Cannabis use is on the rise due to popularity, legalization and increase in medical use. Cannabis is primarily inhaled as smoke and acts as an instigator for respiratory symptoms especially in patients with Asthma. There are no population-based studies available to estimate the burden and outcomes of cannabis use during asthma hospitalizations. We aim to estimate the trends and characteristics associated with cannabis use among asthma patients. METHODS:Study cohort is derived from the Nationwide Inpatient Sample (NIS) for the years 2008-2017. Hospitalizations due to asthma were identified using previously validated ICD-9-CM/ICD-10-CM. We excluded pregnant patients and restricted our cohort to the younger age group of 18-49 years for final analysis. Cannabis use disorder and other diagnosis of interests were identified by ICD-9/10-CM codes. We then utilized the Cochran Armitage trend test and multivariable survey logistic regression models to analyze temporal trends, predictors and outcomes.RESULTS: Out of a total 1,014,328 hospitalizations due to Asthma in young adult patients, 36,008 (3.6%) had concurrent cannabis use disorder. Proportion of patients using cannabis increased from 1.8% in 2007 to 7.5% in 2018 with a yearly increase of 14.9% (OR 1.2; 95%CI 1.1-1.2; p<0.01). Patients with concurrent cannabis use were younger and more likely to be male and African American. In multivariable regression analysis, age group 18-34 (OR 1.9; 95%CI 1.5-2.0; P< 0.01); females (OR 2.1; 95% CI 2.0-2.3; p<0.01), African American (OR 1.8; 95%CI 1.6 -1.9, p<0.01), lowest income status (OR 1.3; 95%CI 1.2-1.4, p<0.01), west region (OR 1.6; 95% CI 1.4-1.7, p<0.01), mid-west, uninsured/self-pay (OR 1.1 ;95% CI 1.1-1.2, P¼0.006) and conditions such as weight loss (OR 1.8; 95% CI 1.4-2.2, p<0.01), alcoholism (OR 3.8; p <0.01) and cancer were associated with higher odds of concurrent cannabis use. After adjusting with confounding factors cannabis use was not associated with inhospital mortality or discharge to facilities. However, cannabis use was associated with higher odds of non-invasive ventilation (OR 1.3; 95% CI 1.2-1.5, p<0.01) and invasive ventilation (OR 1.4; p<0.01).CONCLUSIONS: Cannabis use is more prevalent in younger, male gender, African American and lower socio-economic asthmatic patients. Although concurrent cannabis use disorders are not associated with increased in-hospital mortality or discharge to facilities, it is associated with increased ventilation utilization rates.CLINICAL IMPLICATIONS: Our study identifies the determinants among the cannabis usage in Asthma patients depicting the increasing trend and requirement of ventilation among the hospitalizations. Ultimately, additional research and guidelines are needed to curtail the cannabis use in asthmatic patients.
Stroke has been the leading cause of mortality in the United States and 12 percent of all the strokes comprise of Intra Cerebral Hemorrhage (ICH). Patients with ICH also have a higher risk of facing post stroke complications like increased ICP, Herniation, Seizures, Aspiration and so on. One of the most fatal complications in patients with ICH is occurrence of Acute Respiratory Distress Syndrome (ARDS). ARDS itself is associate with poor prognosis. There is paucity of data in regards to prevalence or ARDS and impact of outcomes during the hospitalization due to ICH. Our objective is to estimate temporal trends, predictors and outcomes of ARDS during ICH hospitalizations from a largest available database.METHODS: National Inpatient Sample (NIS) for the years 2011-2018 were used to identify adult hospitalizations due to nontraumatic ICH by using International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM). ALI and IMV as well as other concurrent diagnosis and comorbidities were identified by previously validated ICD-9/10-CM procedure and diagnosis codes. Our primary objective was to delineate trends, predictors and outcomes of ARDS during hospitalizations due to ICH. Cochran Armitage trend test and multivariable survey logistic regression models were used to analyze the data.
Palliative care for terminal illnesses has been growing rapidly in the United States and is associated with increased patient satisfaction during the end-of-life care. We sought to estimate utilization trends and factors associated with palliative care among end stage COPD patients using nationally representative data. METHODS:Study cohort is derived from the Nationwide Inpatient Sample (NIS) for the years 2007-2018. Adult hospitalizations due to end stage COPD were identified previously validated ICD-9-CM/ICD-10-CM. Palliative care and other diagnosis of interests were identified by International Classification of Diseases (9th/10th Editions) Clinical Modification (ICD-9-CM/ICD-10-CM) codes and comorbidities by Elixhauser comorbidity software. We then utilized the Cochran Armitage trend test and multivariable survey logistic regression models to analyze temporal trends, predictors and outcomes. We used SAS 9.4 software for analysis.RESULTS: Out of a total 1,544,988 hospitalizations due to end stage COPD from 2007 to 2018, palliative care was utilized by 39,423(2.6%). Trends of palliative care utilization increased from 0.8% in 2007 to 3.5 % in 2018 with yearly increase of 2.6% (OR 1.1; 95%CI 1.1 -1.1; p<0.01). Patients who had palliative care were more likely to be older, female and Caucasian. In multivariable regression analysis, palliative care utilization was higher among females (OR 1.2; 95%CI 1.2-1.2; p<0.01), Caucasians (OR 1.3; 95% CI 1.1-1.4; p<0.01), western region (OR 1.5; 95% CI 1.4-1.7; p<0.01), private insurance (OR 1.6; 95% CI 1.4-1.7; p<0.01) and uninsured/self-pay (OR 2.6; 95% CI 2.3-2.9; p<0.01), patients with cancer. Lower socio-economic status was associated with lower utilization of palliative care. CONCLUSIONS:We observed significant increasing utilization of palliative care among end stage COPD patients over the years. Socioeconomic and Insurance status plays a pivotal role in the acceptance of palliative care.CLINICAL IMPLICATIONS: There has been a lack of nationwide data regarding utilization of palliative care among end stage COPD patients. Our study identifies trends and disparities in palliative care utilization and lays foundation for further studies to address these barriers.
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