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Adejumo AC, Adejumo KL, Adegbala OM, Enwerem N, Ofosu A, Akanbi O, Fijabi DO, Ogundipe OA, Pani L, Adeboye A. Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition. JPEN J Parenter Enteral Nutr 2019; 44:454-462. [DOI: 10.1002/jpen.1680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 06/28/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Adeyinka Charles Adejumo
- Department of MedicineNorth Shore Medical Center Salem Massachusetts USA
- Department of MedicineTufts University Medical School Boston Massachusetts USA
- School of Public HealthUniversity of Massachusetts Lowell Lowell Massachusetts USA
| | | | | | - Ngozi Enwerem
- Division of GastroenterologyDepartment of MedicineUniversity of California San Diego California USA
| | - Andrew Ofosu
- Department of Gastroenterology and HepatologyBrooklyn Hospital Brooklyn New York USA
| | - Olalekan Akanbi
- Division of Hospital MedicineUniversity of Kentucky College of Medicine Lexington Kentucky USA
| | | | | | - Lydie Pani
- Department of MedicineNorth Shore Medical Center Salem Massachusetts USA
- Department of MedicineTufts University Medical School Boston Massachusetts USA
| | - Adedayo Adeboye
- WJB Dorn VAMC Heart and Vascular Institute/USC School of Medicine Columbia South Carolina USA
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Adejumo AC, Samuel GO, Adegbala OM, Adejumo KL, Ojelabi O, Akanbi O, Ogundipe OA, Pani L. Prevalence, trends, outcomes, and disparities in hospitalizations for nonalcoholic fatty liver disease in the United States. Ann Gastroenterol 2019; 32:504-513. [PMID: 31474798 PMCID: PMC6686099 DOI: 10.20524/aog.2019.0402] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
Background As the frequency of nonalcoholic fatty liver disease (NAFLD) continues to rise in the United States (US) community, more patients are hospitalized with NAFLD. However, data on the prevalence and outcomes of hospitalizations with NAFLD are lacking. We investigated the prevalence, trends and outcomes of NAFLD hospitalizations in the US. Methods Hospitalizations with NAFLD were identified in the National Inpatient Sample (2007-2014) by their ICD-9-CM codes, and the prevalence and trends over an 8-year period were calculated among different demographic groups. After excluding other causes of liver disease among the NAFLD cohorts (n=210,660), the impact of sex, race and region on outcomes (mortality, discharge disposition, length of stay [LOS], and cost) were computed using generalized estimating equations (SAS 9.4). Results Admissions with NAFLD tripled from 2007-2014 at an average rate of 79/100,000 hospitalizations/year (P<0.0001), with a larger rate of increase among males vs. females (83/100,000 vs. 75/100,000), Hispanics vs. Whites vs. Blacks (107/100,000 vs. 80/100,000 vs. 48/100,000), and government-insured or uninsured patients vs. privately-insured (94/100,000 vs. 74/100,000). Males had higher mortality, LOS, and cost than females. Blacks had longer LOS and poorer discharge destination than Whites; while Hispanics and Asians incurred higher cost than Whites. Uninsured patients had higher mortality, longer LOS, and poorer discharge disposition than the privately-insured. Conclusions Hospitalizations with NAFLD are rapidly increasing in the US, with a disproportionately higher burden among certain demographic groups. Measures are required to arrest this ominous trend and to eliminate the disparities in outcome among patients hospitalized with NAFLD.
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Affiliation(s)
- Adeyinka Charles Adejumo
- Department of Medicine, North Shore Medical Center, Salem, MA (Adeyinka Charles Adejumo, Lydie Pani).,Department of Medicine, Tufts University Medical School, Boston, MA (Adeyinka Charles Adejumo, Lydie Pani).,Department of Medicine, University of Massachusetts Medical School, Worcester MA (Adeyinka Charles Adejumo, Ogooluwa Ojelabi).,Department of Public Health Program, University of Massachusetts Lowell, Lowell, MA (Adeyinka Charles Adejumo, Kelechi Lauretta Adejumo)
| | - Gbeminiyi Olanrewaju Samuel
- Department of Medicine, East Carolina University, Vidant Health Center, Greenville, NC (Gbeminiyi Olanrewaju Samuel)
| | - Oluwole Muyiwa Adegbala
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, NJ (Oluwole Muyiwa Adegbala)
| | - Kelechi Lauretta Adejumo
- Department of Public Health Program, University of Massachusetts Lowell, Lowell, MA (Adeyinka Charles Adejumo, Kelechi Lauretta Adejumo)
| | - Ogooluwa Ojelabi
- Department of Medicine, University of Massachusetts Medical School, Worcester MA (Adeyinka Charles Adejumo, Ogooluwa Ojelabi)
| | - Olalekan Akanbi
- University of Kentucky College of Medicine, Division of Hospital Medicine, Lexington, KY (Olalekan Akanbi)
| | | | - Lydie Pani
- Department of Medicine, North Shore Medical Center, Salem, MA (Adeyinka Charles Adejumo, Lydie Pani).,Department of Medicine, Tufts University Medical School, Boston, MA (Adeyinka Charles Adejumo, Lydie Pani)
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Adejumo AC, Adejumo KL, Adegbala OM, Chinedozi I, Ndansi J, Akanbi O, Onyeakusi NE, Ogundipe OA, Bob-Manuel T, Adeboye A. Protein-Energy Malnutrition and Outcomes of Hospitalizations for Heart Failure in the USA. Am J Cardiol 2019; 123:929-935. [PMID: 30612726 DOI: 10.1016/j.amjcard.2018.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 01/01/2023]
Abstract
Chronically elevated cytokines from un-abating low-grade inflammation in heart failure (HF) results in Protein-Energy Malnutrition (PEM). However, the impact of PEM on clinical outcomes of admissions for HF exacerbations has not been evaluated in a national data. From the 2012 to 2014 Nationwide Inpatient Sample (NIS) patient's discharge records for primary HF admissions, we identified patients with concomitant PEM, and their demographic and comorbid factors. We propensity-matched PEM cohorts (32,771) to no-PEM controls (1:1) using a greedy algorithm-based methodology and estimated the effect of different clinical outcomes (SAS 9.4). There were 32,771 (∼163,885) cases of PEM among the 541,679 (∼2,708,395) primary admissions for HF between 2012 and 2014 in the US. PEM cases were older (PEM:76 vs no-PEM:72 years), Whites (70.75% vs 67.30%), and had higher comorbid burden, with Deyo-comorbidity index >3 (31.61% vs 26.30%). However, PEM cases had lower rates of obesity, hyperlipidemia and diabetes. After propensity-matching, PEM was associated with higher mortality (AOR:2.48 [2.31 to 2.66]), cardiogenic shock (3.11[2.79 to 3.46]), cardiac arrest (2.30[1.96 to 2.70]), acute kidney failure (1.49[1.44 to 1.54]), acute respiratory failure (1.57[1.51 to 1.64]), mechanical ventilation (2.72[2.50 to 2.97]). PEM also resulted in higher non-routine discharges (2.24[2.17 to 2.31]), hospital cost ($80,534[78,496 to 82,625] vs $43,226[42,376 to 44,093]) and longer duration of admission (8.6[8.5 to 8.7] vs 5.3[5.2 to 5.3] days). In conclusion, PEM is a prevailing comorbidity among hospitalized HF subjects, and results in devastating health outcomes. Early identification and prevention of PEM in HF subjects during clinic visits and prompt treatment of PEM both in the clinic and during hospitalization are essential to decrease the excess burden of PEM.
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Affiliation(s)
- Adeyinka Charles Adejumo
- Department of Medicine, North Shore Medical Center, Salem, Massachusetts; Department of Medicine, Tufts University Medical School, Boston, Massachusetts; School of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts.
| | | | | | | | - Jordan Ndansi
- Department of Biochemistry, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Olalekan Akanbi
- University of Kentucky College of Medicine, Division of Hospital Medicine, Lexington, Kentucky
| | | | | | | | - Adedayo Adeboye
- Associate Professor of Medicine, WJB Dorn VAMC Heart and Vascular Institute/USC School of Medicine, Columbia, South Carolina
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Levitan EB, Van Dyke MK, Chen L, Durant RW, Brown TM, Rhodes JD, Olubowale O, Adegbala OM, Kilgore ML, Blackburn J, Albright KC, Safford MM. Medical therapy following hospitalization for heart failure with reduced ejection fraction and association with discharge to long-term care: a cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) population. BMC Cardiovasc Disord 2017; 17:249. [PMID: 28915854 PMCID: PMC5602915 DOI: 10.1186/s12872-017-0682-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/11/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Less intensive treatment for heart failure with reduced ejection fraction (HFrEF) may be appropriate for patients in long-term care settings because of limited life expectancy, frailty, comorbidities, and emphasis on quality of life. METHODS We compared treatment patterns between REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants discharged to long-term care versus home following HFrEF hospitalizations. We examined medical records and Medicare pharmacy claims for 147 HFrEF hospitalizations among 80 participants to obtain information about discharge disposition and medication prescriptions and fills. RESULTS Discharge to long-term care followed 22 of 147 HFrEF hospitalizations (15%). Participants discharged to long-term care were more likely to be prescribed beta-blockers and less likely to be prescribed aldosterone receptor antagonists and hydralazine/isosorbide dinitrate (96%, 14%, and 5%, respectively) compared to participants discharged home (81%, 22%, and 23%, respectively). The percentages of participants discharged to long-term care and home who had claims for filled prescriptions were similar for beta-blockers (68% versus 66%) and angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARBs) (45% versus 47%) after 1 year. Smaller percentages of participants discharged to long-term care had claims for filled prescriptions of other medications compared to participants discharged home (diuretics: long-term care-50%, home-72%; hydralazine/isosorbide dinitrate: long-term care-5%, home-23%; aldosterone receptor antagonists: long-term care-5%, home-23%). CONCLUSIONS Differences in medication prescriptions and fills among individuals with HFrEF discharged to long-term care versus home may reflect prioritization of some medical therapies over others for patients in long-term care.
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Affiliation(s)
- Emily B Levitan
- University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 220, Birmingham, AL, 35294-0022, USA.
| | | | - Ligong Chen
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Todd M Brown
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - J David Rhodes
- University of Alabama at Birmingham, Birmingham, AL, USA
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Adejumo AC, Alliu S, Ajayi TO, Adejumo KL, Adegbala OM, Onyeakusi NE, Akinjero AM, Durojaiye M, Bukong TN. Cannabis use is associated with reduced prevalence of non-alcoholic fatty liver disease: A cross-sectional study. PLoS One 2017; 12:e0176416. [PMID: 28441459 PMCID: PMC5404771 DOI: 10.1371/journal.pone.0176416] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/09/2017] [Indexed: 12/24/2022] Open
Abstract
Cannabis use is associated with reduced prevalence of obesity and diabetes mellitus (DM) in humans and mouse disease models. Obesity and DM are a well-established independent risk factor for non-alcoholic fatty liver disease (NAFLD), the most prevalent liver disease globally. The effects of cannabis use on NAFLD prevalence in humans remains ill-defined. Our objective is to determine the relationship between cannabis use and the prevalence of NAFLD in humans. We conducted a population-based case-control study of 5,950,391 patients using the 2014 Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Survey (NIS) discharge records of patients 18 years and older. After identifying patients with NAFLD (1% of all patients), we next identified three exposure groups: non-cannabis users (98.04%), non-dependent cannabis users (1.74%), and dependent cannabis users (0.22%). We adjusted for potential demographics and patient related confounders and used multivariate logistic regression (SAS 9.4) to determine the odds of developing NAFLD with respects to cannabis use. Our findings revealed that cannabis users (dependent and non-dependent) showed significantly lower NAFLD prevalence compared to non-users (AOR: 0.82[0.76-0.88]; p<0.0001). The prevalence of NAFLD was 15% lower in non-dependent users (AOR: 0.85[0.79-0.92]; p<0.0001) and 52% lower in dependent users (AOR: 0.49[0.36-0.65]; p<0.0001). Among cannabis users, dependent patients had 43% significantly lower prevalence of NAFLD compared to non-dependent patients (AOR: 0.57[0.42-0.77]; p<0.0001). Our observations suggest that cannabis use is associated with lower prevalence of NAFLD in patients. These novel findings suggest additional molecular mechanistic studies to explore the potential role of cannabis use in NAFLD development.
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Affiliation(s)
- Adeyinka Charles Adejumo
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- Biomedical Engineering & Biotechnology Program, University of Massachusetts Lowell, Lowell Massachusetts, United States of America
| | - Samson Alliu
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, United States of America
| | - Tokunbo Opeyemi Ajayi
- Johns Hopkins Medicine, Howard County General Hospital, Columbia, Maryland, United States of America
| | | | - Oluwole Muyiwa Adegbala
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, United States of America
| | | | - Akintunde Micheal Akinjero
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, United States of America
| | - Modupeoluwa Durojaiye
- Department of Maternal and Child Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Terence Ndonyi Bukong
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- INRS-Institut Armand-Frappier, Institut National de la Reserche Scientifique, Laval, Quebec, Canada
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