Against Medical Advice Discharges in Injection and Non-injection Drug Use-associated Infective Endocarditis: A Nationwide Cohort Study
Against Medical Advice Discharges in Injection and Non-injection Drug Use-associated Infective Endocarditis: A Nationwide Cohort Study
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DOI：
10.1093/cid/ciaa1126
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发表时间：
2021-11-01
影响因子：
11.8
通讯作者：
Larochelle, Marc R.
中科院分区：
文献类型：
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作者：
Kimmel, Simeon D.;Kim, June-Ho;Larochelle, Marc R.
背景。在注射吸毒相关感染性心内膜炎 (IDU-IE) 患者中，违反医疗建议 (AMA) 出院很常见，并且与不良后果相关。需要了解趋势、风险因素和时间安排，以减少 IDU-IE AMA 排放。方法。我们在国家住院患者样本（2010 年 1 月至 2015 年 9 月美国住院的代表性样本）中识别了年龄为 18-64 岁的个体，其年龄为国际疾病分类第 9 版、感染性心内膜炎 (IE) 诊断代码。我们绘制了 AMA 出院未经调整的季度趋势，并使用多变量逻辑回归来确定与 IE 住院中 AMA 出院相关的因素，将 IDU-IE 与非 IDU-IE.结果。我们确定了 7259 例 IDU-IE 住院病例和 23 633 例非 IDU-IE 住院病例。在这些住院治疗中，14.2% 的 IDU-IE 和 1.9% 的非 IDU-IE 导致 AMA 出院。两组均超过 30% 的 AMA 出院发生在住院第 3 天之前。在调整后的模型中，IDU 状态（调整后的优势比 [AOR]，3.92；95% 置信区间 [CI]，3.43-4.48）] 与 AMA 出院几率增加相关。在 IDU-IE 中，女性（AOR，1.21；95% CI，1.04-1.41）和西班牙裔（AOR，1.32；95% CI，1.03-1.69）的 AMA 出院几率增加，这与非 IDU-IE 不同。近 6 年来，IDU-IE 的 AMA 出院几率每年增加 12%（AOR，1.12；95% CI，1.07-1.18），非 IDU-IE 的 AMA 出院几率每年增加 6%（AOR，1.06；95% CI，1.00-1.13）。结论。 IDU-IE 和非 IDE-IE 患者的 AMA 出院率有所增加。在注射吸毒者中，AMA 放电更为常见，且增加得更快。需要努力解决 IDU-IE AMA 排放量上升的比例、差异和时间问题。
Background. Among those with injection drug use-associated infective endocarditis (IDU-IE), against medical advice (AMA) discharge is common and linked to adverse outcomes. Understanding trends, risk factors, and timing is needed to reduce IDU-IE AMA discharges.Methods. We identified individuals ages 18-64 with International Classification of Diseases, 9th Revision, diagnosis codes for infective endocarditis (IE) in the National Inpatient Sample, a representative sample of United States hospitalizations from January 2010 to September 2015. We plotted unadjusted quarter-year trends for AMA discharges and used multivariable logistic regression to identify factors associated with AMA discharge among IE hospitalizations, comparing IDU-IE with non-IDU-IE.Results. We identified 7259 IDU-IE and 23 633 non-IDU-IE hospitalizations. Of these hospitalizations, 14.2% of IDU-IE and 1.9% of non-IDU-IE resulted in AMA discharges. More than 30% of AMA discharges for both groups occurred before hospital day 3. In adjusted models, IDU status (adjusted odds ratio [AOR], 3.92; 95% confidence interval [CI], 3.43-4.48)] was associated with increased odds of AMA discharge. Among IDU-IE, women (AOR, 1.21; 95% CI, 1.04-1.41) and Hispanics ( AOR, 1.32; 95% CI, 1.03- 1.69) had increased odds of AMA discharge, which differed from non- IDU-IE. Over nearly 6 years, odds of AMA discharge increased 12% per year for IDU-IE (AOR, 1.12; 95% CI, 1.07-1.18) and 6% per year for non-IDU-IE ( AOR, 1.06; 95% CI. 1.00- 1.13).Conclusions. AMA discharges have risen among individuals with IDU-IE and non-IDE-IE. Among those who inject drugs, AMA discharges were more common and increases sharper. Efforts that address the rising fraction, disparities, and timing of IDU-IE AMA discharges are needed.