Seasonal Variation in Diverticulitis: Evidence From Both Hemispheres.
ABSTRACT: Diverticulitis is a common and morbid disease with incompletely understood risk factors and pathophysiology. Geographic and, recently, seasonal trends in diverticulitis have been described in the United States.The purpose of this study was to investigate and compare seasonal trends in urgent hospital admission for diverticulitis in geographically distinct populations in the northern and southern hemispheres.Inpatient, urgent admissions for diverticulitis were identified within the Dr Foster Intelligence Global Comparators Dataset, a global benchmarking collaborative.Admissions to participating hospitals in the United Kingdom, Australia, and the United States were identified between 2008 and 2013.A total of 18,672 urgent admissions for diverticulitis were identified among 5.5-million admissions.Four separate hypothesis testing methods were used to identify seasonal trends in diverticulitis admissions among international patient populations.Seasonal trends were present in all 3 countries. A summer peak was observed in both hemispheres using multiple statistical testing methods. Logistic regression analyses identified summer months as significantly associated with diverticulitis admission in all 3 countries.This study is limited by restriction to inpatient admissions, reliance on administrative data, and participation of select hospitals within the database.These data suggest a shared seasonal risk factor among geographically distinct populations for diverticulitis.
Project description:The incidence of diverticulitis has been associated with geographic and seasonal variation. Low levels of circulating vitamin D are associated with diverticulitis. We investigated the association between UV light and diverticulitis.We identified nonelective diverticulitis admissions in the Nationwide Inpatient Sample and linked hospital locations to UV data. We examined UV exposure in relation to risk of admission for diverticulitis. We identified geographic and seasonal trends among 226?522 nonelective admissions for diverticulitis. Compared with high-UV areas, low-UV areas had a higher rate of diverticulitis (751.8 vs 668.1 per 100?000 admissions; P?<?.001), diverticular abscess (12.0% vs 9.7%; P?<?.001), and colectomy (13.5% vs 11.5%; P?<?.001). We also observed significant seasonal variation, with a lower rate of diverticulitis in the winter (645 per 100?000) compared with the summer (748 per 100?000) (P?<?.001). The summer increase was more evident in areas with the greatest UV fluctuation vs areas with the least UV fluctuation (120 vs 70 per 100?000; P?=?.01).Low UV light exposure is associated with an increased rate of diverticulitis admissions and greater seasonal variation. Because UV exposure largely determines vitamin D status, these findings support a role for vitamin D in the pathogenesis of diverticulitis.
Project description:The aim of our study was to evaluate the seasonal variations and whether short-term exposure to environmental risk factors, such as climate and air pollution, is associated with PTB-related hospital admissions in human immunodeficiency virus (HIV)-infected patients in Spain during the era of combined antiretroviral therapy (cART). A retrospective study was carried out using data from the Minimum Basic Data Set (MBDS) and the State Meteorological Agency (AEMET) of Spain. The primary outcome variable was hospital admissions with PTB diagnosis. The environmental risk factors evaluated were season, temperature, humidity, NO2, SO2, O3, PM10, and CO. Overall, HIV-infected patients had a lower frequency of PTB-related hospital admissions in summer (22.8%) and autumn (22.4%), but higher values in winter (26.6%) and spring (28.2%). Using a Bayesian temporal model, PTB-related hospital admissions were less frequent in summer-autumn and more abundant in winter-spring during the first years of follow-up. During the later years of follow-up, the seasonal trends continued resulting in the lowest values in autumn and the highest in spring. When considering short-term exposure to environmental risk factors, lower temperatures at 1 week (odds ratio (OR) = 1.03; p = 0.008), 1.5 weeks (OR = 1.03; p<0.001), 2 weeks (OR = 1.04; p<0.001), and 3 weeks (OR = 1.03; p<0.001) prior to PTB admission. In addition, higher concentration of NO2 at the time of admission were significantly associated with higher likelihoods of PTB-related hospital admission in HIV-infected patients when 1.5 weeks (OR = 1.1; p = 0.044) and 2 weeks (OR = 1.21; p<0.001) were used as controls. Finally, higher concentration of SO2 at 1.5 weeks prior to PTB admission was significantly associated with a higher likelihood of PTB-related hospital admissions (OR = 0.92; p = 0.029). In conclusion, our data suggest an apparent seasonal variation in hospital admissions of HIV-infected patients with a PTB diagnosis (summer/autumn vs. winter/spring), as well as a link to short-term exposure to environmental risk factors, such as temperature and ambient NO2 and SO2.
Project description:BACKGROUND:There are limited data on the seasonal variation in acute myocardial infarction (AMI) in the contemporary literature. HYPOTHESIS:There would be decrease in the seasonal variation in the management and outcomes of AMI. METHODS:Adult (>18?years) AMI admissions were identified using the National Inpatient Sample (2000-2017). Seasons were classified as spring, summer, fall, and winter. Outcomes of interest included prevalence, in-hospital mortality, use of coronary angiography, and percutaneous coronary intervention (PCI). Subgroup analyses for type of AMI and patient characteristics were performed. RESULTS:Of the 10 880?856 AMI admissions, 24.3%, 22.9%, 22.2%, and 24.2% were admitted in spring, summer, fall, and winter, respectively. The four cohorts had comparable age, sex, race, and comorbidities distribution. Rates of coronary angiography and PCI were slightly but significantly lower in winter (62.6% and 40.7%) in comparison to the other seasons (64-65% and 42-43%, respectively) (P?<?.001). Compared to spring, winter admissions had higher in-hospital mortality (adjusted odds ratio [aOR]: 1.07; 95% confidence interval [CI]: 1.06-1.08), whereas summer (aOR 0.97; 95% CI 0.96-0.98) and fall (aOR 0.98; 95% CI 0.97-0.99) had slightly lower in-hospital mortality (P?<?.001). ST-segment elevation (10.0% vs 9.1%; aOR 1.07; 95% CI 1.06-1.08) and non-ST-segment elevation (4.7% vs 4.2%; aOR 1.07; 95% CI 1.06-1.09) AMI admissions in winter had higher in-hospital mortality compared to spring (P?<?.001). The primary results were consistent when stratified by age, sex, race, geographic region, and admission year. CONCLUSIONS:Compared to other seasons, winter admission was associated with higher in-hospital mortality in AMI in the United States.
Project description:Increasing human population size and the concomitant expansion of urbanisation significantly impact natural ecosystems and native fauna globally. Successful conservation management relies on precise information on the factors associated with wildlife population decline, which are challenging to acquire from natural populations. Wildlife Rehabilitation Centres (WRC) provide a rich source of this information. However, few researchers have conducted large-scale longitudinal studies, with most focussing on narrow taxonomic ranges, suggesting that WRC-associated data remains an underutilised resource, and may provide a fuller understanding of the anthropogenic threats facing native fauna. We analysed admissions and outcomes data from a WRC in Queensland, Australia Zoo Wildlife Hospital, to determine the major factors driving admissions and morbidity of native animals in a region experiencing rapid and prolonged urban expansion. We studied 31,626 admissions of 83 different species of native birds, reptiles, amphibians, marsupials and eutherian mammals from 2006 to 2017. While marsupial admissions were highest (41.3%), admissions increased over time for all species and exhibited seasonal variation (highest in Spring to Summer), consistent with known breeding seasons. Causes for admission typically associated with human influenced activities were dominant and exhibited the highest mortality rates. Car strikes were the most common reason for admission (34.7%), with dog attacks (9.2%), entanglements (7.2%), and cat attacks (5.3%) also high. Admissions of orphaned young and overt signs of disease were significant at 24.6% and 9.7%, respectively. Mortality rates were highest following dog attacks (72.7%) and car strikes (69.1%) and lowest in orphaned animals (22.1%). Our results show that WRC databases offer rich opportunities for wildlife monitoring and provide quantification of the negative impacts of human activities on ecosystem stability and wildlife health. The imminent need for urgent, proactive conservation management to ameliorate the negative impacts of human activities on wildlife is clearly evident from our results.
Project description:Diverticulitis is a common diagnosis in the emergency department (ED). Outpatient management of diverticulitis is safe in selected patients, yet the rates of admission and surgical procedures following ED visits for diverticulitis are unknown, as are the predictive patient characteristics. Our goal is to describe trends in admission and surgical procedures following ED visits for diverticulitis, and to determine which patient characteristics predict admission.: We performed a cross-sectional descriptive analysis using data on ED visits from 2006-2011 to determine change in admission and surgical patterns over time. The Nationwide Emergency Department Sample database, a nationally representative administrative claims dataset, was used to analyze ED visits for diverticulitis. We included patients with a principal diagnosis of diverticulitis (ICD-9 codes 562.11, 562.13). We analyzed the rate of admission and surgery in all admitted patients and in low-risk patients, defined as age <50 with no comorbidities (Elixhauser). We used hierarchical multivariate logistic regression to identify patient characteristics associated with admission for diverticulitis.Fryom 2006 to 2011 ED visits for diverticulitis increased by 21.3% from 238,248 to 302,612, while the admission rate decreased from 55.7% to 48.5% (-7.2%, 95% CI [-7.78 to -6.62]; p<0.001 for trend). The admission rate among low-risk patients decreased from 35.2% in 2006 to 26.8% in 2011 (-8.4%, 95% CI [-9.6 to -7.2]; p<0.001 for trend). Admission for diverticulitis was independently associated with male gender, comorbid illnesses, higher income and commercial health insurance. The surgical rate decreased from 6.5% in 2006 to 4.7% in 2011 (-1.8%, 95% CI [-2.1 to -1.5]; p<0.001 for trend), and among low-risk patients decreased from 4.0% to 2.2% (-1.8%, 95% CI [-4.5 to -1.7]; p<0.001 for trend).From 2006 to 2011 ED visits for diverticulitis increased, while ED admission rates and surgical rates declined, with comorbidity, sociodemographic factors predicting hospitalization. Future work should focus on determining if these differences reflect increased disease prevalence, increased diagnosis, or changes in management.
Project description:Sigmoid diverticulitis is an increasingly common Western disease associated with a high morbidity and cost of treatment. Improvement in the understanding of the disease process, along with advances in the diagnosis and medical management has led to recent changes in treatment recommendations. The natural history of diverticulitis is more benign than previously thought, and current trends favor more conservative, less invasive management. Despite current recommendations of more restrictive indications for surgery, practice trends indicate an increase in elective operations being performed for the treatment of diverticulitis. Due to diversity in disease presentation, in many cases, optimal surgical treatment of acute diverticulitis remains unclear with regard to patient selection, timing, and technical approach in both elective and urgent settings. As a result, data is limited to mostly retrospective and non-randomized studies. This review addresses the current treatment recommendations for surgical management of diverticulitis, highlighting technical aspects and patterns of care.
Project description:BACKGROUND:Rates of hospital admissions for bronchiolitis vary seasonally and geographically across England; however, seasonal differences by area remain unexplored. We sought to describe spatial variation in the seasonality of hospital admissions for bronchiolitis and its association with local demographic characteristics. METHODS:Singleton children born in English National Health Service hospitals between 2011 and 2016 (n=3 727 013) were followed up for 1?year. Poisson regression models with harmonic functions to model seasonal variations were used to calculate weekly incidence rates and peak timing of bronchiolitis admissions across English regions and clinical commissioning groups (CCGs). Linear regression was used to estimate the joint association of population density and deprivation with incidence and peak timing of bronchiolitis admissions at the CCG level. RESULTS:Bronchiolitis admission rates ranged from 30.9 per 1000 infant-years (95%?CI 30.4 to 31.3) in London to 68.7 per 1000 (95% CI 67.9 to 69.5) in the North West. Across CCGs, there was a 5.3-fold variation in incidence rates and the epidemic peak ranged from week 49.3 to 52.2. Admission rates were positively associated with area-level deprivation. CCGs with earlier peak epidemics had higher population densities, and both high and low levels of deprivation were associated with earlier peak timing. CONCLUSIONS:Approximately one quarter of the variation in admission rates and two-fifths of the variation in peak timing of hospital admissions for bronchiolitis were explained by local demographic characteristics. Implementation of an early warning system could help to prepare hospitals for peak activity and to time public health messages.
Project description:We examine the seasonality of asthma-related hospital admissions in Melbourne, Australia, in particular the contribution and predictability of episodic thunderstorm asthma. Using a time-series ecological approach based on asthma admissions to Melbourne metropolitan hospitals, we identified seasonal peaks in asthma admissions that were centred in late February, June and mid-November. These peaks were most likely due to the return to school, winter viral infections and seasonal allergies, respectively. We performed non-linear statistical regression to predict daily admission rates as functions of the seasonal cycle, weather conditions, reported thunderstorms, pollen counts and air quality. Important predictor variables were the seasonal cycle and mean relative humidity in the preceding two weeks, with higher humidity associated with higher asthma admissions. Although various attempts were made to model asthma admissions, none of the models explained substantially more variation above that associated with the annual cycle. We also identified a list of high asthma admissions days (HAADs). Most HAADs fell in the late-February return-to-school peak and the November allergy peak, with the latter containing the greatest number of daily admissions. Many HAADs in the spring allergy peak may represent episodes of thunderstorm asthma, as they were associated with rainfall, thunderstorms, high ambient grass pollen levels and high humidity, a finding that suggests thunderstorm asthma is a recurrent phenomenon in Melbourne that occurs roughly once per five years. The rarity of thunderstorm asthma events makes prediction challenging, underscoring the importance of maintaining high standards of asthma management, both for patients and health professionals, especially during late spring and early summer.
Project description:BACKGROUND: Understanding disease seasonality can provide guidance for future biomedical research. OBJECTIVE: To examine whether meteorological factors and calendar months impact duodenal ulcer (DU) exacerbations. DESIGN: We conducted a retrospective time series analysis of population-based claims data. PARTICIPANTS: DU inpatients (1997-2003; all endoscopy confirmed) from Taiwan, a small island nation, n = 160,510. Inpatient admission was used as a proxy for exacerbation because 98.5% of cases had hemorrhage or perforation or both. MEASUREMENTS: We used multivariate autoregressive integrated moving average (ARIMA) modeling to examine if DU admissions/100,000 was associated with calendar month, ambient temperature, relative humidity, rainfall, atmospheric pressure, and sunshine hours, controlling for available DU-relevant comorbidities. RESULTS: DU admissions increased with age. ARIMA modeling showed a February (Chinese New Year-related) trough in all age groups (all p < 0.001; adjusted for meteorological variables and comorbidities), consistent with a February dip in all-cause admissions. Among 35-49 and 50+ age groups, DU admissions were negatively associated with temperature (both p < 0.05; model R2 = 0.875 and 0.920, respectively), representing a winter peak and summer trough. Among the < or = 19 age group, sunshine hours and rainfall are positively associated with DU admissions (both p < 0.001; R2 = 0.565), representing a summer peak. CONCLUSION: Meteorological variables are associated with DU exacerbations, although the potential role of nonsteroidal anti-inflammatory drug (NSAID) use because of seasonal acute respiratory illness cannot be ruled out. We recommend in-depth studies using chart reviews of DU patients admitted during peak and trough (incidence) months to clarify whether meteorological factors or the associated seasonal peaks of respiratory and other illnesses involving NSAID use are responsible for the observed seasonality.
Project description:To investigate heart failure (HF) hospitalization trends in the United States and change in trends after publication of management guidelines.Using data from the National Inpatient Sample and the US Census Bureau, annual national estimates in HF admissions and in-hospital mortality were estimated for years 2001 to 2014, during which an estimated 57.4 million HF-associated admissions occurred. Rates (95% confidence intervals) of admissions and in-hospital mortality among primary HF hospitalizations declined by an average annual rate of 3% (2.5%-3.5%) and 3.5% (2.9%-4.0%), respectively. Compared with 2001 to 2005, the average annual rate of decline in primary HF admissions was more in 2006 to 2009 (ie, 3.4% versus 1.1%; P=0.02). In 2010 to 2014, primary HF admission continued to decline by an average annual rate of 4.3% (95% confidence interval, 3.9%-5.1%), but this was not significantly different from 2006 to 2009 (P=0.14). In contrast, there was no further decline in in-hospital mortality trend after the guideline-release years. For hospitalizations with HF as the secondary diagnosis, there was an upward trend in admissions in 2001 to 2005. However, the trend began to decline in 2006 to 2009, with an average annual rate of 2.4% (95% confidence interval, 0.8%-4%). Meanwhile, there was a consistent decline in in-hospital mortality by an average annual rate of 3.7% (95% confidence interval, 3.3%-4.2%) during the study period, but the decline was more in 2006 to 2009 compared with 2001 to 2005 (ie, 5.4% versus 3.4%; P<0.001). Beyond 2009, admission and in-hospital mortality rates continued to decline, although this was not significantly better than the preceding interval.From 2001 to 2014, HF admission and in-hospital mortality rates declined significantly in the United States; the greatest improvements coincided with the publication of the 2005 American College of Cardiology/American Heart Association HF guidelines.