The association of socioeconomic status with mortality and hospital length of stay in patients with parapneumonic empyema

The Resource The association of socioeconomic status with mortality and hospital length of stay in patients with parapneumonic empyema

Label

The association of socioeconomic status with mortality and hospital length of stay in patients with parapneumonic empyema

Statement of responsibility

Seemeen Hassan

Language

eng

Summary

Background: Parapneumonic empyema is an uncommon but serious complication of pneumonia. Anecdotal evidence suggests that the prevalence of empyema may be on the rise. The aim of this study is to estimate the current prevalence of empyema and its demographic distribution in the US in 2014 and the first three quarters of 2015. Health outcomes of empyema (mortality, length of hospital stay and annual hospitalization rate) are also examined. Methods: The National Inpatient Sample (NIS) / The Healthcare Cost and Utilization Project (HCUP) database was queried for parapneumonic empyema hospitalizations between January 1, 2014 and October 1, 2015. The prevalence of empyema was calculated and compared in subjects with different age groups, sexes, races and socioeconomic status. The annual hospitalization rate of empyema, length of hospital stay and inpatient mortality was also compared across the same demographic groups using Chi square and Kruskal Wallis tests; SAS statistical software was used for all data analysis. Standardization methods were used to calculate age, sex and race specific mortality rates and prevalence rates. Results: A total of 12,449,482 hospital discharges were found in the NIS database in the study period. Among those, 20811 discharges were associated with parapneumonic empyema. Of those, 11516 (55%) were males and 9293 (45%) were females. The mean age in the empyema cohort was 66 years. Majority of empyema patients were age 65 or older (56%), white (75%), and insured by Medicare (61%). The poorest income quartile had the largest share of population (31%). The standardized age-specific prevalence of empyema in the NIS was 44 per 100,000 hospitalizations per year up from 11.8 per 100,000 in 20111. The standardized sex specific prevalence was higher in patient who were male (109 vs 47.1 per 100,000 hospitalizations per year). White patients had the highest standardized race specific prevalence and black patients had the lowest standardized race specific prevalence (109.3 vs 75.0 per 100,000 hospitalization per year). The standardized race specific prevalence was 85.9 in Hispanic patients and 89.0 per 100,000 hospitalizations per year in other races respectively. The unweighted hospitalization rate of empyema was 95.5 (95% CI 94.6 - 96.3 per 100,000 hospitalizations per year). Standardized age specific in-hospital mortality was 18.9 per 100,000 hospitalizations per year. The standardized sex and race specific mortality for males, females, white patients, black patients and other races were 40.0, 15.8, 38.3, 24.1 and 41.3 per 100,000 hospitalizations per year respectively. The crude mortality rate in the overall empyema cohort was 12.4%. There was no statistically significant difference between males and females regarding inpatient mortality in empyema (p = 0.074). Mortality among empyema patients was 5.9% vs 10.1% vs 14.8% in the three age groups (ages 18 to 39, ages 40 to 64 and ages 65 & up respectively), increasing with age (p < 0.001). The mortality was 12% in white patients, 13% in black patients, 12% in Hispanic patients and 15% in others (p 0.015). Mortality did not vary by median income of residential zip code (12-13%; p = 0.372). The mortality was 13.9% in cases insured by Medicare, 10.2% by Medicaid, 9.8% in private insurance and 9.9% in others (p < 0.001). The standardized race specific mortality was 38.3 in white patients, 24.1 in black patients and 41.3 per 100,000 hospitalizations per year in other races (excluding Hispanic patients). The median length of hospital stay (LOS) for the empyema cohort was 10 days (IQR 6 - 15). LOS of males and females were both 10 days (p = 0.498). LOS in the longest in 18 - 39 age group (11 days) (p < 0.001). LOS was the longest in black patients (11 days) (p < 0.001). LOS was the longest in income quartile 1 (9.8 days) (p < 0.001). LOS was the longest in patients insured by Medicaid (12 days) and shortest in patients with private insurance (p < 0.001). Conclusion: The prevalence of empyema based on annual hospitalization rate may be on the rise. Standardized age specific in-hospital mortality was 18.9 per 100,000 hospitalizations per year. The standardized sex specific mortality for males, females, white patients, black patients and other races were 40.0, 15.8, 38.3, 24.1 and 41.3 per 100,000 hospitalizations per year respectively. Inpatient mortality was the highest in those aged 65 +, those insured by Medicare and "other" races. The median LOS has shortened over time. LOS was highest in the youngest age group (18 - 39), black patients, those in the poorest income quartile and in those with Medicaid

Cataloging source

UMK

Degree

M.S.

Dissertation note

(School of Medicine).

Dissertation year

2018.

Granting institution

University of Missouri-Kansas City,

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illustrations

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no index present

Literary form

non fiction

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dictionaries
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theses

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