- Email: [email protected]
Systematic Determinants of Anemia Among Women in India: A Dis-integrated Analyses of Pregnant, Lactating and Non-Pregnant and Non-Lactating Women
712
P40. Systemic and Individual Morbidity in the United States
Abstracts / Annals of Epidemiology 25 (2015) 702e719
Determinants
of
Maternal
Riddhi Doshi MBBS, MPH, Gregory Vaughan, Jun Yan PhD, Kiesha Benn MD, Robert H. Aseltine Jr. PhD. University of Connecticut Purpose: Obstetric trauma to the perineum and vulva was among the top five causes of hospitalization among young adults, resulting in almost 7.5 million hospital stays among Medicaid beneficiaries alone. Childbirth and related complications cost over 16 billion US dollars annually. The primary objective of this study is to determine the prevalence of perineal lacerations during childbirth, examine the associations with individual and systemic predictors and predict the risk of obstetric trauma. Methods: For this large retrospective cohort study, we utilized data regarding hospital deliveries from 30 hospitals integrated through the Connecticut Acute Care Hospital Inpatient Discharge Database (HIDD). Predictors can be broadly classified into individual (demographic, socioeconomic, clinical) and systemic (facility volume, payer/insurance type). Outcomes examined were 3rd and 4th degree perineal lacerations. R statistical package was utilized to perform generalized linear models. Logistic regression modeling was utilized to predict the risk of perineal injuries with significant systemic determinants. Results: Insurance type (p<0.001) and facility volume (p<0.001) of the delivering hospital were found to be significant systemic determinants of perineal injuries after childbirth. Income (p<0.025), maternal age (p<0.001) and instrument use (p<0.001) were significant predictors of trauma. Asian race doubled the odds of trauma (OR: 2.15; 95%CI 1.89-2.44) while instrument use increased it four times (OR: 3.98; 95%CI 3.56-4.44). Conclusions: The association between systemic factors like larger facility volume in terms of number of deliveries is a critical finding. This warrants further temporospatial investigation into facility-based systemic determinants of maternal health.
P41. Systematic Determinants of Anemia Among Women in India: A Dis-integrated Analyses of Pregnant, Lactating and Non-Pregnant and Non-Lactating Women Riddhi Doshi MBBS, MPH, Srinivas Goli PhD. University of Connecticut Purpose: The prevalence of anemia among pregnant women in developing countries is almost five times that among developed countries [Prevalence: development (14%); developing (51%)]. India bears a high burden (upto 70%) of anemia prevalence. This study aims to determine the predictors of anemia among pregnant and lactating women, thereby providing guidance for tailored health policy and programs. Methods: Analyses were performed on data from the National Family Health Survey (2005-06). Three binary logistic regression models determined the association of sociodemographic and economic predictors with the occurrence of anemia among pregnant, lactating, non-pregnant and non-lactating women. In addition, the regression models for pregnant and lactating women included predictors related to healthcare-seeking during pregnancy. Results: For pregnant women, duration of pregnancy, 2 children, work status, education of partners, wealth quintile, nutritional advice and supplementary nutrition were found to be significant predictors. Among lactating women, the odds of anemia significantly increased during the third trimester. Young age (15-24 years), primary education among women and secondary education among partners significantly reduced the odds of developing anemia. For nonpregnant, non-lactating women, age 25 years, caste, secondary and higher education among women, primary education among partners, highest wealth quintile had a protective effect. Conclusions: Economic, cultural and individual factors need to be considered while assessing risk of anemia among pregnant and lactating women. India needs to strengthen Maternal and Child Health programs through a focus on nutritional care during pregnancy in order to improve the overall health outcomes among women.
Health Outcomes P42. Surgical Site Infections Following Total Joint Arthroplasty, 2013-2014. Thea Rogers MPH, Linda Abella MSN, RN, ONC, Scott Sporer MD. Northwestern Medicine Central DuPage Hospital Purpose: Total Joint Arthroplasty (TJA) is quickly becoming one of the most common orthopaedic surgeries. In 2030 it is expected that 3.5 million total
knee arthroplasty (TKA) and 572,000 total hip arthroplasty (THA) surgeries will be performed, due in part to our aging population. Approximately 19% of all surgical patients have a readmission within 30 days after discharge for surgical site infection (SSI). Therefore it would be beneficial to document the incidence of SSI and organisms responsible following THA/TKA. Methods: All patients that had a primary or revision TKA/THA between January 1, 2013 and December 31, 2014 at 2 community hospitals were identified. Independent variables such as age, type of insurance, chronic conditions and inpatient complications were collected. The outcome of interest was surgical site infection within 90 days of discharge. In addition, information on readmission rates, mortality and organisms that grew from SSI culture were collected. Results: During the set time period, 4520 surgeries were identified of which 88.7% were primary arthroplasties. The average patient age at time of surgery was 65 (SD¼0.14), and 58.8% were female. Infection rates were low, at less than 1% across all procedure types. The most common organism that grew from SSI culture differed from 2013 to 2014. Conclusions: SSI after THA/TKA is of particular importance because of the effect on reimbursement and penalties from healthcare insurance companies. Changes in the microbiology of SSI following THA/TKA should be taken into consideration when using empiric therapies for treatment.
Infectious Diseases P43. Social and Behavioral Risk Factors of Sexually Transmitted Infections in Community College and University Male Students Oswald Attin PhD. Liberty University Purpose: This study compared several behavioral risk factors of STIs among males (condom use, number of sexual partners, type of sex (anal or vaginal), and drinking habits) between two distinct educational settings and their association with socioeconomic risk factors (low income and parent’s lower level of education) that have been shown to increase the incidence of STIs among college-aged students. The goals of this research were to understand the social and behavioral epidemiology of STIs in 2 educational settings. Methods: Of 238 male college students asked to participate, 135 responded consisting of 71 students attending a 4 year university and 64 students attending a 2 year community college. Data were analyzed using chisquare, linear and logistic regression analysis to determine which educational setting has males with more STI behavioral risk factors and if there is a greater risk of students with lower socioeconomic status (SES). Results: Men enrolled in a community college were nearly 3 times more likely to have more than one sexual partner in the last year (OR: 2.76, 95%CI: 1.31-5.78, p < .01). After controlling for SES, men enrolled in a community college were still 2½ times more likely to report not using a condom during vaginal intercourse (OR: 2.64; 95% CI: 1.06-6.57; p < .05). Conclusion: Male college students exhibited different behavioral risk factors, based on their educational setting. This research could help increase awareness of STIs among college-aged male students which can lead to lower STI incidence rates regardless of the institution type.
Injuries P44. Trends in Acute Injuries and Injury-Related Musculoskeletal Conditions in the U.S. Army Esther Dada MPH, Bruce H. Jones MD, MPH. U.S. Army Institute of Public Health Purpose: Injuries are the leading cause of medical encounters, disability, and lost duty days in the U.S. Army. This investigation examined recent Army trends in acute injury and injury-related musculoskeletal condition (IMC) incidence rates, and described leading causes of unintentional injuries. Methods: Medical encounter data for nondeployed active duty Army personnel were obtained from Armed Forces Health Surveillance Center. Time trends in incidence rates of acute injuries and IMCs for 2008-2013 were analyzed using Mantel-Haenszel chi square test for linear trend. Leading causes of unintentional injuries are identified. Results: Acute injury hospitalization and outpatient visit rates showed statistically significant declining trends among Army personnel for 2008-2013 (p<0.001 for trend). A similarly declining trend was seen in IMC hospitalization rates (43% decrease; 4.9 to 2.8 hospitalized injuries per 1,000
P40. Systemic and Individual Morbidity in the United States
Abstracts / Annals of Epidemiology 25 (2015) 702e719
Determinants
of
Maternal
Riddhi Doshi MBBS, MPH, Gregory Vaughan, Jun Yan PhD, Kiesha Benn MD, Robert H. Aseltine Jr. PhD. University of Connecticut Purpose: Obstetric trauma to the perineum and vulva was among the top five causes of hospitalization among young adults, resulting in almost 7.5 million hospital stays among Medicaid beneficiaries alone. Childbirth and related complications cost over 16 billion US dollars annually. The primary objective of this study is to determine the prevalence of perineal lacerations during childbirth, examine the associations with individual and systemic predictors and predict the risk of obstetric trauma. Methods: For this large retrospective cohort study, we utilized data regarding hospital deliveries from 30 hospitals integrated through the Connecticut Acute Care Hospital Inpatient Discharge Database (HIDD). Predictors can be broadly classified into individual (demographic, socioeconomic, clinical) and systemic (facility volume, payer/insurance type). Outcomes examined were 3rd and 4th degree perineal lacerations. R statistical package was utilized to perform generalized linear models. Logistic regression modeling was utilized to predict the risk of perineal injuries with significant systemic determinants. Results: Insurance type (p<0.001) and facility volume (p<0.001) of the delivering hospital were found to be significant systemic determinants of perineal injuries after childbirth. Income (p<0.025), maternal age (p<0.001) and instrument use (p<0.001) were significant predictors of trauma. Asian race doubled the odds of trauma (OR: 2.15; 95%CI 1.89-2.44) while instrument use increased it four times (OR: 3.98; 95%CI 3.56-4.44). Conclusions: The association between systemic factors like larger facility volume in terms of number of deliveries is a critical finding. This warrants further temporospatial investigation into facility-based systemic determinants of maternal health.
P41. Systematic Determinants of Anemia Among Women in India: A Dis-integrated Analyses of Pregnant, Lactating and Non-Pregnant and Non-Lactating Women Riddhi Doshi MBBS, MPH, Srinivas Goli PhD. University of Connecticut Purpose: The prevalence of anemia among pregnant women in developing countries is almost five times that among developed countries [Prevalence: development (14%); developing (51%)]. India bears a high burden (upto 70%) of anemia prevalence. This study aims to determine the predictors of anemia among pregnant and lactating women, thereby providing guidance for tailored health policy and programs. Methods: Analyses were performed on data from the National Family Health Survey (2005-06). Three binary logistic regression models determined the association of sociodemographic and economic predictors with the occurrence of anemia among pregnant, lactating, non-pregnant and non-lactating women. In addition, the regression models for pregnant and lactating women included predictors related to healthcare-seeking during pregnancy. Results: For pregnant women, duration of pregnancy, 2 children, work status, education of partners, wealth quintile, nutritional advice and supplementary nutrition were found to be significant predictors. Among lactating women, the odds of anemia significantly increased during the third trimester. Young age (15-24 years), primary education among women and secondary education among partners significantly reduced the odds of developing anemia. For nonpregnant, non-lactating women, age 25 years, caste, secondary and higher education among women, primary education among partners, highest wealth quintile had a protective effect. Conclusions: Economic, cultural and individual factors need to be considered while assessing risk of anemia among pregnant and lactating women. India needs to strengthen Maternal and Child Health programs through a focus on nutritional care during pregnancy in order to improve the overall health outcomes among women.
Health Outcomes P42. Surgical Site Infections Following Total Joint Arthroplasty, 2013-2014. Thea Rogers MPH, Linda Abella MSN, RN, ONC, Scott Sporer MD. Northwestern Medicine Central DuPage Hospital Purpose: Total Joint Arthroplasty (TJA) is quickly becoming one of the most common orthopaedic surgeries. In 2030 it is expected that 3.5 million total
knee arthroplasty (TKA) and 572,000 total hip arthroplasty (THA) surgeries will be performed, due in part to our aging population. Approximately 19% of all surgical patients have a readmission within 30 days after discharge for surgical site infection (SSI). Therefore it would be beneficial to document the incidence of SSI and organisms responsible following THA/TKA. Methods: All patients that had a primary or revision TKA/THA between January 1, 2013 and December 31, 2014 at 2 community hospitals were identified. Independent variables such as age, type of insurance, chronic conditions and inpatient complications were collected. The outcome of interest was surgical site infection within 90 days of discharge. In addition, information on readmission rates, mortality and organisms that grew from SSI culture were collected. Results: During the set time period, 4520 surgeries were identified of which 88.7% were primary arthroplasties. The average patient age at time of surgery was 65 (SD¼0.14), and 58.8% were female. Infection rates were low, at less than 1% across all procedure types. The most common organism that grew from SSI culture differed from 2013 to 2014. Conclusions: SSI after THA/TKA is of particular importance because of the effect on reimbursement and penalties from healthcare insurance companies. Changes in the microbiology of SSI following THA/TKA should be taken into consideration when using empiric therapies for treatment.
Infectious Diseases P43. Social and Behavioral Risk Factors of Sexually Transmitted Infections in Community College and University Male Students Oswald Attin PhD. Liberty University Purpose: This study compared several behavioral risk factors of STIs among males (condom use, number of sexual partners, type of sex (anal or vaginal), and drinking habits) between two distinct educational settings and their association with socioeconomic risk factors (low income and parent’s lower level of education) that have been shown to increase the incidence of STIs among college-aged students. The goals of this research were to understand the social and behavioral epidemiology of STIs in 2 educational settings. Methods: Of 238 male college students asked to participate, 135 responded consisting of 71 students attending a 4 year university and 64 students attending a 2 year community college. Data were analyzed using chisquare, linear and logistic regression analysis to determine which educational setting has males with more STI behavioral risk factors and if there is a greater risk of students with lower socioeconomic status (SES). Results: Men enrolled in a community college were nearly 3 times more likely to have more than one sexual partner in the last year (OR: 2.76, 95%CI: 1.31-5.78, p < .01). After controlling for SES, men enrolled in a community college were still 2½ times more likely to report not using a condom during vaginal intercourse (OR: 2.64; 95% CI: 1.06-6.57; p < .05). Conclusion: Male college students exhibited different behavioral risk factors, based on their educational setting. This research could help increase awareness of STIs among college-aged male students which can lead to lower STI incidence rates regardless of the institution type.
Injuries P44. Trends in Acute Injuries and Injury-Related Musculoskeletal Conditions in the U.S. Army Esther Dada MPH, Bruce H. Jones MD, MPH. U.S. Army Institute of Public Health Purpose: Injuries are the leading cause of medical encounters, disability, and lost duty days in the U.S. Army. This investigation examined recent Army trends in acute injury and injury-related musculoskeletal condition (IMC) incidence rates, and described leading causes of unintentional injuries. Methods: Medical encounter data for nondeployed active duty Army personnel were obtained from Armed Forces Health Surveillance Center. Time trends in incidence rates of acute injuries and IMCs for 2008-2013 were analyzed using Mantel-Haenszel chi square test for linear trend. Leading causes of unintentional injuries are identified. Results: Acute injury hospitalization and outpatient visit rates showed statistically significant declining trends among Army personnel for 2008-2013 (p<0.001 for trend). A similarly declining trend was seen in IMC hospitalization rates (43% decrease; 4.9 to 2.8 hospitalized injuries per 1,000