ABSTRACT
Background: Colorectal cancer (CRC) poses a significant burden on healthcare systems globally. Sociodemographic factors intricately influence CRC epidemiology, yet their impact on inpatient care remains underexplored. This study aimed to assess trends in CRC hospitalization and the effect of sociodemographic factors on outcomes of CRC patients. Methods: A retrospective longitudinal analysis was conducted using data from the Healthcare Cost and Utilization Project National Inpatient Sample. Trends in CRC admissions were assessed, stratified by sociodemographic variables. Disparities in hospital-associated outcomes were examined. Statistical methods included multivariable regression and joinpoint regression analysis. Results: The prevalence of CRC hospitalizations uptrended from 760 per 100,000 hospitalizations in 2010 to 841 per 100,000 hospitalizations in 2019 (P trend < 0.001). The mean age decreased from 67 to 66 years (P < 0.001). Male gender and White race were predominant across the study period. Inpatient mortality decreased from 4.5% in 2010 to 4.16% in 2019 (P trend = 0.033). On sex subgroup analysis, men had a significantly higher mortality rate (P = 0.034). Racially, Blacks had the highest mortality rate (P = 0.550) and only Whites showed a significant decline in mortality over the study period (P = 0.003). Hospitalization length decreased while total hospital charges increased. Conclusion: Our study highlights sociodemographic disparities in CRC outcomes, emphasizing the need for targeted interventions to address inequity in screening, diagnosis, and treatment. Continued research is needed to inform effective healthcare practices in mitigating these disparities and improving survival outcomes.
ABSTRACT
Background: Several factors are reported to be associated with palliative care utilization among patients with various cancers, but literature is lacking on metastatic prostate cancer (MPC) specific factors. Early integration of palliative care in management of MPC patients could increase their quality of life and overall outcomes. Methods: Retrospective longitudinal analyses were conducted using the National Inpatient Sample (NIS) data (2010 - 2019). Prevalence trends in palliative care utilization were assessed, and sociodemographic and hospital-level factors associated with palliative care utilization in MPC patients were examined. Results: The overall prevalence of palliative care utilization was 13.1% with an increasing trend from 8490 to 15,231 per 100,000 MPC admissions (p-trend <.001). MPC patients aged 65 years and above had similar odds of receiving palliative care compared to younger patients. Relative to non-Hispanic Whites, other racial groups had similar likelihood to utilize palliative care services. Patients in higher median household national income quartiles had greater odds of utilizing palliative care relative to those in the first income quartile. Patients on Medicaid, private insurance and other insurance types had greater odds of palliative care use in comparison to those on Medicare. Other factors identified were hospital region, location and teaching status, patient disposition, admission type, length of stay, and number of comorbidities. Conclusion: Our findings underscore the significance of enhanced government policies and institutional support in improving palliative care use among hospitalized MPC patients. Health systems must be proactive in addressing barriers to optimization of palliative care utilization in this population.
ABSTRACT
This mini-narrative review explores the relationship between diabetes and dementia, focusing on the potential mitigating role of metformin in reducing cognitive decline among individuals with type 2 diabetes. The interplay of factors such as glycemic control, diabetic complications, and lifestyle influences characterises diabetes-related dementia. This review emphasises the significance of comprehensive diabetes management in addressing the heightened risk of dementia in this population. Methodologically, the review synthesises evidence from 23 studies retrieved through searches on PubMed, Embase, Google Scholar, and Scopus. Current evidence suggests a predominantly positive association between metformin use and a reduced risk of dementia in individuals with diabetes. However, the review shows the complex nature of these outcomes, revealing variations in results in some studies. These discrepancies show the importance of exploring dose-response relationships, long-term effects, and demographic diversity to unravel the complexities of metformin's impact on cognitive health. Limitations in the existing body of research, including methodological disparities and confounding variables, necessitate refined approaches in future studies. Large-scale prospective longitudinal studies and randomised controlled trials focusing specifically on cognitive effects are recommended. Propensity score matching and exploration of molecular mechanisms can enhance the validity of findings in clinical practice. From a clinical perspective, metformin can serve as a potential adjunctive therapy for individuals with diabetes at risk of cognitive decline.
