Pneumonia and Influenza Hospitalizations in Elderly People with Dementia
ABSTRACT To compare the demographic and geographic patterns of pneumonia and influenza (P&I) hospitalizations in older adults with dementia with those of the U.S. population and to examine the relationship between healthcare accessibility and P&I.
Observational study using historical medical claims from the Centers for Medicare and Medicaid Services (CMS) and CMS records supplemented with information derived from other large national sources.
Retrospective analysis of medical records uniformly collected over a 5-year period with comprehensive national coverage.
A study population representative of more than 95% of all people aged 65 and older residing in the continental United States.
Six million two hundred seventy-seven thousand six hundred eighty-four records of P&I between 1998 and 2002 were abstracted, and county-specific outcomes for hospitalization rates of P&I, mean length of hospital stay, and percentage of deaths occurring in a hospital setting were estimated. Associations with county-specific elderly population density, percentage of nursing home residents, median household income per capita, and rurality index were assessed.
Rural and poor counties had the highest rate of P&I and percentage of influenza. Patients with dementia had a lower frequency of influenza diagnosis, a shorter length of hospital stay, and 1.5 times as high a rate of death as the national average.
The results suggest strong disparities in healthcare practices in rural locations and vulnerable populations; infrastructure, proximity, and access to healthcare are significant predictors of influenza morbidity and mortality. These findings have important implications for influenza vaccination, testing, and treatment policies and practices targeting the growing fraction of patients with cognitive impairment.
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ABSTRACT: To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.The Gerontologist 06/2011; 51(6):761-73. DOI:10.1093/geront/gnr065 · 2.48 Impact Factor
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ABSTRACT: In temperate regions, influenza epidemics occur annually with the highest activity occurring during the winter months. While seasonal dynamics of the influenza virus, such as time of onset and circulating strains, are well documented by the Centers for Disease Control and Prevention Influenza Surveillance System, an accurate prediction of timing, magnitude, and composition of circulating strains of seasonal influenza remains elusive. To facilitate public health preparedness for seasonal influenza and to obtain better insights into the spatiotemporal behavior of emerging strains, it is important to develop measurable characteristics of seasonal oscillation and to quantify the relationships between those parameters on a spatial scale. The objectives of our research were to examine the seasonality of influenza on a national and state level as well as the relationship between peak timing and intensity of influenza in the United States older adult population. A total of 248,889 hospitalization records were extracted from the Centers for Medicare and Medicaid Services for the influenza seasons 1991-2004. Harmonic regression models were used to quantify the peak timing and absolute intensity for each of the 48 contiguous states and Washington, DC. We found that individual influenza seasons showed spatial synchrony with consistent late or early timing occurring across all 48 states during each influenza season in comparison to the overall average. On a national level, seasons that had an earlier peak also had higher rates of influenza (r(s) = -0.5). We demonstrated a spatial trend in peak timing of influenza; western states such as Nevada, Utah, and California peaked earlier and New England States such as Rhode Island, Maine, and New Hampshire peaked later. Our findings suggest that a systematic description of influenza seasonal patterns is a valuable tool for disease surveillance and can facilitate strategies for prevention of severe disease in the vulnerable, older adult population.PLoS ONE 04/2010; 5(4):e10187. DOI:10.1371/journal.pone.0010187 · 3.53 Impact Factor
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ABSTRACT: To assess how influenza vaccination coverage in children is related to pneumonia and influenza (P&I) in older adults and whether sociodemographic factors modify these associations. Approximately 5 million hospitalization records from the Centers for Medicare and Medicaid Services for four influenza years (2002-2006) were abstracted. A single-year age distribution of rates of P&I hospitalization was estimated according to state for each influenza season; an exponential acceleration in the P&I rates with age was observed for each influenza season. State- and season-specific P&I rate accelerations were regressed against the percentage of vaccinated children, older adults, or both using mixed effects models. U.S. population, 2002 to 2006. U.S. population aged 65 and older. State-level influenza annual vaccination coverage data in children and older adults were obtained from the National Immunization Survey and the Behavioral Risk Factor Surveillance System, respectively. Child influenza vaccination coverage was negatively associated with age acceleration in P&I, whereas influenza vaccination in the older adults themselves was not significantly associated with P&I in older adults. Vaccination of children against influenza may induce herd immunity against influenza for older adults and has the potential to be more beneficial to older adults than the existing policy of preventing influenza by vaccinating older adults themselves.Journal of the American Geriatrics Society 02/2011; 59(2):327-32. DOI:10.1111/j.1532-5415.2010.03271.x · 4.22 Impact Factor