scholarly journals Rural–Urban Differences in Hospitalizations for Opioid Use–Associated Infective Endocarditis in the United States, 2003–2016

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
E Katherine Nenninger ◽  
Jenny L Carwile ◽  
Katherine A Ahrens ◽  
Brett Armstrong ◽  
Kinna Thakarar
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Rural Areas ◽  
Urban Residents ◽  
Opioid Use ◽  
Annual Percent Change ◽  
Urban Populations ◽  
Percent Change ◽  
Rural And Urban

Abstract Background The incidence of infective endocarditis, a serious heart infection that can result from injection drug use, has increased in step with the opioid epidemic. Harm reduction services aimed at decreasing infectious complications of injection drug use are limited in rural areas; however, it is unknown whether the burden of opioid use–associated infective endocarditis varies between rural and urban populations. Methods We used 2003–2016 National (Nationwide) Inpatient Sample data and joinpoint regression to compare trends in hospitalization for opioid use–associated infective endocarditis between rural and urban populations. Results Rates of US hospitalizations for opioid use–associated infective endocarditis increased from 0.28 to 3.86 per 100 000 rural residents, as compared with 1.26 to 3.49 for urban residents (overall difference in annual percent change P < .01). We observed 2 distinct trend periods, with a period of little change between 2003 and 2009/2010 (annual percent change, 0.0% rural vs –0.08% urban) followed by a large increase in hospitalization rates between 2009/2010 and 2016 (annual percent change, 0.35% rural vs 0.36% urban). Over the study period, opioid use–associated infective endocarditis hospitalizations shifted toward younger age groups for both rural and urban residents, and rural resident hospitalizations increasingly occurred at urban teaching hospitals. For both groups, Medicaid was the most common payer. Conclusions The increase in US hospitalizations for opioid use–associated infective endocarditis over the past decade supports the importance of public health efforts to reduce injection-related infections in both urban and rural areas. Future studies should examine factors affecting the higher increase in rate of these hospitalizations in rural areas.

scholarly journals Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Laura R Marks ◽  
Nathanial S Nolan ◽  
Linda Jiang ◽  
Dharushana Muthulingam ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Diagnosis Code ◽  
Opioid Use ◽  
Diagnosis Codes ◽  
All Cause Mortality ◽  
Icd 10

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

scholarly journals Association of Treatment With Medications for Opioid Use Disorder With Mortality After Hospitalization for Injection Drug Use–Associated Infective Endocarditis

2020 ◽  
Vol 3 (10) ◽  
pp. e2016228 ◽  
Author(s):  
Simeon D. Kimmel ◽  
Alexander Y. Walley ◽  
Yijing Li ◽  
Benjamin P. Linas ◽  
Sara Lodi ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Opioid Use

scholarly journals Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Clinical Characteristics ◽  
National Registry ◽  
Injection Drug ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Increased Risk ◽  
History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P <  0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P <  0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P <  0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P <  0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P <  0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P <  0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P <  0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P <  0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P <  0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

Infective endocarditis secondary to injection drug use: A survey of Canadian cardiac surgeons

2021 ◽  
Author(s):  
Kevin R. An ◽  
Jessica G.Y. Luc ◽  
Derrick Y. Tam ◽  
Olina Dagher ◽  
Rachel Eikelboom ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Cardiac Surgeons

scholarly journals Injection Drug Use–Associated Infective Endocarditis

JAMA ◽  
2018 ◽  
Vol 320 (18) ◽  
pp. 1939 ◽  
Author(s):  
David Phillip Serota ◽  
J. Deanna Wilson ◽  
Jessica S. Merlin
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug

scholarly journals Impact Des Facteurs Intersubjectifs Sur L'engagement Des Cadres Ivoiriens Au Développement De Leur Localité d’Origine

2018 ◽  
Vol 14 (32) ◽  
pp. 237
Author(s):  
Daboné Inoussa ◽  
Méité Zoumana
Keyword(s):  
Statistical Analysis ◽  
Data Collection ◽  
Public Administration ◽  
Rural Areas ◽  
Present Survey ◽  
Urban Populations ◽  
Local Populations ◽  
Personal Commitment ◽  
Rural And Urban

Despite the policy of developing localities initiated by the Ivorian state, disparities between rural and urban populations are still obvious. The lack of interest in this process of development from localities’ native executives is highlighted. The present survey tempts to examine this lack of personal commitment from executives in relation with intersubjective factors such as sympathy, autonomy, mystical practices and communication. In so doing, a sample of 121 executives from the Ivorian public administration are selected rationally in the purpose of data collection through a questionnaire. Statistical analysis indicate that, except the autonomy to bring innovations in rural areas, the targeted intersubjective factors have a significant impact on the executives' level of commitment in their locality’s development. As regards to practical repercussions, these results underline the necessity to develop the local populations’ mind of sympathy and communication towards their executives. Local populations have also to put an end to any mystical practice able to frighten their native executives if they want them to fully take part in the development of their different localities.

scholarly journals A Vulnerability Assessment for a Future HIV Outbreak Associated With Injection Drug Use in Illinois, 2017–2018

2021 ◽  
Vol 6 ◽  
Author(s):  
Cara Jane Bergo ◽  
Jennifer R. Epstein ◽  
Stacey Hoferka ◽  
Marynia Aniela Kolak ◽  
Mai T. Pho
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Drug Use ◽  
Injection Drug Use ◽  
Negative Binomial ◽  
Cook County ◽  
Injection Drug ◽  
County Level ◽  
Opioid Use ◽  
Zip Code

The current opioid crisis and the increase in injection drug use (IDU) have led to outbreaks of HIV in communities across the country. These outbreaks have prompted country and statewide examination into identifying factors to determine areas at risk of a future HIV outbreak. Based on methodology used in a prior nationwide county-level analysis by the US Centers for Disease Control and Prevention (CDC), we examined Illinois at the ZIP code level (n = 1,383). Combined acute and chronic hepatitis C virus (HCV) infection among persons &lt;40 years of age was used as an outcome proxy measure for IDU. Local and statewide data sources were used to identify variables that are potentially predictive of high risk for HIV/HCV transmission that fell within three main groups: health outcomes, access/resources, and the social/economic/physical environment. A multivariable negative binomial regression was performed with population as an offset. The vulnerability score for each ZIP code was created using the final regression model that consisted of 11 factors, six risk factors, and five protective factors. ZIP codes identified with the highest vulnerability ranking (top 10%) were distributed across the state yet focused in the rural southern region. The most populous county, Cook County, had only one vulnerable ZIP code. This analysis reveals more areas vulnerable to future outbreaks compared to past national analyses and provides more precise indications of vulnerability at the ZIP code level. The ability to assess the risk at sub-county level allows local jurisdictions to more finely tune surveillance and preventive measures and target activities in these high-risk areas. The final model contained a mix of protective and risk factors revealing a heightened level of complexity underlying the relationship between characteristics that impact HCV risk. Following this analysis, Illinois prioritized recommendations to include increasing access to harm reduction services, specifically sterile syringe services, naloxone access, infectious disease screening and increased linkage to care for HCV and opioid use disorder.

The Need for Multidisciplinary Hospital Teams for Injection Drug Use-Related Infective Endocarditis

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Melissa B. Weimer ◽  
Caroline G. Falker ◽  
Nikhil Seval ◽  
Marjorie Golden ◽  
Sarah C. Hull ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hospital Teams
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