CDC reports sharp rise in kidney disease hospitalizations
Recent statistics from the CDC indicate that hospitalizations for kidney disease have increased significantly over the last 25 years, especially among older adults, and that more patients are being hospitalized for acute renal failure.
The findings, published in the March 28 Morbidity and Mortality Weekly Report, revealed that there has been a shift in the type of kidney disease accounting for most hospitalizations, from chronic kidney disease (CKD) to acute renal failure (ARF). The report also noted an increasing trend of kidney disease hospital discharges associated with a concomitant diagnosis of diabetes mellitus or hypertension.
The report, based on data from the National Hospital Discharge Survey for the period 1980 to 2005, also found that:
- The annual number of hospitalizations with a recorded diagnosis of kidney disease quadrupled from 1980 to 2005, from approximately 416,000 in 1980 to 1,646,000 in 2005.
- In 2005, nearly two-thirds (61.4%) of patients hospitalized with kidney disease were over 65 years old, compared with 49.9% in 1980.
- The age-adjusted rate per 10,000 population for hospitalization for ARF increased from 1.8 in 1980 to 36.5 in 2005, with a smaller increase for CKD (from 7.4 to 13.8 per 10,000 population) during the same period.
- The proportion of kidney disease hospitalizations with hypertension listed among discharge diagnoses increased from 19.6% in 1980 to 41.1% in 2005. The proportion listed with diabetes mellitus as an additional discharge diagnosis rose from 23.4% in 1980 to 27% in 2005.
An accompanying editorial noted that the findings underscore the need for continued efforts in the early detection of kidney disease through screening programs. In addition, efforts should be made to standardize the criteria for diagnosing ARF, which has various causes (including infections, toxins, acute organ system dysfunction, surgery, and dehydration) and can be acquired during hospitalizations for other conditions.
Patient safety errors remain common, costly in U.S. hospitals
Patient safety incidents in U.S. hospitals have shown some improvement but remain a common and costly problem, an annual study reports.
HealthGrades, a company that rates hospitals, nursing homes and physicians, used data from 41 million Medicare records to conduct its fifth Patient Safety in American Hospitals Study. The study found that Medicare spent $8.8 billion on patient safety incidents from 2004 through 2006 and that these incidents led to 238,337 deaths that could potentially have been prevented. Patients who were treated at hospitals rated as “top performing” were 43% less likely to experience medical errors than were patients treated at the poorest-performing hospitals.
Medicare patients who had a patient safety incident during the study period had a one in five chance of dying because of it. Although the mortality rate overall decreased almost 5% in Medicare beneficiaries who experienced at least one patient safety incident from 2004 through 2006, rates of four patient safety indicators—postoperative respiratory failure, postoperative pulmonary embolism or deep venous thrombosis, postoperative sepsis and postoperative abdominal wound separation/splitting—increased compared with 2004. The most common medical errors (63.4% of all incidents) were bed sores, failure to rescue and postoperative respiratory failure. Failure to rescue improved 11.1%, but rates of bed sores and postoperative respiratory failure worsened.
The study authors concluded that while progress has been made in certain patient safety areas, particularly at top-performing hospitals, more work is needed. Hospital boards and CEOs can help improve patient safety efforts by publicly demonstrating “inspiring and committed leadership,” the authors wrote.
Clinical trial populations don't reflect everyone who gets ill
Patients enrolled in clinical trials don't represent the diversity of the population afflicted with diseases, concluded a study group of medical researchers and patient advocates who have drafted ways to enlist more minorities into studies.
Despite federal and state policies, very few Americans actually take part in clinical trials, especially those at greatest risk for disease, according to a report issued in April by more than 300 public health officials, medical researchers and patient advocates.
For example, older Americans are routinely left out of clinical trials studying Alzheimer's, arthritis and incontinence. And although more than 60% of all cancer occurs in older Americans, only 25% of those taking part in cancer studies in 2003 were over age 65.
The study was conducted by the Chronic Disease Prevention and Control Research Center at Baylor College of Medicine in Houston and the Intercultural Cancer Council, and was funded by Genentech. They created the EDICT (Eliminating Disparities in Clinical Trials) Initiative, which recommended changes at the federal, state and institutional levels:
- Implement more regulatory changes to improve enrollment of women and minorities;
- Increase government and industry collaboration in research design and implementation to prompt more diversity;
- Include community organizations in clinical trials;
- Require investigators to include in their peer-reviewed journal manuscripts an analysis of how the study's demographics correspond to the population that bears the greatest disease burden;
- Train institutional review boards to recognize how disparities manifest themselves in research protocols;
- Avoid duplication of effort between and address disparities among government, non-profit and industry trials;
- Enhance public education about clinical trials, including non-English speakers;
- Implement “participant navigation,” a new tool that helps patients keep their appointments and solves their non-medical problems; and
- Assure insurance coverage of the costs associated with clinical trials.
Rates of C. difficile-associated disease more than doubled from 2001 to 2005, AHRQ reports
Rates of Clostridium difficile-associated disease (CDAD) in hospitalized patients more than doubled from 2001 to 2005, according to a statistical brief from the Agency for Healthcare Research and Quality (AHRQ).
AHRQ researchers used data from the Healthcare Cost and Utilization Project to examine trends in CDAD from 1993 to 2005, as well as details on related hospitalizations in 2005. Major findings from the report included the following:
- More than 2 million cases of C. difficile occurred in U.S. hospitals between 1993 and 2005.
- Infection rates in hospitalized patients increased by 102% from 2001 to 2005, compared with a 74% increase from 1993 to 2001.
- Two-thirds of infected hospitalized patients in 2005 were elderly.
- Patients with CDAD were hospitalized an average of almost three times longer than uninfected patients.
- The in-hospital mortality rate was higher for patients with CDAD than overall (9.5% vs. 2.1%).
- Rates of CDAD in hospitalized patients were highest in the northeastern U.S. (144 stays per 100,000 population) and lowest in the West (67 stays per 100,000 population).
Mortality gap widens between the best-off and worst-off counties
Inequality in U.S. death rates steadily increased between 1983 and 1999 because of stagnating or increasing mortality rates in the worst-off regions, concluded a county-by-county analysis.
Average U.S. life expectancy increased steadily between 1960 and 2000, rising by more than seven years for men (from 66.9 to 74.1 years) and more than six years for women (73.5 to 79.6 years). But not everyone benefited equally.
In the 1980s, the disparity in death rates across different counties began to increase, with the worst-off counties reporting either no decline or an increase in death rates, reported researchers from Harvard University, the University of Washington and the University of California, San Francisco. They looked at data from the National Center for Health Statistics and the Census Bureau. The study was released online by PLoS Medicine, a publication of the Public Library of Science.
The difference between life expectancies in the counties in the top 2.5% and bottom 2.5% of mortality rates increased annually between 1983 and 1999. For men, the difference between best and worst increased from 9 years to 11; for women, it rose from 6.7 years to 7.5. Regions with the worst mortality rates included the Deep South, along the Mississippi River, and Appalachia, extending into the southern Midwest and Texas.
Female mortality was affected more heavily due to rising deaths from lung cancer, COPD and diabetes. Those diseases also affected men, but their overall impact was countered by relatively large reductions in cardiovascular death. Instead, men were affected by rising death rates from HIV/AIDS and homicide.
The study reinforces how important it is to monitor health inequalities between different groups to ensure that everyone enjoys gains in life expectancy regardless of economic status, said an editors' summary accompanying the report.
AAMC recommends against free lunches and speakers' bureaus
The Association of American Medical Colleges (AAMC) called for academic physicians to reject industry-funded gifts, lunches and speakers' bureaus in recommendations released in late April.
Such support from the pharmaceutical industry can influence the objectivity and integrity of academic teaching, learning and practice, concluded the AAMC's Task Force on Industry Funding of Medical Education. The task force, which had been studying the issue since 2006, proposed a number of specific steps which academic medical centers should take to reduce the interaction between their physicians and the pharmaceutical and device industries.
The recommendations for the medical schools include the following:
- Prohibit the acceptance of gifts, food and travel funding from industry by faculty, staff, students and trainees.
- Centrally manage distribution of pharmaceutical samples, if feasible, or look for an alternative way to manage distribution.
- Restrict pharma representatives' access to physicians to nonpatient, nonpublic areas and require scheduling by appointment or invitation.
- Strongly discourage faculty participation in industry-sponsored speakers' bureaus.
- Prohibit physicians, trainees and students from making presentations that have been ghostwritten by any party.
- Prohibit faculty, students and trainees from attending non-ACCME-accredited industry-sponsored education events.
The report's stand on speakers' bureaus was particularly strong, since many of the medical schools that currently restrict other contacts continue to allow such industry funding, noted the April 28 New York Times. Chief executives of Pfizer and Eli Lilly, who served on the task force, dissented from the report's recommendations on speakers' bureaus. A representative of Amgen endorsed the recommendations but disagreed with the report's wording on the motives of participants in industry-academic interactions, the New York Times said.
According to the report, the AAMC should collaborate with ACCME to create a process for auditing CME offerings for compliance with guidelines. An expert panel of academic and industry representatives should also be convened to identify best practices in information exchange between academia and industry and to highlight those that are transparent, rely on rigorous evaluation of evidence, and are consistent with the standards of professionalism.