ABSTRACT
Introduction The global burden of cardiovascular disease (CVD) has risen over the past decade, potentially escalating resource utilization, morbidity, and mortality. We analyzed trends in hospitalization for CVDs, outcomes of hospitalizations, and the impact of the COVID-19 pandemic on CVD hospitalizations between 2016 and 2020. Methods Adult CVD hospitalizations recorded in the 2016-2020 nationwide inpatient sample (NIS) were identified using major diagnostic categories (MDC- class 5). The NIS is the largest all-payer repository of all hospitalizations in the USA within a calendar year. We compared sociodemographic factors and outcomes (mortality, length of stay, and hospital charges) of CVD hospitalization before and during the pandemic using Pearson's χ2 tests. We used Stata ranking commands and ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems) codes to identify the most recurring diagnoses associated with CVD mortality during the study period. Trends in mortality and resource use were assessed using the Jonckheere-Terpstra trend test. Hospital charges were adjusted for inflation using the Medical Expenditure Panel Survey index. We used stepwise multivariate logistic regression analyses (P ≤ 0.05 for entry; P > 0.10 for removal) to identify covariates associated with cardiovascular mortality during the study period. Results Hospitalizations for CVDs rose from 4,283,502 in 2016 to 4,635,246 in 2019 (Ptrend < 0.001) and declined to 3,865,399 in 2020. 452,930 mortalities were recorded during the study period. In-hospital mortality rose from 111,090 (2.6%) in 2016 to 118,825 (2.8%) in 2020 (Ptrend < 0.001). Compared with the prepandemic years, mortality rates were higher during the pandemic (108,231 [2.8%] vs. 445,373 [2.5%]; P<0.001), and increased in hospitalizations for hypertensive heart disease with chronic kidney disease (CKD) (15,585 [14.4%] vs. 45,873 [10.3%]; P<0.001), hypertensive heart disease with heart failure (7,468 [6.9%] vs. 21,378 [4.8%]), ventricular tachycardia (2,056 [1.9%] vs. 7,571 [1.7%]; P=0.022), and peripheral angiopathy with gangrene (1,191 [1.1%] vs. 3,118 [0.7%]; P<0.001). CVD hospitalizations totaled 80.3 million hospital days and 39.7 million hospital procedures during the period. The mean number of procedures (3 vs. 2) and mean length of hospital stay (5.6 vs. 4.5 days) increased during the pandemic (P<0.001). The mean hospital cost for CVD increased from US$ 69,394 in 2016 to US$ 89,728 in 2020 (Ptrend < 0.001). Conclusion CVD mortality increased despite increased resource use over the study period. Hospitalizations during the pandemic had poorer mortality and resource use outcomes than those in the preceding years.
ABSTRACT
OBJECTIVE: This study evaluated the age-group differences in the levels of awareness of cardiovascular lifestyle risk factors. METHODS: Data from 5,219 individuals were analyzed. Age was classified as young, middle-aged, and older adults. Lifestyle factors included smoking, exercise, noting calorie information, and alcohol. The Chi-square (Χ2) test was used to analyze age-group differences in awareness. Multiple logistic regression was used to examine the relationship between age group and level of awareness. RESULTS: Awareness of at least one lifestyle factor was highest in middle-aged adults at 47.8% (2232/5095), followed by young adults at 32.1% (991/5095) and older adults at 20.1% (1872/5095). The older age group was linked to an increment in the odds ratios (AOR: 1.47, CI: 1.06 to 2.03) of being aware of exercise recommendations. There was a significant association between the middle-aged (AOR 0.74, CI: 0.56 to 0.99) and older-aged (AOR 0.76, CI: 0.58 to 0.99) categories with reduced odds of individuals becoming increasingly aware of the calorie information found in various menu boards and food menus. CONCLUSION: Middle-aged adults were the most aware of lifestyle risk factors. Middle-aged or older adults are associated with being less aware of calorie information on food menus and menu boards. Further research should evaluate the reasons behind low levels of awareness in younger adults.
