Promoting Breastfeeding at the Start: Hospital Practices and Breastfeeding Initiation and Exclusivity Among Low-income Women

Objectives To determine whether hospital breastfeeding-related practices are associated with breastfeeding initiation (BF) and exclusive breastfeeding (EBF) at discharge in a low-income population. Methods This is a secondary analysis of the Infant Toddler Feeding Practices Study II (ITFPS-2), a nationally representative sample of low-income mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). This analysis included birth mothers who delivered at a hospital, whose infants did not spent time in the NICU, and had survey weighting data. BF and EBF (in women who initiated breastfeeding), hospital practices (rooming in, breastfeeding encouragement from staff, availability of staff who provided breastfeeding support, reception of gift pack, and among those who initiated breastfeeding, breastfeeding in the first hour and on demand, ) and sociodemographic data were collected via interview at 1 month postpartum. Logistic regression analysis, adjusting for maternal age, race and ethnicity, income, breastfeeding history, and delivery type, was conducted. We further adjusted for breastfeeding intentions, assessed in a sub-sample during pregnancy. Results The weighted analytic sample included 394,022 women (n = 311,355 for EBF). Rooming in was positively associated with BF (P < 0.0001). Among those who initiated breastfeeding, doing so within the first hour was associated with EBF (P < 0.0001). Breastfeeding encouragement from staff and availability of breastfeeding support staff were strongly associated with BF (both P < 0.0001), but not with EBF (P = 0.74 and P = 0.08, respectively). Receiving a pro-formula gift pack was associated with a 40% and 50% reduction in the odds of BF and EBF, respectively (both P < 0.0001). Further adjustment for breastfeeding intentions in a sub-sample (n = 250,665 for BF, n = 202,412 for EBF) provided similar findings. Conclusions Hospital practices were associated with breastfeeding practices, regardless of breastfeeding intentions. Limiting pro-formula gifts and providing breastfeeding support at hospitals, either directly or by creating an environment that allows for breastfeeding opportunities, may improve breastfeeding rates in the WIC population. Funding Sources The WIC ITFPS-2 is a federal study conducted under the direction of Office of Policy Support in the USDA FNS.

Impact of coronavirus disease 2019 (COVID-19) on US Hospitals and Patients, April–July 2020

Objective: The rapid spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) throughout key regions of the United States in early 2020 placed a premium on timely, national surveillance of hospital patient censuses. To meet that need, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), the nation’s largest hospital surveillance system, launched a module for collecting hospital coronavirus disease 2019 (COVID-19) data. We present time-series estimates of the critical hospital capacity indicators from April 1 to July 14, 2020. Design: From March 27 to July 14, 2020, the NHSN collected daily data on hospital bed occupancy, number of hospitalized patients with COVID-19, and the availability and/or use of mechanical ventilators. Time series were constructed using multiple imputation and survey weighting to allow near–real-time daily national and state estimates to be computed. Results: During the pandemic’s April peak in the United States, among an estimated 431,000 total inpatients, 84,000 (19%) had COVID-19. Although the number of inpatients with COVID-19 decreased from April to July, the proportion of occupied inpatient beds increased steadily. COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased. The proportion of inpatients with COVID-19 on ventilators decreased from April to July. Conclusions: The NHSN hospital capacity estimates served as important, near–real-time indicators of the pandemic’s magnitude, spread, and impact, providing quantitative guidance for the public health response. Use of the estimates detected the rise of hospitalizations in specific geographic regions in June after they declined from a peak in April. Patient outcomes appeared to improve from early April to mid-July.

How Long Do Older Adults Remain Homebound in the Community? Implications for Long-Term Services and Support Systems

A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community but are homebound (never/rarely leave home). While homebound status is associated with decreased access to medical services and poor health outcomes, it is unclear how long individuals remain homebound. We used the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries age 65 and over, with survey weighting to assess duration of homebound status in the community. Among the incident homebound in 2016 (n=253) , only 28% remained homebound after 1 year. 21% died, 18% were recovered, and one-third left the home but still reported difficulty. As the locus of long-term care shifts from nursing homes to the community and models of care expand to serve the needs of the homebound, it is critical that we better understand the heterogeneity and transitions of the homebound population.

Abstract 15446: In-hospital Mortality Outcomes Between Urban and Rural Hospitals for Patients Undergoing Percutaneous Coronary Intervention

Introduction: Percutaneous Coronary Intervention (PCI) is among the most common procedures in cardiology. However, in-hospital mortality for patients undergoing PCI procedures based on hospital location and teaching status needs evaluation. Understanding this relationship is necessary for identifying disparities in patient outcomes for PCI procedures. Hypothesis: To evaluate whether urban teaching hospitals have lower in-hospital mortality rates for PCI procedures than urban non-teaching and rural hospitals. Methods: We used data from the 2016 National Inpatient Sample (NIS) database to identify inpatient PCI hospitalizations. Hospitals were categorized as rural, urban teaching, and urban non-teaching. We used multivariable logistic regression to evaluate in-hospital mortality for PCI by hospital location and teaching status. We controlled for age, sex, race, length of stay, and comorbidities. Analyses accounted for the survey weighting design. Results: We identified 80,793 unweighted inpatient hospitalizations for PCI, representing 390,070 admissions when accounting for the survey weighting design. Of the 390,090 admissions, there were 21,020 (5.4%) from rural hospitals and 369,070 from urban hospitals (94.6%). Within the urban hospitals, there were 267,365 (72.4%) admissions from teaching hospitals and 101,705 (27.6%) admissions from non-teaching hospitals. There were no significant differences for in-hospital mortality between urban (6885 +/- 224.2 deaths) and rural hospitals (355 +/- 52.6 deaths, p= 0.6351). In-hospital mortality was found to be lower at urban teaching hospitals (4895 +/- 187.1 deaths) than at urban non-teaching hospitals (1990 +/- 123.5 deaths, p= 0.0096). Conclusions: In-hospital mortality for inpatient PCI procedures was not associated with hospital location, but rather with hospital teaching status. Urban teaching hospitals had lower rates of in-hospital mortality for PCI procedures than urban non-teaching hospitals. Further investigation to identify causes for this discrepancy is necessary.

Multilevel Regression and Poststratification Versus Survey Sample Weighting for Estimating Population Quantities in Large Population Health Studies

Multilevel regression and poststratification (MRP) is a model-based approach for estimating a population parameter of interest, generally from large-scale surveys. It has been shown to be effective in highly selected samples, which is particularly relevant to investigators of large-scale population health and epidemiologic surveys facing increasing difficulties in recruiting representative samples of participants. We aimed to further examine the accuracy and precision of MRP in a context where census data provided reasonable proxies for true population quantities of interest. We considered 2 outcomes from the baseline wave of the Ten to Men study (Australia, 2013–2014) and obtained relevant population data from the 2011 Australian Census. MRP was found to achieve generally superior performance relative to conventional survey weighting methods for the population as a whole and for population subsets of varying sizes. MRP resulted in less variability among estimates across population subsets relative to sample weighting, and there was some evidence of small gains in precision when using MRP, particularly for smaller population subsets. These findings offer further support for MRP as a promising analytical approach for addressing participation bias in the estimation of population descriptive quantities from large-scale health surveys and cohort studies.

SPOUSE OR CAREGIVER? EXAMINING CORRELATES AND CONSEQUENCES OF SPOUSES BEING IDENTIFIED AS CANCER CAREGIVERS

Spouses provide critical support to cancer survivors, but are not always identified as caregivers. This study sought to understand the differences between such spouses. Using the Medical Expenditures Panel Survey 2016 Experiences with Cancer Supplement, spousal dyads in which one spouse had cancer were identified (n=670). Cancer survivors reported which family members or friends, if any, provided care during or after their cancer treatment. Survivor and spouse sociodemographic characteristics and spouse psychosocial characteristics including depression (Patient Health Questionnaire-2), distress (Kessler-6), and self-rated health were self-reported in the survey. The proportion of spouses identified as caregivers was calculated and compared with those not identified as caregivers on dyadic characteristics. Multivariable logistic regressions compared spouses’ depression, distress, and self-rated health by identification as a caregiver. All analyses employed survey weighting. Most married cancer survivors reported that their spouse was a caregiver (32%) or that they did not have a caregiver (65%); very few did not list their spouse as a caregiver (3%). Survivors who were white (non-Hispanic) or off treatment were less likely to report that their spouse was a caregiver (30% vs. 46%, p0.10; 9.6% vs 11.1%, p>0.10; and 46% vs 50%, p>0.10, respectively). The findings suggest that spouses’ experiences may be similar regardless of whether they are considered a caregiver, with implications for research and service delivery.

Impact of banning smoking in cars with children on exposure to second-hand smoke: a natural experiment in England and Scotland

ABSTRACTA ban on smoking in cars with children was implemented in April 2015 in England and December 2016 in Scotland. With survey data from both countries (NEngland=3,483-6,920 and NScotland=232-319), we used this natural experiment to assess the impact of the ban using a difference-in-differences approach. We conducted logistic regression analyses within a Difference-in-Difference framework and adjusted for age, sex, a marker of deprivation and survey weighting for non-response. Among children aged 13-15 years, self-reported levels of regular exposure to smoke in cars were 3.4% in 2012, 2.2% in 2014 and 1.3% in 2016 for Scotland and 6.3%, 5.9% and 1.6% in England. The ban was associated with a 73% reduction (95%CI -59%, -81%) in self-reported exposure to tobacco smoke among children.

Adverse Drug Events as a Reason for Adult Hospitalization: A Nationwide Readmission Study

Background: Adverse drug events (ADEs) are common; however, there are limited data on the impact of ADEs on post-discharge outcomes. Objectives: To identify ADEs responsible for readmission within 6 months of hospital discharge in the United States. Secondary objectives were to examine whether demographic, clinical, and hospital characteristics were associated with ADE readmission. Methods: We identified all adults hospitalized between January and June using the 2014 Nationwide Readmission Database. Nationally representative estimates of hospitalization outcomes and ADE-related readmissions, excluding ADEs from illicit drug use and intentional overdose, were computed using survey weighting methods. Associations between patient, clinical, and hospital characteristics, and ADE readmission were assessed using unconditional logistic regression. Results: We identified 10 889 282 hospitalizations meeting inclusion criteria. The 6-month readmission rate was 17.8% (n = 1 943 111). A total of 6964 readmissions were attributed to an ADE, most frequently “poisoning by opiates and related narcotics” (18.3%), “poisoning by benzodiazepines” (11.9%), and “dermatitis due to drugs and medicines taken internally” (9.4%). Factors identified as being positively associated with ADE readmission included age <60 years (adjusted odds ratio [AOR] = 1.69; 95% CI = 1.45-1.97), Medicare insurance (AOR = 2.93; 95% CI = 2.55-3.38), and discharge to home health care (AOR = 1.42; 95% CI = 1.28-1.59). Conclusion and Relevance: Readmissions caused by ADEs are frequently attributed to opiate and benzodiazepine poisonings, and factors such as age, insurance status, and discharge disposition were found to be associated with ADE readmission. Future studies are needed to examine whether ADE readmissions are preventable.

Eliminating implausible fisheries assessment models using fishers’ knowledge

Peer review of competing deepwater redfish (Sebastes mentella) assessment models revealed data inconsistencies where stock biomass decline shown by the survey in the 1990s was too rapid to be explained solely by reported catch. The models invoked different techniques to achieve fits, one by changing mortality at age and the other by survey weighting. The former fitted reported catch well, while the latter accepted a mismatch between reported and estimated catch. The assessments produced different estimates of historical stock size and future productivity. Interviews conducted with fishers of the stock suggested that catch was at least twice as high as the official record. In light of the fishers’ evidence, the model that invoked a large change in mortality with age to follow reported catch closely now appears less credible. This serves as a warning against introducing new biological mechanisms without credible justification. This is an example of how indicators derived from fisher’s knowledge, even if only from a small number of interviews, can be used to eliminate less plausible models.