Potentially Preventable Hospitalizations for Chronic Conditions among Youth

Objective

Chronic, preventable conditions like diabetes and hypertension previously seen primarily in adults are increasing among young people. Chronic disease-related potentially preventable hospitalizations (PPH) are costly. The study goal was to quantify potentially preventable hospitalizations (PPH) for chronic disease in those aged 5-29 years in one diverse state of the USA.

Methods

With Hawai'i statewide inpatient 2015-2016 data across all payers, we used standard metrics to capture asthma, diabetes, and hypertension PPH. Denominators were obtained by age group, gender, race/ethnicity, and living in O'ahu vs. other Hawaiian Islands from American Community Survey data. A multivariable negative binomial regression model predicted having a PPH adjusting for age group, gender, race/ethnicity, and O'ahu residency.

Results

Six percent (775) of inpatient hospitalizations among young people, representing 455 unique individuals, were PPH for a chronic disease. The types of PPH inpatient hospitalizations include diabetes (436), asthma (261), heart disease (64) and hypertension (14). The number of PPH visits per individual ranged from 1-20 with a mean of 1.7 (SD: 2.28) visits. The total cost of these PPH during this 2-year time period was $16,762,262. Among unique individuals with a chronic disease PPH (N = 455), the mean age was 17.5 (SD: 8.2); 55% were male. In the multivariable model, those who were between 10-14 years (RR:0.47;0.32-0.69) and 15-19 years (RR:0.46;0.31-0.69) were significantly less likely to have a PPH compared to those aged 5-9 years. Other Pacific Islanders were significantly more likely to have a PPH (RR: 3.08; 2.05-4.63) compared to whites.

Conclusions

Many hospitalizations by those aged 5-29 years were PPH. Pacific Islander youth had PPH chronic disease disparities. Chronic disease prevention and management is critical. Solutions may include equitable chronic disease prevention policies and improving access to culturally relevant care.

Key messages

This study reveals important disparities in youth that may lead to future health risks as well as current poor outcomes.

Other Pacific Islanders were at significantly increased risk for PPH for chronic disease compared to other racial/ethnic groups from early childhood to young adulthood.

Chronic conditions among children, adolescents, and young adults in acute care settings

Background

Despite a growing prevalence of chronic disease risk factors, such as obesity, among young people in the United States and other countries, little is known about actual disease prevalence in this population. Almost nothing is known about this topic in many racial/ethnic groups that are rapidly growing in the United States, including Native Hawaiians, Other Pacific Islanders, and Filipinos. Yet these understudied groups are at high risk. The study goal was to determine the statewide prevalence of chronic disease in acute care for those aged 5-29 years, including Native Hawaiians, Filipinos, and Pacific Islanders.

Methods

Using Hawai'i statewide inpatient and emergency department (ED) data across all payers from 2015-2016, we considered the presence of at least one of five target chronic conditions (asthma, hypertension, chronic kidney disease, diabetes, stroke) from 13,514 inpatient stays by 9,467 unique individuals and 228,548 ED visits by 127,854 individuals.

Results

Twenty-eight percent of youth who were hospitalized and 12% with an ED visit had at least one chronic condition. In both inpatient and ED settings, race/ethnicity, age group, and payer varied significantly when comparing those with a chronic condition to those without a chronic condition. Notably, those with a chronic condition were disproportionately Native Hawaiian, Filipino, and Pacific Islander; 32.3% percent of those with an inpatient chronic condition and 34.9% of those with an ED chronic condition were Native Hawaiian.

Conclusions

Chronic diseases, including those more often seen in adulthood, are prevalent in young people in acute care settings in the state of Hawai'i with notable disparities. This data can help justify, guide, and support programs urgently needed to address these changing epidemiological trends, which may be of particular interest for Medicaid.

Key messages

We show that chronic conditions are prevalent in young people in acute care settings in the state of Hawai‘i with notable disparities. This can help justify, guide, and support programs to address these troubling epidemiological trends.

Effect of mifepristone on pregnancy, pregnancy-specific protein B (PSPB), progesterone, estradiol-17beta, prostaglandin F2alpha (PGF2alpha) and prostaglandin E (PGE) in ovariectomized 90-day pregnant ewes

The objective of this experiment was to determine the effect of mifepristone, a progesterone receptor antagonist, on pregnancy and secretion of steroids, pregnancy-specific protein B (PSPB) and prostaglandins at mid-pregnancy in ewes. Ninety-day pregnant ewes were ovariectomized (OVX) and treatments were initiated 72 h post-OVX. Ewes received (1) vehicle, (2) prostaglandin F2alpha (PGF2alpha, 8 mg/58 kg/bw, i.m.) 84 h post-OVX, (3) mifepristone (50 mg intrajugular at 72, 84, 96, and 108 h post-OVX), (4) mifepristone (50mg) + PGF2alpha, (5) mifepristone (100 mg intrajugular at 72, 84, 96, and 108 h), and (6) mifepristone (100 mg) + PGF2alpha. Ewes treated with vehicle or PGF2alpha alone did not abort (P > or = 0.05). But, 60, 80, 60, and 100% of ewes treated with mifepristone (50 mg), mifepristone (50 mg) + PGF2alpha, mifepristone (100 mg), and mifepristone (100 mg) + PGF2alpha, respectively, aborted (P < or = 0.05). Profiles of progesterone, estradiol-17beta, prostaglandin E (PGE), or PSPB did not differ (P > or = 0.05) among treatment groups. Profiles of PGF2alpha of treatment groups receiving mifepristone with or without PGF2alpha differed (P < 0.05) from vehicle or PGF2alpha alone-treated ewes. It is concluded that progesterone actions are necessary to suppress uterine/placental secretion of PGF2alpha and that maintenance of critical progesterone: estradiol-17beta and PGE:PGF2alpha ratios are necessary for maintenance of pregnancy.

Effect of the aromatase inhibitor CGS-16949A on pregnancy and secretion of progesterone, estradiol-17beta, prostaglandins E and F2alpha (PGE; PGF2alpha) and pregnancy specific protein B (PSPB) in 90-day ovariectomized pregnant ewes

The aromatase inhibitor CGS-16949A was used to determine whether CGS-16949A altered secretion of progesterone, estradiol-17beta, PGE (PGE1 + PGE2), PGF2alpha and PSPB. Ninety day pregnant ewes were ovariectomized and received vehicle, PGF2alpha, CGS-16949A or PGF2alpha+CGS-16949A. None of the ewes treated with PGF2alpha, CGS-16949A or PGF2alpha+CGS-16949A aborted (P > or = 0.05) during the 108-h experimental period. Treatment with CGS-16949A lowered (P < or = 0.05) progesterone in jugular venous plasma but concentrations of progesterone were not affected (P > or = 0.05) by treatment with PGF2alpha. Concentrations of estradiol-17beta and PSPB in jugular venous plasma and PGE in inferior vena cava plasma were decreased (P < or = 0.05) by treatment with CGS-16949A. Concentrations of PGF2alpha in inferior vena cava plasma were not affected (P > or = 0.05) by treatment with CGS-16949A. Decreases in estradiol-17beta occurred before decreases in PSPB, which was then followed by decreases in PGE (P < or = 0.05). It is concluded that these data support the hypothesis that estradiol-17beta regulates placental secretion of PSPB; PSPB regulates placental secretion of PGE; and PGE regulates placental secretion of progesterone during mid-pregnancy in ewes.

Effects of indomethacin, luteinizing hormone (LH), prostaglandin E2 (PGE2), trilostane, mifepristone, ethamoxytriphetol (MER-25) on secretion of prostaglandin E (PGE), prostaglandin F2alpha (PGF2alpha) and progesterone by ovine corpora lutea of pregnancy or the estrous cycle

Two experiments were conducted to determine the luteotropin of pregnancy in sheep and to examine autocrine and paracrine roles of progesterone and estradiol-17 beta on progesterone secretion by the ovine corpus luteum (CL). Secretion of progesterone per unit mass by day-8 or day-11 CL of the estrous cycle was similar to day-90 CL of pregnancy (P > or = 0.05). In experiment 1, secretion of progesterone in vitro by slices of CL from ewes on day-8 of the estrous cycle was increased (P < or = 0.05) by LH or PGE2. Secretion of progesterone in vitro by CL slices from day-90 pregnant ewes was not affected by LH (P > or = 0.05) while PGE2 increased (P < or = 0.05) secretion of progesterone. Day 8 ovine CL of the estrous cycle did not secrete (P > or = 0.05) detectable quantities of PGF2alpha or PGE while day-90 ovine CL of pregnancy secreted PGE (P < or = 0.05) but not PGF2alpha. Secretion of progesterone and PGE in vitro by day-90 CL of pregnancy was decreased (P < or = 0.05) by indomethacin. The addition of PGE2, but not LH, in combination with indomethacin overcame the decreases in progesterone by indomethacin (P < or = 0.05). In experiment 2, secretion of progesterone in vitro by day-11 CL of the estrous cycle was increased at 4-h (P < or = 0.05) in the absence of treatments. Both day-11 CL of the estrous cycle and day-90 CL of pregnancy secreted detectable quantities of PGE and PGF2alpha (P < or = 0.05). In experiment 1, PGF2alpha secretion by day-8 CL of the estrous cycle and day-90 ovine CL of pregnancy was undetectable, but was detectable in experiment 2 by day-90 CL. Day 90 ovine CL of pregnancy also secreted more PGE than day-11 CL of the estrous cycle (P < or = 0.05), whereas day-8 CL of the estrous cycle did not secrete detectable quantities of PGE (P > or = 0.05). Trilostane, mifepristone, or MER-25 did not affect secretion of progesterone, PGE, or PGF2alpha by day- 11 CL of the estrous cycle or day-90 CL of pregnancy (P > or = 0.05). It is concluded that PGE2, not LH, is the luteotropin at day-90 of pregnancy in sheep and that progesterone does not modify the response to luteotropins. Thus, we found no evidence for an autocrine or paracrine role for progesterone or estradiol-17 36 on luteal secretion of progesterone, PGE or PGF2alpha.