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This study evaluates and compares US trends between 2010 and 2019 in per-capita primary care physician supply by county-level racial and ethnic minority concentration, poverty, rurality, and region.
Objective
The aim of this study is to assess change in stunting and its associated factors among children aged less than 5 years in Ethiopia using Ethiopia Demographic and Health Survey data from 2005 to 2019.
Design
A community-based cross-sectional study was conducted.
Setting
The study was conducted in Ethiopia.
Participants
In 2005, 4586 individuals were examined, followed by 10 282 in 2011, 9462 in 2016 and 4937 in 2019.
Primary and secondary outcomes
The primary outcome of the study was stunting, and the secondary outcome was factors associated with stunting and its change. A multilevel logistic regression model was fitted to identify individual and community-level factors associated with stunting among children aged less than 5 years. Multivariate decomposition analysis was also carried out to assess the role of compositional characteristics and behavioural change for decline in stunting among children aged less than 5 years in Ethiopia.
Results
Over the study period, the prevalence rate of stunting in children aged less than 5 years decreased from 47% to 37% in 2019. Differences in behavioural change among children under the age of 5 years account for 76.69% of the overall decline in stunting prevalence rate in the years 2005–2011, 86.53% in the years 2005–2016, 98.9% in the years 2005–2019, 70.34% in the years 2011–2016 and 73.77% in the years 2011–2019. Behavioural adjustments among breastfed children, diet diversity, place of delivery, ANC follow-up and region have all had a major effect on stunting prevalence rate. The wealth index, parenteral education, child’s age in months, length of breast feeding and area were among the compositional change factors.
Conclusion
A large percentage of children aged less than 5 years remains stunted in Ethiopia. Stunting was associated with alterations in the compositional and behavioural characteristics of children. Stimulating existing nutritional measures and improving the wealth index will make a significant difference in reducing stunting among Ethiopian children aged less than 5 years.
Peggio del nostro Paese solo Cipro e Grecia; obeso più del 15%
This study uses administrative health care data from Ontario, Canada, to assess whether changes in diabetes management practices have affected trends in the association between diabetes vs prior cardiovascular disease and risk of cardiovascular events from 1994 to 2019 among adults aged 20 to 84 years.
Circulation, Volume 146, Issue Suppl_1, Page A14430-A14430, November 8, 2022. Introduction:Advanced heart failure therapies and heart transplantation (HTx) have been underutilized in women. Therefore, we aimed to explore the clinical characteristics and outcomes of HTx by sex.Methods:We conducted a retrospective analysis of adult discharges from the National Inpatient Sample (NIS) between 2012 and 2019. International Classification of Disease (ICD) procedure codes were used to identify those who underwent HTx.Results:A total of 20,180 HTx hospitalizations were identified from 2012-2019. Among them, 28% were female. Women undergoing HTx were younger (mean age 51 vs. 54.5 years, p
Circulation, Volume 146, Issue Suppl_1, Page A12142-A12142, November 8, 2022. Introduction:After FDA approval in 2017, chimeric antigen receptor (CAR) T-cell therapy gained high popularity in various hematological malignancies.Hypothesis:There are no sex-based differences in in-hospital mortality and length of stay after CAR T-cell therapy.Methods andResults:From 2018 to 2019, using national inpatient sample, among a total of 14,189,303 hospitalizations (unweighted sample) 704 (0.01%) CAR T-cell therapy were performed, 306 in 2018 and 408 in 2019. Among the CAR T-cell therapy performed, 58.4% (n = 417) were males, 2.9% (n=21) had pulmonary edema, 0.6% (n=6) had acute decompensated heart failure, 3.08% (n=22) had supraventricular tachycardia, 3.36% (n=24) had ventricular tachycardia, 1.94% (n=14) had pericardial effusion (including chronic pericarditis or tamponade), 0.14% (n=1) had acute pericarditis, 0.14% (n=1) had non ST-segment elevation myocardial infarction, 3.64% (n=26) required pressors, 8.68% (n=64) had atrial fibrillation, 3.64% (n=26) had disseminated intravascular coagulation, 4.76% (n=34) required mechanical ventilation. 3.92% (n=28) died in the hospital and mean length of stay (LOS) was 20.5 days. The mean age for CAR T-cell therapy was 54 ± 18 years. Among CAR T cell therapy population, compared to males, females were similar in age (mean age: 54.6 vs. 54 years; p=0.606), had lower incidence of atrial fibrillation (4.38% vs 11.75%, p
Circulation, Volume 146, Issue Suppl_1, Page A14473-A14473, November 8, 2022. Introduction:Dietary risk factors contribute to cardiovascular mortality. To the best of our knowledge, there are no studies comparing two first world countries with respect to cardiovascular deaths (CVD) and the impact of dietary risk factors. We sought to compare these parameters in Great Britain (GBR) and the United States of America (USA)Methods:A total of 33,041,416 patients with dietary risk factors and CVD from GBR and USA was obtained from the Global Burden of Disease Study between 1990 and 2016.The 30-year mean CVD was compared for all risk factors with the Welch Two sample t-test. Trends of CVD proportions of 30-years is as shown (Fig 1 and 2).Results:30-year mean cardiovascular death for all variables between GBR and USA was statistically significant (p< 0.05) with the exception of diet low in whole grains. Cardiovascular death with risk factors of diet low in PUFA, fruits, vegetable, nuts and seeds were measures where GBR had a higher 30-year mean CVD than the USA. Remaining factors contributed to higher CVD proportion in USA.Conclusions:A higher proportion of CVD was seen in the USA with dietary risk factors including low PUFA, processed meat, sweetened beverages, low legumes, high sodium and high trans-fatty acids when compared to GBR. Our study proves that there exists significant disparity in CVD proportions between two first world countries despite similar dietary risk factors.
Circulation, Volume 146, Issue Suppl_1, Page A10073-A10073, November 8, 2022. Introduction:With the increasing burden of Acute Myocardial Infarction(AMI) on Medicare, there is a paucity of information on the incidence of Acute Ischemic Stroke(AIS) in those patients and their risk factors.Methods:Patients with a principal diagnosis of AMI covered by Medicare from the 2019 National Inpatient Sample were extracted. Multiple variable regression allowed us to estimate the adjusted odds ratio (aOR) of AIS among patients while acknowledging various possible factors.Results:A total of 378,390 cases of AMI covered by Medicare were found, amongst which 6110 patients,1.6%, also experienced AIS. The mean age of AIS cases was 75.34 years, while it was 74.31 years in non-AIS patients. Patients with AMI are more likely to have a diagnosis of AIS during their hospitalization if they are females (aOR 1.195, 95% CI 1.134-1.260, p
Circulation, Volume 146, Issue Suppl_1, Page A13455-A13455, November 8, 2022. Introduction:Intravascular Ultrasound (IVUS) is a catheter-based real-time imaging procedure that assists in both diagnosis and treatment during Percutaneous Coronary Intervention (PCI). Over the years, IVUS-guided PCI have become more popular. In this study, we aimed to analyze the trends of use of IVUS-guided PCI, adjusted in-hospital mortality, hospital length of stay (LOS) and inpatient cost over the years.Methods:Data were extracted from the National Inpatient Sample (NIS) 2014 through 2019 Database. The NIS was searched for PCI with and without IVUS in adult patients (age≥18) using ICD 9 and 10 codes. Outcomes of interest were utilization rates of IVUS during PCI, trend of adjusted in-hospital mortality, adjusted mean LOS and adjusted mean cost. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis.Results:Of 2,871,865 PCIs in 2014 through 2019, 201,075 (7.0%) were coupled with IVUS. The use of IVUS during PCI steadily increased from 6.2% in 2014 to 9.3% in 2019 (trend p
Circulation, Volume 146, Issue Suppl_1, Page A11755-A11755, November 8, 2022. Background:The burden of prediabetes (pDM) in smokers remains unknown. We aimed to analyze the burden and impact of prediabetes on AMI [Type 1/Type 2] hospitalizations in smokers and outcomes using a nationally representative sample.Methods:We queried the National Inpatient Sample (2019) to identify AMI-related hospitalizations in adult non-diabetic smokers with vs without pDM using ICD-10 codes. Demographics, comorbidities, and outcomes including major cardiovascular and cerebrovascular adverse events (MACCE) were compared between two cohorts.Results:Overall prevalence of pDM in hospitalized non-diabetic smokers in 2019 was 1.2% (46770/3880640). AMI cohort with pDM often had males (59.4% vs 54.6%), blacks (23 vs 17.7%), Hispanics (8.7 vs 6.4%), Asian/Pacific Islanders (2.7 vs 1%), patients from higher-income quartile (16.4 vs 12.6%), and higher rates of modifiable CVD risk factors. Adjusted multivariable analysis revealed higher risk of overall (aOR 1.73 [1.60-1.88]), T1MI (1.86 [1.70-2.03]) and T2MI (OR 1.39 [1.16-1.67]). The risk of overall AMI was 1.73 times higher in patients with vs. without prediabetes, which was comparable in male (aOR 1.73) and female (aOR 1.72) smokers, however, female smokers with prediabetes had higher T2MI risk (aOR F:1.55, M:1.30) vs. males. Black smokers with prediabetes have the highest risk of overall (aOR 1.85), T1MI (aOR 2.03) and T2MI (aOR 1.77). Among Hispanics, prediabetes increased the risk of overall (aOR 1.69) and T1MI (aOR 1.92) but not T2MI. Prediabetes increased the risk of T1MI (aOR 1.74) in Asians without any association with overall or T2MI[Table 1].Conclusions:Prediabetes independently increased the risk of overall AMI/T1MI/T2MI-related hospitalizations in non-diabetic smokers. Black smokers with prediabetes had the highest risk of AMI, T1MI and T2MI, and females had a higher risk of T2MI. This highlights the need for a tailored management of CVD risk by sex and race among smokers with prediabetes..
Circulation, Volume 146, Issue Suppl_1, Page A11773-A11773, November 8, 2022. Background:The impact of recreational marijuana use/cannabis use disorder (CUD) in elderly chronic kideney disease (CKD) patients remains unknown amidst the rising use of cannabis in the USA. We conducted a nationwide study to assess the impact of CUD on cardiovascular outcomes in these patients.Methods:We used National Inpatient Sample (2016-2019) and geriatric (≥65 years) admissions with CKD. We compared baseline characteristics, comorbidities and composite in-hospital outcomes [MACCE- all-cause mortality, acute myocardial infarction-AMI, cardiac arrest and acute ischemic stroke-AIS] between the age-matched (1:1 propensity score matching) CUD+ vs. CUD- cohorts.Results:Age-matched (median 70 years, p=0.998) geriatric CKD-CUD+ (n=34255) and CUD- (n=34225) cohorts were compared. CUD+ cohort often consisted of males (75.0 vs. 53.8%), blacks (35.9 vs 20.8%) and patients from lowermost income quartile (38.7 vs. 33.5%) (p
Circulation, Volume 146, Issue Suppl_1, Page A10072-A10072, November 8, 2022. Introduction:Sarcoidosis involves many organs in the body, including the heart, thus triggering various cardiovascular dysrhythmias and complications. We sought to analyze the cardiovascular events seen in these patients.Methods:The 2019 National Inpatient Sample (NIS) is one of the most extensive inpatient databases in the United States. It was used to explore and identify patients diagnosed with sarcoidosis and a valid entry for the variable “Sex”. Hospitalizations associated with several cardiac events were also examined (reported as cases per 100 males or females), and their occurrences were compared between males and females. Multiple logistic regression adjusted to non-cardiac characteristics allowed us to estimate the adjusted odds ratio (aOR) of the cardiovascular events in females relative to males.Results:We found 84,640 cases of sarcoidosis (61.5% females, and 38.5% males). Females were less likely to present with supraventricular tachycardia (2.1 vs. 2.4, aOR 0.804, p
Circulation, Volume 146, Issue Suppl_1, Page A13230-A13230, November 8, 2022. Introduction:Contemporary data on the prevalence, trends, and outcomes of cardiovascular diseases (CVD) in pregnant patients are limited.Hypothesis:We aimed to analyze the prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant patients in the United States (U.S.).Methods:This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from January 1, 2010, to December 31, 2019. Pregnancy-associated hospitalizations were identified, and patients with missing information on the length of stay (LOS) and mortality were excluded. Main outcomes were prevalence and trend of CVD burden in pregnant patients.Results:39,212,104 hospitalized pregnant patients were identified: 4,409,924 with CVD (11.25%) and 34,802,180 without CVD (88.75%). The annual CVD burden increased from 9.49 % in 2010 to 15.54 % in 2019 (p
Circulation, Volume 146, Issue Suppl_1, Page A10057-A10057, November 8, 2022. Introduction:Past studies have suggested that respiratory diseases are the most common cause of death among children with cerebral palsy (CP). At the same time, cardiovascular complications and cancer could be the leading killer among adult in those patients. The outcomes of cerebral palsy patients and risk factors following an episode of Acute Myocardial Infarction (AMI) have not been widely examined.Methods:A retrospective study via the 2019 National Inpatient Sample was conducted. Cases with CP diagnosis were retrieved via their appropriate ICD-10 codes (G80.0x). We also filtered to include patients with a principal diagnosis of AMI. Various categorical variables were compared via Chi-Square tests.Results:In 2019, 295 patients with cerebral palsy were admitted with AMI. CP patients were younger (mean age 63.20 vs. 66.93 years) and more common among Whites (86.0%), covered by Medicare (79.7%), and of ages >60 (66.1%). Compared to non-CP patients, CP patients also recorded more cases with depression (20.3% vs. 9.3%) and drug abuse (8.5% vs. 3.0%). However, they had less cases with smoking (28.8% vs. 49.3), obesity (13.6% vs. 21.0%), hyperlipidemia (59.3% vs. 68.6%), old myocardial infarct (8.5% vs. 16.6%), hypertension (78.0% vs. 82.8%), diabetes (35.6% vs. 41.2%), peripheral vascular disease (6.8% vs. 10.6%), acute kidney injury (10.2 % vs. 20.8%), ventricular tachycardia (6.8% vs. 7.2%), and paroxysmal atrial fibrillation (6.8% vs. 9.9%). Only 38.6% of CP patients underwent PCI.Conclusions:CP patients may present with AMI at a younger age and express a higher depression and drug abuse rate. Physicians and providers linked with their care should be encouraged to reach out to them for signs of depression and provide them with adequate facilities to seek treatment.
Circulation, Volume 146, Issue Suppl_1, Page A11742-A11742, November 8, 2022. Background:Inpatient outcomes in obese patients have been investigated, although regional inequalities in cardiac and cerebrovascular events in young obese patients have not been explored previously.Methods:The National Inpatient Sample 2019 was queried for young obese patients (18-44 years) in 4 regions (Northeast, Midwest, South, West) using ICD-10-CM codes. Baseline characteristics and comorbidities inpatient MACCE including all-cause mortality, AMI, cardiac arrest, and stroke were identified.Results:Young obese cohort (Total n: 1,285,775, median age: 33 years, females: 75.4%) often consisted of admissions in the South (41.1%), followed by the Midwest (22.3%), West (20.7%), and Northeast (20.7%). HTN and DM were more frequent in the Midwest (32.3% and 22.3%) and South (34.4% and 22.8%) respectively, with higher MACCE of South (3.3%) and Midwest (3%) as compared to Northeast (2.3%) and West (2.6%) regions. All regions had comparable median hospital stay (3 days); however, the admissions in the West and Northeast regions (USD 36861 and 31211) had a higher cost burden. After adjusting for sociodemographic and comorbidities, the odds of in-hospital MACCE were higher in the West (aOR 1.15 95%CI 1.02-1.29), and South (aOR 1.16 95%CI 1.04-1.29), (p
Circulation, Volume 146, Issue Suppl_1, Page A11761-A11761, November 8, 2022. Background:Acute myocardial infarction (AMI) in elderly patients who have previously undergone coronary artery bypass grafting (CABG) poses a diagnostic and therapeutic complexity. There is limited data on cardiovascular and mortality outcomes for this population.Methods:Using the National Inpatient Sample (NIS) from 2016-2019, we identified patients over 65 years with a prior CABG presenting with AMI, excluding those with a history of percutaneous coronary intervention. After assessing baseline characteristics, we analyzed trends in cardiovascular disease (CVD) risk and all-cause in hospital mortality (ACM) while stratifying for gender and race. Pearson’s chi-squared test was utilized to compare the CVD variables.Results:There were 266,365 hospitalizations included in the study with a median age of 77 years. They were predominantly males(69.5%), of Caucasian origin (81.7%), Medicare enrollees (91.4%) and were admitted in urban teaching hospitals (67.2%) located in the South of the US (39.5%) as non-elective cases (93.8%). Between 2016-19, Hyperlipidemia (HLD), smoking(Sm), and obesity(Ob) showed an increasing trend in males (2.8%, 1.3%, and 2% respectively) and females (2.1%, 2.4%, and 2% respectively), whereas hypertension (HTN) decreased by 4.5% in males and 6.3% in females.The length of stay remained constant at 4 days and the average cost of stay was 58963.5 USD. HTN among all races decreased from 2016 to 2019 except for Native Americans. HLD and obesity exhibited an upward trend among all races. Hispanics and Asians/Pacific Islanders(PI) had a consistent downtrend in mortality rates, with Native Americans showing the biggest drop in mortality rate (6.9%). All-cause mortality decreased from 2016 to 2019 by 1.4% except for Blacks which has increased by 2.6%, overtaking Asian/PI. All p
