Dataset Information

Burden of Pneumonia-Associated Hospitalizations: United States, 2001-2014.

ABSTRACT: BACKGROUND:The epidemiology of pneumonia has likely evolved in recent years, reflecting an aging population, changes in population immunity, and socioeconomic disparities. METHODS:Using the National (Nationwide) Inpatient Sample, estimated numbers and rates of pneumonia-associated hospitalizations for 2001-2014 were calculated. A pneumonia-associated hospitalization was defined as one in which the discharge record listed a principal diagnosis of pneumonia or a secondary diagnosis of pneumonia if the principal diagnosis was respiratory failure or sepsis. RESULTS:There were an estimated 20,361,181 (SE, 95,601) pneumonia-associated hospitalizations in the United States during 2001-2014 (average annual age-adjusted pneumonia-associated hospitalization rate of 464.8 per 100,000 population [95% CI, 462.5-467.1]). The average annual age-adjusted pneumonia-associated hospitalization rate decreased over the study period (P < .0001). In-hospital death occurred in 7.4% (SE, 0.03) of pneumonia-associated hospitalizations. Non-Hispanic American Indian/Alaskan Natives and non-Hispanic blacks had the highest average annual age-adjusted rates of pneumonia-associated hospitalization of all race/ethnicities at 439.2 (95% CI, 415.9-462.5) and 438.6 (95% CI, 432.5-444.7) per 100,000 population, respectively. During 2001-2014, the proportion of pneumonia-associated hospitalizations colisting an immunocompromising condition increased from 18.7% (SE, 0.2) in 2001 to 29.9% (SE, 0.2) in 2014. Total charges for pneumonia-associated hospitalizations in 2014 were over $84 billion. CONCLUSIONS:Pneumonia is a major cause of morbidity and mortality in the United States. Differences in rates and outcomes of pneumonia-associated hospitalizations between sociodemographic groups warrant further investigation. The immunocompromised population has emerged as a group experiencing a disproportionate burden of pneumonia-associated hospitalizations.

SUBMITTER: Hayes BH

PROVIDER: S-EPMC6556777 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Burden of Pneumonia-Associated Hospitalizations: United States, 2001-2014.

Hayes Brandon H BH Haberling Dana L DL Kennedy Jordan L JL Varma Jay K JK Fry Alicia M AM Vora Neil M NM

Chest 20171007 2

<h4>Background</h4>The epidemiology of pneumonia has likely evolved in recent years, reflecting an aging population, changes in population immunity, and socioeconomic disparities.<h4>Methods</h4>Using the National (Nationwide) Inpatient Sample, estimated numbers and rates of pneumonia-associated hospitalizations for 2001-2014 were calculated. A pneumonia-associated hospitalization was defined as one in which the discharge record listed a principal diagnosis of pneumonia or a secondary diagnosis ...[more]

PMID: 29017956

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Project description:BackgroundInfectious disease epidemiology has changed over time, reflecting improved clinical interventions and emergence of threats such as antimicrobial resistance. This study investigated infectious disease hospitalizations in the United States from 2001 to 2014.MethodsEstimated rates of infectious disease hospitalizations were calculated by using the National (Nationwide) Inpatient Sample. Infectious disease hospitalizations were defined as hospitalizations with a principal discharge diagnosis of an infectious disease. Diagnoses according to site of infection and sepsis were examined, as was occurrence of in-hospital death. The leading nonsepsis infectious disease secondary diagnoses for hospitalizations with a principal diagnosis of sepsis were identified.ResultsThe mean annual age-adjusted infectious disease hospitalization rate was 1,468.2 (95% CI, 1,459.9-1,476.4) per 100,000 population; in-hospital death occurred in 4.22% (95% CI, 4.18-4.25) of infectious disease hospitalizations. The mean annual age-adjusted infectious disease hospitalization rate increased from 2001-2003 to 2012-2014 (rate ratio, 1.05; 95% CI, 1.01-1.09), as did the percentage of in-hospital death (4.21% [95% CI, 4.13-4.29] to 4.30% [95% CI, 4.26-4.35]; P = .049). The diagnoses with the highest hospitalization rates among all sites of infection and sepsis diagnoses were the lower respiratory tract followed by sepsis. The most common nonsepsis infectious disease secondary diagnoses among sepsis hospitalizations were "urinary tract infection," "pneumonia, organism unspecified," and "intestinal infection due to Clostridium [Clostridioides] difficile."ConclusionsAlthough hospital discharge data are subject to limitations, particularly for tracking sepsis, lower respiratory tract infections and sepsis seem to be important contributors to infectious disease hospitalizations. Prevention of infections that lead to sepsis and improvements in sepsis management would decrease the burden of infectious disease hospitalizations and improve outcomes, respectively.

Project description:ImportanceEye trauma is a common cause of vision loss and a substantial public health problem.ObjectiveTo determine the changes in the incidence of eye trauma hospitalizations in the United States and compare the demographics of affected patients and outcomes of eye trauma as a primary or secondary admitting diagnosis.Design, setting, and participantsThis retrospective longitudinal cohort study used the National Inpatient Sample, a representative sample of all US community hospitals, to determine the incidence, characteristics, and causes of primary and secondary inpatient eye trauma admissions from 2001 through 2014. All inpatients with relevant diagnoses were included. Linear regression was used to estimate changes in incidence. Logistic regression was used to compare demographics and outcomes between primary and secondary diagnoses, including age, sex, race, income, primary payer, region, year of admission, length of stay, cost, and disposition at discharge.ExposuresEye trauma.Main outcomes and measuresIncidence and characteristics of inpatient primary and secondary eye trauma.ResultsFrom 2001 to 2014, there were an estimated 939 608 inpatient admissions (of whom 556 886 were male patients [59.3%]; overall mean [SD] age, 49.4 [25.2] years) in the United States because of eye trauma diagnoses, with 778 967 of these (82.9%) as a secondary diagnosis. The incidence of primary eye trauma decreased from 3.9 to 3.0 per 100 000 population (difference, 0.9 [95% CI, 0.2-1.6] per 100 000 population; P = .001). The incidence of eye trauma as a secondary admitting diagnosis increased from 14.5 to 19.0 per 100 000 population (difference, 4.5 [95% CI, 1.9-7.2] per 100 000 population; P = .004). This was largely attributed to an increasing number of falls in individuals older than 65 years. The most frequent diagnosis was orbital fracture (64 149 [39.9%]) for primary trauma and contusion of eye and adnexa (19 301 [37.8%]) for secondary trauma. Primary trauma was more common in children (adjusted odds ratio [aOR], 2.21 [95% CI, 2.09-2.32]) and adolescents (aOR, 1.25 [95% CI, 1.19-1.32]) than adults (reference), African American individuals (aOR, 1.89 [95% CI, 1.81-1.97]) and Hispanic individuals (aOR, 1.52 [95% CI, 1.45-1.59]) than white individuals, and uninsured patients (aOR, 1.14 [95% CI, 1.07-1.22]) and those receiving Medicaid (aOR, 1.12 [95% CI, 1.05-1.19]) than Medicare beneficiaries. Patients with a primary diagnosis were more likely to have a stay of less than 3 days (patients with a primary diagnosis: 101 796 [63.4%]; secondary diagnosis: 274 538 [35.2%]), more likely to have costs in the lowest quartile (patients with a primary diagnosis: 51 212 [31.9%]; secondary diagnosis: 166 260 [21.3%]), and less likely to die (patients with a primary diagnosis: 526 [0.3%]; secondary diagnosis: 20 929 [2.7%]).Conclusions and relevanceThese findings suggest that the increasing number of falls in individuals older than 65 years and the high risk of primary eye trauma in populations such as children and adolescents warrant the development and implementation of effective preventive strategies. Many of these patients are seen in ophthalmology practices where proactive risk assessment and counseling can play a critical role.

Project description:ImportanceThe relationship between income and life expectancy is well established but remains poorly understood.ObjectivesTo measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation.Design and settingIncome data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy.ExposurePretax household earnings as a measure of income.Main outcomes and measuresRelationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas.ResultsThe sample consisted of 1,408,287,218 person-year observations for individuals aged 40 to 76 years (mean age, 53.0 years; median household earnings among working individuals, $61,175 per year). There were 4,114,380 deaths among men (mortality rate, 596.3 per 100,000) and 2,694,808 deaths among women (mortality rate, 375.1 per 100,000). The analysis yielded 4 results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r = -0.69, P < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r = 0.42, P < .001), and government expenditures (r = 0.57, P < .001).Conclusions and relevanceIn the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics.

Dataset Information

Burden of Pneumonia-Associated Hospitalizations: United States, 2001-2014.

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Burden of Pneumonia-Associated Hospitalizations: United States, 2001-2014.

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