study of a nationally representative sample of adolescents in the United States. Lagged negative binomial and logistic regression and propensity score matching models (n = 2,250), fixed-effects models of within-individual change (n = 3,061), and random-effects models of sibling differences (n = 618) all showed that married men engaged in significantly less antisocial behavior than unmarried men. Our findings replicate results from other quasiexperimental studies of marriage and men's antisocial behavior and extend the results to a nationally representative sample of young adults in the United States.


2013 ◽  
Vol 61 (2) ◽  
pp. 175-194 ◽  
Author(s):  
Kenneth Elpus

This study examined the college entrance examination scores of music and non-music students in the United States, drawing data from the restricted-use data set of the Education Longitudinal Study of 2002 (ELS), a nationally representative education study ( N = 15,630) conducted by the National Center for Education Statistics. Analyses of high school transcript data from ELS showed that 1.127 million students (36.38% of the U.S. class of 2004) graduated high school having earned at least one course credit in music. Fixed-effects regression procedures were used to compare standardized test scores of these music students to their non-music peers while controlling for variables from the domains of demography, prior academic achievement, time use, and attitudes toward school. Results indicated that music students did not outperform non-music students on the SAT once these systematic differences had been statistically controlled. The obtained pattern of results remained consistent and robust through internal replications with another standardized math test and when disaggregating music students by type of music studied.


2016 ◽  
Vol 42 (7) ◽  
pp. 1023-1038 ◽  
Author(s):  
Juan L. Nicolau ◽  
Florian J. Zach ◽  
Iis P. Tussyadiah

The analysis of length of stay and its determinants remains important in tourism due to its significant implications for tourism management. Results from previous studies show conflicting effects of the two central factors of length of stay: distance and first-time visitation. Hence, taking into account the not always unambiguous effect of distance and the variety-seeking and inertial behaviors of repeat visitation, the objective of this research is to add to the extant literature further empirical evidence. Data were collected from 908 U.S. visitors to a tourism destination in the Atlantic Coast of the United States and analyzed using the truncated negative binomial models. A positive impact of both distance and first-time visitation on length of stay is found. Managerial implications are provided.


2020 ◽  
Author(s):  
Cara Hamann ◽  
Corinne Peek-Asa ◽  
Brandon Butcher

Abstract Background. Racial/ethnic disparity has been documented in a wide variety of health outcomes, and environmental components are contributors. For example, food deserts have been tied to obesity rates. Pedestrian injuries are strongly tied to environmental factors, yet no studies have examined racial disparity in pedestrian injury rates. We examine a nationally-representative sample of pedestrian-related hospitalizations in the United States to identify differences in incidence, severity, and cost by race/ethnicity.Methods. Patients with ICD diagnosis E-codes for pedestrian injuries were drawn from the United States Nationwide Inpatient Sample (2009-2016). Rates were calculated using the United States Census. Descriptive statistics and generalized linear regression were used to examine characteristics (age, sex, severity of illness, mortality rates, hospital admissions, length of stay, total costs) associated with hospitalizations for pedestrian injuries.Results. Hospitalization rates were The burden of injury was higher among Black, Hispanic, and Multiracial/Other groups in terms of admission rates, costs per capita, proportion of children injured, and length of stay compared to Whites and Asian or Pacific Islander race/ethnicities. Extreme and major loss of function proportions were also highest among Black and Multiracial/Other groups.Discussion. Results from this study show racial disparities in pedestrian injury hospitalizations and outcomes, particularly among Black, Hispanic, and Multiracial/Other race/ethnicity groups and support population and system-level approaches to prevention. Access to transportation is an indicator for health disparity, and these results indicate that access to safe transportation also shows inequity by race/ethnicity.


Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nauman Tariq ◽  
Saqib A Chaudhry ◽  
Ashter Rizvi ◽  
M Fareed K Suri ◽  
Gustavo J Rodriguez ◽  
...  

Background: The estimates of patients who present with transient ischemic attacks (TIA) in the emergency departments (ED) of United states and their disposition including factors that determine hospital admission are not well understood. Objective: We used a nationally representative database to determine the rate and predictors of admission in TIA patients presenting to the ED. Methods: We analyzed the data from National Emergency Department Sample (NEDS 2006-2007) for all patients presenting with primary diagnosis of TIAs in the United States. Samples were weighted to provide national estimates of TIA hospitalizations and identify factors that increase the odds of hospital admission including age, sex, type of insurance, hospital type (urban teaching, urban nonteaching and non urban). Multivariate logistic regression analysis was used to identify predictors of hospital admission. Results: Of the total of 631750 patients presenting with TIA to the EDs in a period of two years in US, 41, 9447 (66.4%) were admitted to the hospital. In the multivariate analysis, independent factors associated with hospital admissions were women (odds ratio[OR] 1.042, 95% confidence interval [CI] 1.014-1.071, p =0.003) , Medicare insurance type (OR 0.82, 95% CI 0.88-0.93, p<0.0001), and urban non-teaching hospital ED (OR 0.825, 95% CI 0.778-0.875, p<0.0001). Conclusion: Approximately 70% of all patients presenting with TIAs to the EDs within United States are admitted. Factors unrelated to patients condition such as insurance status and ED affiliated hospital type play an important role in the decision to admit TIA patients to the hospitals.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 956-956
Author(s):  
Sophie Lanzkron ◽  
Carlton Haywood ◽  
Peter Fagan

Abstract The benefits of HU for the treatment of adults with sickle cell anemia were confirmed by the multicenter study of hydroxyurea (MSH), the results of which were published in 1995. The purpose of this study was to investigate how HU is used outside of the research setting. We performed a retrospective analysis of five years of de-identified data (2001–2005) from a managed care organization (PP) serving the needs of patients on medical assistance in the State of Maryland. ICD-9 codes were used to identify patients that had SCD. Pharmacy data, outpatient visits, hospital admissions and LOS were examined using T-tests and Mann-Whitney tests and negative binomial regressions (relationship of total admissions to HU use). HU refill data was available on each patient for which it was prescribed. 390 people with SCD were covered over the time period. 97 were male and 293 were female. The mean age in 2001 was 29.2 yrs and 33.2 yrs in 2005. The majority of enrollees were adults. 350 of the 390 patients had an average age at or above 18 throughout their time in the data. 40 patients had an average age less than 18 throughout their time in the data. The mean number of months that the members were covered by PP was 33.4. There were1824 admissions for these 390 patients over the time period accounting for 8572 hospital days. Enrollees averaged 2 admissions per every 12 months enrolled in the plan. Mean LOS was 4.7 days. 41% of the inpatient hospital admissions were coded as readmissions. Mean readmission LOS was 4.7 days. Of the 390 patients, 335 never had a claim for an HU refill while 55 had at least one claim for an HU refill. A total of 158 individuals were admitted 2 or more times in any 12 month period and never had any HU refill claims. Males were more likely than females to have any HU use (22% vs. 12%, p=0.01). The mean number of HU fills for the time period for patients with any HU use was 10.7. On average, HU users had more months of enrollment in PP than non-HU users (41 vs 32, p=0.002). HU users had a higher admission per 12 month enrolled rate than non-HU users (5 vs. 1.5 admits per 12 months p=0.004). Among HU users, persons with 13 or more total refills for HU had a lower admit rate per 12 months than persons with 12 or less total refills (2.1 vs. 6.1, p=0.02). For HU users, each additional refill for HU received was associated with a 4% decrease in the expected hospitalization rate per member month, controlling for covariates (gender, mean age, and mean daily supply of medicine per refill).(p<0.001) There was no statistical difference in the mean number of outpatient visits for persons with 12 or less HU refills compared to persons with 13 or more. Mean medical costs per month enrolled in PP plan was as follows: $1524 for non-HU users, $4016 for HU users with 12 or less total refills of HU and $1611 for HU users with 13 or more total HU refills. There was no statistical difference in costs between the non-users and the users with 13 or more refills. These data show that those patients that received more HU refills, suggesting that they were taking HU on a regular basis, had a decrease in admissions to the hospital and markedly decreased costs. This validates the finding of the MSH in the community setting, patients that take HU are less likely to be admitted to the hospital and the use of HU on a regular basis can decrease costs.


2018 ◽  
Vol 31 (9) ◽  
Author(s):  
S Sarvepalli ◽  
S K Garg ◽  
S S Sarvepalli ◽  
M P Parikh ◽  
V Wadhwa ◽  
...  

Summary Esophageal cancer (EC) continues to be a major source of morbidity and mortality in the United States. However, there has been a relative dearth of research into hospital utilization in patients with EC. This study examines temporal trends in hospital admissions, length of stay (LOS), mortality, and costs associated with EC. In addition, we also analyzed factors associated with inpatient mortality and LOS. We interrogated National Inpatient Sample (NIS), a large registry of inpatient data, to retrieve information about various demographic and factors associated with hospital stay in patients who were admitted for EC between the years 1998 and 2013 in the United States. After examining trends over time, multivariate analysis was performed to identify factors associated with LOS and mortality. During 1998–2013, 538,776 hospital stays with principal diagnosis of EC were reviewed. Number of hospital stays and inpatient charges increased by 397 per year (±67.8;P &lt; 0.0001) and $3,033 per patient per year (±135; &lt;0.0001) respectively. Mortality and LOS decreased by 0.23% per year (±0.03;P &lt; 0.0001) and 0.07 days per year (±0.006;P &lt; 0.0001) respectively. Multiple factors associated with LOS and mortality were outlined. Despite overall increase in hospital utilization with respect to number of admissions and inpatient charges, inpatient mortality and LOS associated with EC declined. Factors associated with inpatient mortality and LOS may help drive clinical decision-making and influence healthcare or hospital policy.


2017 ◽  
Vol 46 (1) ◽  
pp. 74-82 ◽  
Author(s):  
Jon Ivar Elstad

Aims: Health care should be allocated fairly, irrespective of patients’ social standing. Previous research suggests that highly educated patients are prioritized in Norwegian hospitals. This study examines this contentious issue by a design which addresses two methodological challenges. Control for differences in medical needs is approximated by analysing patients who died from same causes of death. Area fixed effects are used for avoiding that observed educational inequalities are contaminated by geographical differences. Methods: Men and women who died 2009–2011 at age 55–94 were examined ( N=103,000) with register data from Statistics Norway and the Norwegian Patient Registry. Educational differences in quantity of hospital-based medical care during the 12–24 months before death were analysed, separate for main causes of death. Multivariate negative binomial regression models were estimated, with fixed effects for residential areas. Results: High-educated patients who died from cancers had significantly more outpatient consultations at somatic hospitals than low-educated patients during an average observation period of 18 months prior to death. Similar, but weaker, educational inequalities appeared for outpatient visits for patients whose deaths were due to other causes. Also, educational inequalities in number of hospital admissions were marked for those who died from cancers, but insignificant for patients who died from other causes. Conclusions: Even when medical needs are similar for mortally ill patients, those with high education tend to receive more medical services in Norwegian somatic hospitals than patients with low education. The roles played by physicians and patients in generating these patterns should be explored further.


2010 ◽  
Vol 37 (3) ◽  
pp. 544-549 ◽  
Author(s):  
PATRICK W. SULLIVAN ◽  
VAHRAM GHUSHCHYAN ◽  
XING-YUE HUANG ◽  
DENISE R. GLOBE

Objective.The Medical Expenditure Panel Survey (MEPS) was used to estimate the national influence of rheumatoid arthritis (RA) on employment, limitations in work or housework, inability to work or do housework, missed work days, days spent sick in bed, and annual wages.Methods.MEPS is a nationally representative survey of the US population. Multiple logistic, negative binomial, and Heckman selection regression methods were used, controlling for age, sex, race, ethnicity, smoking status, income, education, and chronic comorbidity. RA was identified using International Classification of Diseases-9 code 714.Results.In unadjusted descriptive statistics, individuals with RA were older, had more chronic conditions, missed more work days, spent more days sick in bed, had lower employment rates, had higher rates of limitations and inability to work, and received disability benefits at higher rates. After adjustment, multiple regression analyses showed individuals with RA were 53% less likely to be employed [OR 0.47, 95% CI 0.34–0.65], 3.3 times more likely to have limitations in work or housework (95% CI 2.35–4.64), 2.3 times more likely to be unable to work or do housework (95% CI 1.55–3.53), and spent 3.6 times as many days sick in bed as those without RA (95% CI 2.32–5.53). RA was associated with an expected loss of $8957 in annual earnings (95% CI $1881–$15,937). There was no statistically significant difference in missed work days or the level of wages.Conclusion.In the most recent available national data for adults, RA was associated with reductions in employment, productivity, and function.


2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Mohammed Junaid ◽  
Linda Slack-Smith ◽  
Helen Leonard ◽  
Kingsley Wong

Abstract Background Craniosysnostosis (CS) is a condition ensuing from premature fusion of cranial sutures, resulting in altered craniofacial morphology, requiring early neurosurgical interventions to improve prognosis and outcomes. This study aimed to describe total population hospital admissions related to craniosynostosis in Australia over a 22-year period. Methods Population summary data for admissions to public and private hospitals were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database (July 1996 to June 2018). The primary outcome variable was a hospital separation with the principal diagnosis of craniosynostosis, craniodysostosis or acrocephalosyndactyly (ICD9CM diagnosis codes 756.00 and 756.01 between July 1996– June 1998 and ICD10AM diagnosis codes Q75.0, Q75.1 and Q87.02 for July 1998 onwards). Trends in rates of hospital admission and length of stay by age, gender and type of craniosynostosis were investigated by negative binomial regression. Results A total of 8,115 admissions were identified between July 1996 to June 2018. Marginal decrease in hospital admission rates [-0.02 (95%CI 0.03, 0.001)] has been observed over a duration of 22 years. Admissions were higher for males, infants (&lt;1 year) and nonsyndromic cases of disease. Average length of stay at hospitals for CS was calculated to be 5.3 ± 1.3 days per year which were even lengthier with syndromic conditions. Conclusion This study has identified population level trends in hospital separation for craniosynostosis in Australia. Key Message Population administrative data, despite limitations provides useful information to inform research and practice.


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