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Jiang W, Yan Y, Huang T, Lin Z, Yang X, Luo Z, Ye L. Efficacy and safety of aspirin in venous thromboembolism prevention after total hip arthroplasty, total knee arthroplasty or fracture. VASA 2024; 53:314-325. [PMID: 39052442 DOI: 10.1024/0301-1526/a001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background: This study aims to analyse the efficacy and safety of aspirin in the prevention of venous thromboembolism (VTE) for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA) or fracture. Patients and methods: Two independent investigators searched PubMed, Embase, Cochrane and ClinicalTrials.gov from January 2000 to June 2023 to retrieve randomized control trials (RCTs) about aspirin in VTE prevention after arthroplasty or fracture. Then, the relative risk (RR) was utilized to evaluate its efficiency and safety. Results: A total of 16 RCTs with 27,864 patients were included. There was no statistical difference in the incidence of deep-vein thrombosis (RR: 1.31, p = 0.100), pulmonary embolism (RR:1.05, p = 0.850), VTE (RR:1.28, p = 0.290), major bleeding (RR:0.96, p = 0.900), and death (RR:1.01, p = 0.960) between the aspirin group and the anticoagulants group. Subgroup analysis showed that a relatively higher incidence of deep-vein thrombosis in patients undergoing TKA (RR:1.49, p = 0.030), fracture (RR:1.48, p = 0.001), patients receiving 81 mg aspirin twice daily (RR:1.48, p = 0.001) and patients from North America (RR:1.57, p<0.001) when comparing aspirin with anticoagulants. Meanwhile, the incidence of VTE was higher in patients receiving 100 mg aspirin once daily (RR:1.82, p<0.001) compared with anticoagulants. Additionally, the incidence of all bleeding (RR:2.00, p = 0.030) was higher in patients receiving aspirin in Asia compared with anticoagulants. Conclusions: In terms of clinical effectiveness and safety, aspirin (antiplatelet agent) was generally not inferior to anticoagulants in the prevention of VTE after THA, TKA, or fracture. Notably, the clinical effectiveness of aspirin was affected by different surgical types, the doses of aspirin and races.
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Affiliation(s)
- Wei Jiang
- Department of Intensive Care Unit, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Yici Yan
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tongmin Huang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhenyi Lin
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xinyan Yang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhouqing Luo
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lin Ye
- Department of Intensive Care Unit, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
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Nana Sede Mbakop R, Forlemu AN, Ugwu C, Soladoye E, Olaosebikan K, Obi ES, Amakye D. Racial Differences in Non-variceal Upper Gastrointestinal (GI) Bleeding: A Nationwide Study. Cureus 2024; 16:e61982. [PMID: 38984003 PMCID: PMC11232367 DOI: 10.7759/cureus.61982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/11/2024] Open
Abstract
Background and aims Knowledge about the impact of race on non-variceal upper GI bleeding (NVUGIB) is limited. This study explored the racial differences in the etiology and outcome of NVUGIB. Methods We conducted a study from 2009 to 2014 using the Nationwide Inpatient Sample (NIS) database. NIS is the largest publicly available all-payer inpatient database in the USA with more than seven million hospital stays each year. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for NVUGIB, esophagogastroduodenoscopy (EGD) and demographics were obtained. The outcomes of interest were in-hospital mortality, hospital length of stay (HLOS), total hospital charges, admission to the intensive care unit (ICU), and patient disposition. Analysis was conducted using Chi-square tests and Tukey multiple comparisons between groups. Results Among 1,082,516 patients with NVUGIB, African American and Native Americans had the highest proportions of hemorrhagic gastritis/duodenitis (8.2% and 4.2%, respectively) and Mallory-Weiss bleeding (10.4% and 5.4%, respectively; p<0.01). African Americans were less likely to get an EGD done within 24 hours of admission compared to Whites and Latinxs (45.9% vs 50.1% and 50.4%, respectively; p<0.001). In-hospital mortality was similar among African Americans, Latinxs, and Whites (5.8% vs 5.6% vs 5.9%, respectively; p=0.175). Asian/Pacific Islanders and African Americans were more likely to be admitted to the ICU (9.6% and 9.0%, respectively; p<0.001). Moreover, African Americans had a longer HLOS compared to Latinxs and Whites (7.5 vs 6.5 and 6.4 days, respectively; p<0.001). Conversely, Asian/Pacific Islanders and Latinx incurred the highest hospital total charges compared to African Americans and Whites ($81,821 and $69,267 vs $61,484 and $53,767, respectively; p<0.001). Conclusion African Americans are less likely to receive EGD within 24 hours of admission and are more likely to be admitted to the ICU with prolonged hospital lengths of stay. Latinxs are more likely to be uninsured and incur the highest hospital costs.
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Affiliation(s)
| | - Arnold N Forlemu
- Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, USA
| | - Chidiebube Ugwu
- Public Health, East Tennessee State University, Johnson City, USA
| | | | | | - Emeka S Obi
- Public Health, East Tennessee State University, Johnson City, USA
| | - Dominic Amakye
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
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Kopanczyk R, Lisco SJ, Pearl R, Demiralp G, Naik BI, Mazzeffi MA. Racial and Ethnic Disparities in Veno-Venous Extracorporeal Membrane Oxygenation Mortality for Patients With Severe COVID-19. ASAIO J 2024; 70:62-67. [PMID: 37815999 DOI: 10.1097/mat.0000000000002072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Racial/ethnic disparities in mortality were observed during the coronavirus disease-2019 pandemic, but investigations examining the association between race/ethnicity and mortality during extracorporeal membrane oxygenation (ECMO) are limited. We performed a retrospective observational cohort study using the 2020 national inpatient sample. Multivariable logistic regression was used to estimate the odds of mortality in patients of difference race/ethnicity while controlling for confounders. There was a significant association between race/ethnicity and in-hospital mortality ( p < 0.001). Hispanic patients had significantly higher in-hospital mortality compared with White patients (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.16-1.67, p < 0.001). Black patients and patients of other races did not have significantly higher in-hospital mortality compared with White patients (OR = 0.82, 95% CI = 0.66-1.02, p = 0.07 and OR = 1.20, 95% CI = 0.92-1.57, p = 0.18). Other variables that had a significant association with mortality included age, insurance type, Charlson comorbidity index, all patient-refined severity of illness, and receipt of care in a low-volume ECMO center (all p < 0.001). Further studies are needed to understand causes of disparities in ECMO mortality.
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Affiliation(s)
- Rafal Kopanczyk
- From the Division of Critical Care, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Steven J Lisco
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ronald Pearl
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California
| | - Gozde Demiralp
- Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin
| | - Bhiken I Naik
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Michael A Mazzeffi
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia
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Rodriguez NJ, Zheng NS, Mezzacappa C, Canavan M, Laine L, Shung DL. Disparities in Access to Endoscopy for Patients With Upper Gastrointestinal Bleeding Presenting to Emergency Departments. Gastroenterology 2023; 164:1044-1046.e4. [PMID: 36228735 PMCID: PMC10083188 DOI: 10.1053/j.gastro.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Nicolette J. Rodriguez
- Brigham and Women’s Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | | | - Loren Laine
- Yale School of Medicine, New Haven, CT
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
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Rammohan R, Joy MV, Saggar T, Magam SG, Sinha A, Natt D, Gomez S, Sheikh S, Anand P, Mustacchia P. Healthcare Disparities and Upper Gastrointestinal Bleeding: Exploring the Linkages. Cureus 2023; 15:e37977. [PMID: 37101799 PMCID: PMC10123219 DOI: 10.7759/cureus.37977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Upper gastrointestinal bleeding (UGIB) refers to blood loss from a gastrointestinal (GI) source proximal or above the ligament of Treitz. Health equity means giving everyone an equal chance to achieve optimal health by addressing injustices, overcoming barriers, and eliminating health disparities. Healthcare providers must analyze racial and ethnic disparities in UGIB management to ensure all patients receive equal care. Identifying risk factors in specific populations leads to tailored interventions that improve outcomes. Our study aims to examine trends and identify disparities in upper gastrointestinal bleeding across races and ethnicities to promote health equity. Methods Retrospective data on upper gastrointestinal bleeding from June 2009 to June 2022 were collected and categorized into five groups based on race. The baseline characteristics of each group were matched to ensure equitable comparison. A joinpoint regression model was used to compare incidence trends, identifying potential healthcare disparities for different racial/ethnic groups over time. Patients aged 18-75 who suffered from upper gastrointestinal bleeding at Nassau University Medical Center in New York from 2010 to 2021 were selected, excluding those with incomplete baseline comorbidity information. Results This study examined 5103 cases of upper gastrointestinal bleeding, with 41.9% female. The cohort was diverse, with 29.4% African American, 15.6% Hispanic, 45.3% White, 6.8% Asian, and 2.9% of other races. Data were split into two groups; 49.9% occurred between 2009 and 2015 and 50.1% between 2016 and 2022. Findings showed increased UGIB among Hispanics and decreased bleeding among Asians during 2016-2021 compared to 2009-2015. However, no significant difference was found for African Americans, Whites, and other races. In addition, Hispanics had a rise in the annual percentage change (APC) rate, whereas Asians had a decrease. Conclusion Our study examined trends in upper gastrointestinal bleeding and potential healthcare disparities across races and ethnicities. Our findings highlight an increased incidence of UGIB in Hispanics and a decreased incidence in Asians. Additionally, we identified a significant increase in the annual percentage change rate in Hispanics and a decrease in Asians over time. Our study underscores the importance of identifying and addressing disparities in UGIB management to promote health equity. Future research can build on these findings to develop tailored interventions that improve patient outcomes.
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Affiliation(s)
- Rajmohan Rammohan
- Gastroenterology, Nassau University Medical Center, East Meadow, USA
| | - Melvin V Joy
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Tulika Saggar
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | | | - Atul Sinha
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Dilman Natt
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Sandra Gomez
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Saher Sheikh
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Prachi Anand
- Rheumatology, Nassau University Medical Center, East Meadow, USA
| | - Paul Mustacchia
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
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Helzberg JH, Parish A, Niedzwiecki D, Kim CY, Patel YA, Wilder JM, Muir AJ. Racial disparities in transjugular intrahepatic portosystemic shunt procedure outcomes. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000747. [PMID: 35086849 PMCID: PMC8796249 DOI: 10.1136/bmjgast-2021-000747] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022] Open
Abstract
Objective The transjugular intrahepatic portosystemic shunt (TIPS) procedure is an important intervention for management of complications of portal hypertension. The objective of this study was to identify predictors of mortality from the TIPS procedure with a focus on race and ethnicity. Design TIPS procedures from 2012 to 2014 in the National Inpatient Sample were identified. Weighting was applied to generate nationally representative results. In-hospital mortality was the primary outcome of interest. χ2 and Student’s t-tests were performed for categorical and continuous variables, respectively. Predictors of mortality following TIPS were assessed by survey-weighted logistic regression. Results 17 175 (95% CI 16 254 to 18 096) TIPS cases were identified. Approximately 71% were non-Hispanic (NH) white, 6% were NH black, 16% were Hispanic and 7% were other. NH black patients undergoing TIPS had an in-hospital mortality rate of 20.1%, nearly double the in-hospital mortality of any other racial or ethnic group. NH black patients also had significantly longer median postprocedure and total lengths of stay (p=0.03 and p<0.001, respectively). The interaction of race by clinical indication was a significant predictor of in-hospital mortality (p<0.001). NH black patients had increased mortality compared with other racial/ethnic groups when presenting with bleeding oesophageal varices (OR 3.85, 95% CI 2.14 to 6.95). Conclusion This cohort study presents important findings in end-stage liver disease care, with clear racial disparities in in-hospital outcomes following the TIPS procedure. Specifically, black patients had significantly higher in-hospital mortality and longer lengths of stay. Further research is needed to understand how we can better care for black patients with liver disease.
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Affiliation(s)
- James H Helzberg
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Charles Y Kim
- Department of Radiology, Division of Interventional Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Yuval A Patel
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Julius M Wilder
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrew J Muir
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA .,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
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7
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Finianos A, Mujadzic H, Peluso H, Mujadzic T, Taher A, Abougergi MS. Temporal trends and outcome of splenectomy in adults with immune thrombocytopenia in the USA. Ann Hematol 2021; 100:941-952. [PMID: 33560468 DOI: 10.1007/s00277-021-04449-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
Splenectomy is one of the treatments of immune thrombocytopenia (ITP) with a high response rate. However, it is an irreversible procedure that can be associated with morbidity in this setting. Our aim was to study the trends of splenectomy in adults with ITP, and the factors associated with splenectomy and resource utilization during these hospitalizations. We used the National (Nationwide) Inpatient Sample (NIS) to identify hospitalizations for adult patients with a principal diagnosis of ITP between 2007 and 2017. The primary outcome was the splenectomy trend. Secondary outcomes were (1) incidence of ITP trend, (2) in-hospital mortality, length of stay, and total hospitalization costs after splenectomy trend, and (3) independent predictors of splenectomy, length of stay, and total hospitalization costs. A total of 36,141 hospitalizations for ITP were included in the study. The splenectomy rate declined over time (16% in 2007 to 8% in 2017, trend p < 0.01) and so did the in-hospital mortality after splenectomy. Of the independent predictors of splenectomy, the strongest was elective admissions (adjusted odds ratio [aOR]: 22.1, 95% confidence interval [CI]:17.8-27.3, P < 0.01), while recent hospitalization year, older age, and Black (compared to Caucasian) race were associated with lower odds of splenectomy. Splenectomy tends to occur during elective admissions in urban medical centers for patients with private insurance. Despite a stable ITP hospitalization rate over the past decade and despite listing splenectomy as a second-line option for management of ITP in major guidelines, splenectomy rates consistently declined over time.
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Affiliation(s)
- Antoine Finianos
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut School of Medicine, Beirut, Lebanon
| | - Hata Mujadzic
- Department of Medicine, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Heather Peluso
- Division of Surgery, Prisma Health Upstate, Greenville, SC, USA
| | - Tarik Mujadzic
- Division of Plastic Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Ali Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut School of Medicine, Beirut, Lebanon
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA. .,Catalyst Medical Consulting, Simpsonville, SC, USA.
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Mumtaz K, Lee-Allen J, Porter K, Kelly S, Hanje J, Conteh LF, Michaels AJ, El-Hinnawi A, Washburn K, Black SM, Abougergi MS. Thirty-day readmission rates, trends and its impact on liver transplantation recipients: a national analysis. Sci Rep 2020; 10:19254. [PMID: 33159123 PMCID: PMC7648628 DOI: 10.1038/s41598-020-76396-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/28/2020] [Indexed: 12/17/2022] Open
Abstract
Reduction of early hospital readmissions is a declared goal in the United States economic and quality improvement agenda. A retrospective study was performed using the Nationwide Readmissions Database from 2010 to 2014. Our primary aim was to study the rate of early readmissions and its predictors in liver transplant recipients (LTRs). Our secondary aims were to determine the trends of LT, reasons for readmission, costs and predictors of calendar year mortality. Multivariable logistic regression and Cox proportional hazards models were utilized. The 30-day readmission rate was 30.6% among a total of 25,054 LTRs. Trends of LT were observed to be increased in patients > 65 years (11.7-17.8%, p < 0.001) and decreased in 40-64 years (78.0-73.5%, p = 0.001) during study period. The majority of 30-day readmissions were due to post transplant complications, with packed red blood cell transfusions being the most common intervention during readmission. Medicaid or Medicare insurance, surgery at low and medium volume centers, infections, hemodialysis, liver biopsy, and length of stay > 10 days were the predictors of 30-day readmission. Moreover, number of early readmission, age > 64 years, non-alcoholic cirrhosis, and length of stay > 10 days were significant predictor of calendar year mortality in LTRs. Approximately one third of patients require early admission after LT. Early readmission not only increases burden on healthcare, but is also associated with calendar year mortality. Strategies should be implemented to reduce readmission in patients with high risk of readmission identified in our study.
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Affiliation(s)
- Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA.
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Jannel Lee-Allen
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Sean Kelly
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James Hanje
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lanla F Conteh
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anthony J Michaels
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ashraf El-Hinnawi
- Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Ken Washburn
- Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Sylvester M Black
- Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina, Columbia, SC, USA
- Catalyst Medical Consulting, Simpsonville, USA
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Zhang C, Fu C, Song Y, Feng R, Wu X, Li Y. Utilization of public health care by people with private health insurance: a systematic review and meta-analysis. BMC Public Health 2020; 20:1153. [PMID: 32703180 PMCID: PMC7376853 DOI: 10.1186/s12889-020-08861-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this systematic review was to explore the association between private health insurance and health care utilization. Methods We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases for relevant articles since 2010. Studies were eligible if they described original empirical research on the utilization of public health care by individuals with private health insurance, compared with individuals without private insurance. A pooled measure of association between insurance status with health care utilization was assessed through meta-analysis. Results Twenty-six articles were included in the final analysis. We found that patients with private insurance did not use more public health care than people without private insurance (P < 0.05). According to the subgroup analysis, people with private insurance were more likely to be hospitalized than people with no insurance (OR 1.67; 95% CI, 1.18 to 2.36). Conclusions People with private insurance did not increase their use of health care (outpatient services), compared to those without private insurance. Private health insurance coverage may ease the financial burden on patients and on the public health insurance system.
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Affiliation(s)
- Congcong Zhang
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China
| | - Chenwei Fu
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yimin Song
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China
| | - Rong Feng
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Yongning Li
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China.
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Bilal M, Samuel R, Khalil MK, Singh S, Parupudi S, Abougergi MS. Nonvariceal upper GI hemorrhage after percutaneous coronary intervention for acute myocardial infarction: a national analysis over 11 months. Gastrointest Endosc 2020; 92:65-74.e2. [PMID: 32017916 DOI: 10.1016/j.gie.2020.01.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Nonvariceal upper GI hemorrhage (NVUGIH) is a feared adverse event after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). We aimed to determine the incidence of NVUGIH after PCI for AMI and its impact on mortality, morbidity, and health care resource utilization over 11 months. METHODS We used the Nationwide Readmission Database 2014. Inclusion criteria were (1) a principal diagnosis of ST or non-ST-elevation myocardial infarction, (2) in-hospital PCI, and (3) admission in January. Exclusion criteria were age less than 18 years and elective admission. The primary outcome was the 11-month incidence of NVUGIH. Secondary outcomes were 11-month mortality rate, prolonged mechanical ventilation, shock, upper endoscopy, length of stay, and total hospitalization costs and charges. Independent risk factors for NVUGIH were identified using multivariate logistic regression analysis. RESULTS A total of 22,669 patients were included in the study. The mean age was 63.8 years (range, 63.4-64.1 years), and 31.7% of patients were female. The 11-month incidence of NVUGIH was 1.6%. The onset of NVUGIH was associated with an increase in the 11-month mortality rate (adjusted odds ratio, 1.94; 95% confidence interval, 1.01-3.72; P =.04). The upper endoscopy, shock, and prolonged mechanical ventilation rates were 72%, 6.2%, and 1.9%, respectively. In total, 26,532 days were associated with NVUGIH, with a total health care in-hospital economic burden of U.S.$17.6 million. Independent predictors of NVUGIH were female gender, Charlson comorbidity score, and length of stay. CONCLUSIONS The 11-month incidence of NVUGIH among patients who undergo PCI for AMI is 1.6%. NVUGIH has a substantial impact on mortality, morbidity, and in-hospital health care resource utilization.
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Affiliation(s)
- Mohammad Bilal
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, Texas; Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ronald Samuel
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Shailendra Singh
- Division of Gastroenterology, West Virginia University, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Sreeram Parupudi
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, Texas
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, South Carolina, USA; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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