The Geographic Impact on Hospitalization in Patients with Cystic Fibrosis

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• 作者：Benjamin T. Kopp ; MD¹ ; ² ; ^{Benjamin.Kopp@NationwideChildrens.org" class="auth_mail" title="E-mail the corresponding author} ; Lisa Nicholson ; PhD³ ; Grace Paul ; MD¹ ; Joseph Tobias ; MD⁴ ; Chandar Ramanathan ; MD¹ ; Don Hayes Jr ; MD ; MS¹
• 关键词：BMI ; Body mass index ; CF ; Cystic fibrosis ; CFFPR ; CF Foundation Patient Registry ; FEV1 ; Forced expiratory volume in one second ; HR ; Hazard ratio ; IV ; Intravenous ; LOS ; Length of stay ; NIS ; Nationwide Inpatient Sample
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：170
• 期：Complete
• 页码：246-252.e4
• 全文大小：395 K

文摘

To assess whether geographic location influences hospitalizations for pulmonary exacerbations for patients with cystic fibrosis (CF) in the US, as there is no existing literature regarding this subject.

ec_2">Study design

ra0015">The CF Foundation Patient Registry was analyzed during the years 2007-2012 via geographic grouping of states. The impact of geographic region on recovery from hospitalization, hospitalization length, and time to next hospitalization were analyzed using multivariate models.

ec_3">Results

ra0020">Posthospitalization lung function and nutritional measures were similar among regions for 1 year following hospitalization. The West region was associated with risk of longer hospital stays (OR 1.60, CI 1.45-1.77), however, dornase alfa use (OR 3.85, CI 1.15-12.92) was the only specific factor. History of allergic bronchopulmonary aspergillosis (OR 1.58, CI 1.11-2.25) and adult age (OR 2.48, CI 1.17-5.25) in the Northeast, chronic macrolide use in the South (OR 1.36, CI 1.03-1.79), and infection with <em>Candida albicansem> (OR 1.47, CI 1.18-1.82) and <em>Pseudomonas aeruginosaem> (OR 1.44, CI 1.02-2.04) in the Midwest were associated with increased hospitalization length. There was a significantly decreased risk for subsequent hospitalizations in the Northeast compared with other regions (<em>Pem> = .038). Sociodemographic analysis identified Caucasians in the South having a significantly lower risk of future hospitalization compared with African Americans (hazard ratio 0.79, CI 0.69-0.91, <em>Pem> = .0009).

ec_4">Conclusions

ra0025">There is significant regional variability in hospitalization length and risks for subsequent hospitalizations for patients with CF in the US. Regional variation should be subject to further study to determine if benchmarking standards can be achieved nationally.