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Disparities in demographics among patients with pancreatitis-related mortality
Jonathan M Buscaglia1, Sumit Kapoor, Sanjay B Jagannath
1Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD 21205, USA.
Insights
Older age, male gender, and African American race increase inpatient mortality risk for pancreatitis patients. Multiple diagnoses and longer hospital stays also correlate with higher death rates.
Area of Science:
- Medical research
- Epidemiology
- Health services research
Background:
- Hospital admissions for pancreatitis are rising globally.
- Factors influencing inpatient mortality in pancreatitis patients require large-scale assessment.
Purpose of the Study:
- To investigate risk factors associated with in-hospital death in patients diagnosed with pancreatitis.
- To identify demographic and clinical variables predicting pancreatitis-related mortality.
Main Methods:
- Retrospective analysis of the 2004 U.S. Healthcare Cost and Utilization Project (HCUP) database.
- Utilized logistic regression to identify significant covariates for mortality in 57,068 pancreatitis patients.
Main Results:
- In-hospital mortality for pancreatitis was 2.7% (2,129 deaths).
- Risk factors for mortality included age > 65 (OR=2.92), African American race (OR=1.18), multiple diagnoses (OR=16.7), and longer length of stay (>14 days, OR=1.24).
- Female gender (OR=0.81) and higher income quartiles showed protective effects.
Conclusions:
- Older age, male gender, African American race, multiple diagnoses, and lower income are significant predictors of pancreatitis mortality.
- Increased hospital procedures and extended length of stay are also strongly associated with increased mortality risk.
Context:
Hospital admissions for pancreatitis are increasing. Factors involved in inpatient mortality have not been previously assessed on a large-scale basis.
Objective:
The aim was to study factors associated with pancreatitis-related death in hospitalized patients.
Setting:
Retrospective analysis of the 2004 U.S. Healthcare Cost and Utilization Project (HCUP) database was performed using "pancreatitis" as admitting diagnosis and "mortality" as primary endpoint.
Main Outcome Measures:
Age, race, gender, income, length of stay, number of diagnoses, and number of procedures were identified as candidate risk factors associated with death.
Design:
Univariate and multivariate logistic regression analyses were performed to identify significant covariates.
Results:
In 2004, total of 78,864 patients were admitted with pancreatitis; 2,129 (2.7%) patients died. Complete data were available for 57,068 patients. Age greater than 65 was 3 times more often associated with mortality (OR=2.92; P<0.001), while females were 19% less likely to die (OR=0.81; P<0.001). African American patients were 18% more likely to die than whites (OR=1.18, P=0.025), and increasing length of stay was associated with increasing mortality (more than 14 days compared with less than 3 days: OR=1.24; P=0.004). Patients with more than 3 diagnoses and more than one hospital procedure were 17 times (OR=16.7; P<0.001) and 5 times (OR=5.42; P<0.001) more likely to die, respectively. Compared to the lowest income quartile, patients in the 2nd and 3rd quartiles were 19% (OR=0.81; P=0.004) and 17% (OR=0.83; P=0.016) less likely to die, respectively.
Conclusion:
Age greater than 65 years, male gender, multiple diagnoses, African American race and low income are strongly associated with inpatient mortality from pancreatitis. Increased number of procedures and longer length of stay are also highly correlative with death.
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