Hospitalized Infections in People With Osteoarthritis: A National US Study
Hospitalized Infections in People With Osteoarthritis: A National US Study
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DOI：
10.3899/jrheum.191383
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发表时间：
2021-06-01
影响因子：
3.9
通讯作者：
Cleveland, John D.
中科院分区：
文献类型：
--
作者：
Singh, Jasvinder A.;Cleveland, John D.
目标。目的：探讨骨关节炎（OA）患者严重感染的发生率、时间趋势及预后。我们使用1998-2016年美国国家住院患者样本（NIS）数据。使用推荐体重，我们检查了OA患者需要住院治疗的5种严重感染的流行病学（机会性感染[OIs]、皮肤和软组织感染[SSTIs]、尿路感染[uti]、肺炎和败血症/菌血症）。我们进行了多变量调整logistic回归分析，以分析与医疗保健利用相关的因素（医院收费、住院时间、出院到非家庭环境）和院内死亡率。在所有严重感染住院患者中，46,708,154人没有OA， 3,258,416人患有OA。骨性关节炎患者年龄为16.4岁，女性（52%对65%）、白人（59%对70%）、Deyo-Charlson合并症指数(DCCI) >= 2（42%对51%）、接受医疗保险（54%对80%）、较少在城市教学医院接受治疗（45%对39%）。从1998-2000年至2015-2016年的研究期间，每10万名NIS住院患者的严重感染率有所增加：OI（从4.5增加到7.2）；SSTI（从48.4到145.9）；尿路感染（从8.4到104.6）；肺炎（从164.0到224.3）；脓毒症（从39.4到436.3）。在多变量调整分析中，年龄较大、DCCI较高、败血症、东北地区、城市医院和大中型医院床位与较高的医疗保健利用结果和院内死亡率显著相关；医疗补助保险、非白人种族和女性与较高的医疗保健利用率显著相关。OA患者的严重感染率有所上升。人口统计学、临床和医院变量与严重感染结果的关联确定了未来干预的潜在目标。
Objective. To study the incidence, time trends, and outcomes of serious infections in people with osteoarthritis (OA).Methods. We used 1998-2016 US National Inpatient Sample (NIS) data. Using recommended weights, we examined the epidemiology of 5 types of serious infections requiring hospitalization in people with OA (opportunistic infections [OIs], skin and soft tissue infections [SSTIs], urinary tract infections [UTIs], pneumonia, and sepsis/bacteremia). We performed multivariable-adjusted logistic regression analyses to analyze factors associated with healthcare utilization (hospital charges, length of hospital stay, discharge to nonhome setting), and in-hospital mortality.Results. Of all serious infection hospitalizations, 46,708,154 were without OA and 3,258,416 had OA. People with OA were 16.4 years older, more likely to be female (52% vs 65%), White (59% vs 70%), have a Deyo-Charlson Comorbidity Index (DCCI) >= 2 (42% vs 51%), receive Medicare (54% vs 80%), and less likely to receive care at an urban teaching hospital (45% vs 39%). Serious infection rates per 100,000 NIS hospitalizations increased from the study period of 1998-2000 to 2015-2016: OI (from 4.5 to 7.2); SSTI (from 48.4 to 145.9); UTI (from 8.4 to 104.6); pneumonia (from 164.0 to 224.3); and sepsis (from 39.4 to 436.3). In multivariable-adjusted analyses, older age, higher DCCI, sepsis, northeast region, urban hospital, and medium or large hospital bed size were significantly associated with higher healthcare utilization outcomes and in-hospital mortality; Medicaid insurance, non-White race, and female sex were significantly associated with higher healthcare utilization.Conclusion. Serious infection rates have increased in people with OA. Association of demographic, clinic, and hospital variables with serious infection outcomes identifies potential targets for future interventions.