Background & Aims: Estimates of disease burden can inform national health priorities for research, clinical care, and policy. We aimed to estimate health care use and spending among gastrointestinal (GI) (including luminal, liver, and pancreatic) diseases in the United States. Methods: We estimated health care use and spending based on the most currently available administrative claims from commercial and Medicare Supplemental plans, data from the GI Quality Improvement Consortium Registry, and national databases. Results: In 2015, annual health care expenditures for gastrointestinal diseases totaled $135.9 billion. Hepatitis ($23.3 billion), esophageal disorders ($18.1 billion), biliary tract disease ($10.3 billion), abdominal pain ($10.2 billion), and inflammatory bowel disease ($7.2 billion) were the most expensive. Yearly, there were more than 54.4 million ambulatory visits with a primary diagnosis for a GI disease, 3.0 million hospital admissions, and 540,500 all-cause 30-day readmissions. There were 266,600 new cases of GI cancers diagnosed and 144,300 cancer deaths. Each year, there were 97,700 deaths from non-malignant GI diseases. An estimated 11.0 million colonoscopies, 6.1 million upper endoscopies, 313,000 flexible sigmoidoscopies, 178,400 upper endoscopic ultrasound examinations, and 169,500 endoscopic retrograde cholangiopancreatography procedures were performed annually. Among average-risk persons ages 50–75 years who underwent colonoscopy, 34.6% had 1 or more adenomatous polyps, 4.7% had 1 or more advanced adenomatous polyps, and 5.7% had 1 or more serrated polyps removed. Conclusions: GI diseases contribute substantially to health care use in the United States. Total expenditures for GI diseases are $135.9 billion dollars annually—greater than for other common diseases. Expenditures are likely to continue increasing.

Objective To estimate the lifetime risk of stress incontinence, pelvic organ prolapse surgery, or both using current, population-based surgical rates from 2007–2011. Methods We used a 2007–2011 a U.S. claims and encounters database. We included women aged 18–89 years and estimated age-specific incidence rates and cumulative incidence (lifetime risk) of stress incontinence surgery, pelvic organ prolapse surgery, and either incontinence or prolapse surgery, with 95% confidence intervals. We estimated lifetime risk until the age of 80 to be consistent with prior studies. Results From 2007–2011, we evaluated 10,177,480 adult women who were followed for 24,979,447 person-years. Among these women, we identified 65,397 incident, or first, stress incontinence, and 57,755 incident prolapse surgeries. Overall, we found that the lifetime risk of any primary surgery for stress incontinence or pelvic organ prolapse was 20.0% (95%CI 19.9, 20.2) by the age of 80 years. Separately, the cumulative risk for stress incontinence surgery was 13.6% (95%CI 13.5, 13.7) and that for pelvic organ prolapse surgery was 12.6% (95%CI 12.4, 12.7). For age-specific annual risk, stress incontinence demonstrated a bimodal peak at age 46 and then again at age 70–71 with annual risks of 3.8 and 3.9 per 1,000 women, respectively. For pelvic organ prolapse, the risk increased progressively until ages 71 and 73 when the annual risk was 4.3 per 1,000 women. Conclusion Based on a U.S. claims and encounters database, the estimated lifetime risk of surgery for either stress incontinence or pelvic organ prolapse in women is 20.0% by the age of 80.

No abstract

None.

No abstract

Background:Few population-based descriptive studies on the incidence of anterior cruciate ligament (ACL) reconstruction and concomitant pathology exist.Hypothesis:Incidence of ACL reconstruction has increased from 2002 to 2014.Study Design:Descriptive clinical epidemiology study.Level of Evidence:Level 3.Methods:The Truven Health Analytics MarketScan Commercial Claims and Encounters database, which contains insurance enrollment and health care utilization data for approximately 158 million privately insured individuals younger than 65 years, was used to obtain records of ACL reconstructions performed between 2002 and 2014 and any concomitant pathology using Current Procedures Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9) codes. The denominator population was defined as the total number of person-years (PYs) for all individuals in the database. Annual rates were computed overall and stratified by age, sex, and concomitant procedure.Results:There were 283,810 ACL reconstructions and 385,384,623 PYs from 2002 to 2014. The overall rate of ACL reconstruction increased 22%, from 61.4 per 100,000 PYs in 2002 to 74.6 per 100,000 PYs in 2014. Rates of isolated ACL reconstruction were relatively stable over the study period. However, among children and adolescents, rates of both isolated ACL reconstruction and ACL reconstruction with concomitant meniscal surgery increased substantially. Adolescents aged 13 to 17 years had the highest absolute rates of ACL reconstruction, and their rates increased dramatically over the 13-year study period (isolated, +37%; ACL + meniscal repair, +107%; ACL + meniscectomy, +63%). Rates of isolated ACL reconstruction were similar for males and females (26.1 vs 25.6 per 100,000 PYs, respectively, in 2014), but males had higher rates of ACL reconstruction with concomitant meniscal surgery than females.Conclusion:Incidence rates of isolated ACL reconstruction and rates of concomitant meniscal surgery have increased, particularly among children and adolescents.Clinical Relevance:A renewed focus on adoption of injury prevention programs is needed to mitigate these trends. In addition, more research is needed on long-term patient outcomes and postoperative health care utilization after ACL reconstruction, with a focus on understanding the sex-based disparity in concomitant meniscal surgery.

Purpose Estimating drug effectiveness and safety among older adults in population-based studies using administrative healthcare claims can be hampered by unmeasured confounding due to frailty. A claims-based algorithm that identifies patients likely to be dependent, a proxy for frailty, may improve confounding control. Our objective was to develop an algorithm to predict dependency in activities of daily living (ADL) in a sample of Medicare beneficiaries. Methods Community-dwelling respondents to the 2006 Medicare Current Beneficiary Survey, >65 years old, with Medicare Part A, B, home health, and hospice claims were included. ADL dependency was defined as needing help with bathing, eating, walking, dressing, toileting, or transferring. Potential predictors were demographics, ICD-9 diagnosis/procedure and durable medical equipment codes for frailty-associated conditions. Multivariable logistic regression was to predict ADL dependency. Cox models estimated hazard ratios for death as a function of observed and predicted ADL dependency. Results Of 6391 respondents, 57% were female, 88% white, and 38% were ≥80. The prevalence of ADL dependency was 9.5%. Strong predictors of ADL dependency were charges for a home hospital bed (OR=5.44, 95% CI=3.28–9.03) and wheelchair (OR=3.91, 95% CI=2.78–5.51). The c-statistic of the final model was 0.845. Model-predicted ADL dependency of 20% or greater was associated with a hazard ratio for death of 3.19 (95% CI: 2.78, 3.68). Conclusions An algorithm for predicting ADL dependency using healthcare claims was developed to measure some aspects of frailty. Accounting for variation in frailty among older adults could lead to more valid conclusions about treatment use, safety, and effectiveness.

Objectives To estimate prevalence and determinants of potentially inappropriate prescribing (PIP) among US older adults using 2012 Beers criteria. Design Retrospective cohort study in a random national sample of Medicare beneficiaries. Setting 2007–2012 fee-for-service Medicare beneficiaries. Participants US population aged >65 years with Part A, B and D enrollment in at least 1 month during a calendar year (N=38,250 patients; 1,308,116 observations) Measurement We used 2012 Beers criteria to estimate the prevalence of ≥1 PIP within each calendar month and over a 12-month period using data on diagnoses or conditions present in the previous 12 months. To account for the dependence of multiple monthly observations of a single person when estimating 95% confidence intervals (CI) we used generalized estimating equations. We used logistic regression to identify independent determinants of PIP. Results The point-prevalence of PIP decreased from 37.6% (95%CI: 37.0–38.1) in 2007 to 34.2% (95%CI: 33.6–34.7) in 2012, with a statistically significant 2% (95%CI: 1–3%) decline per year assuming a linear trend. One year period-prevalence declined from 64.9% in 2007 to 56.6% in 2012. The strongest predictor of PIP was the number of drugs dispensed. Individuals aged 70 years or older and those seen by a geriatrician were less likely to receive PIP. Conclusion From 2007 to 2012, the prevalence of PIP in US older adults decreased according to 2012 Beers criteria but remains high, still affecting a third each month and more than a half over 12 months. The number of dispensed prescription could be used to target future interventions.