Variation in risk factors of dementia among four elderly patient cohorts

AIM: To examine variation in risk factors that contributed to dementia among four elderly cohorts by race and gender. METHODS: We examined 2008 Tennessee Hospital Discharged database for vascular factors that play a role in both stroke and dementia. Risk factors for dementia were examined for black and white patients aged 65+. Four race-gender groups of patients-white males(WM), black males(BM), white females(WF), and black females(BF) were compared for prevalence of dementia and stroke. A logistic model predicting dementia in each group separately used several vascular factors affectingdementia directly or indirectly through stroke. RESULTS: Three point six percent of patients hospitalized in 2008 had dementia and dementia was higher among females than males(3.9% vs 3.2%, P < 0.001), and higher among blacks than whites(4.2% vs 3.5%, P < 0.000). Further, BF had higher prevalence of dementia than WF(4.2% vs 3.8%, P < 0.001); similarly BM had more dementia than WM(4.1% vs 3.1%, P < 0.001). In logistic regression models, however, different patterns of risk factors were associated with dementia in four groups: among WF and WM, hypertension, diabetes, congestive heart failure, and stroke predicted dementia. Among BF and BM, only stroke and diabetes were related to dementia.CONCLUSION: Aggressive management of risk factors(hypertension and diabetes) may subsequently reduce stroke and dementia hospitalization.

Depression and race affect hospitalization costs of heart failure patients

Objective:Depression and anxiety are frequently observed in heart failure(HF)patients;however,the effect of such factors on hospitalization costs of HF patients,and whether such costs vary by race and gender remain poorly understood.This analysis delineated the preva-lence of depression/anxiety among HF patients and estimated the effect of race and gender on hospitalization costs.Methods:We examined the 2008 files of the Tennessee Hospital Discharge Data System(HDDS)on patients(≥20 years of age)with a primary diagnosis of HF(ICD-9 codes 402,404,and 428)along with demographic data,depression/anxiety diagnoses,hospital costs,and comorbidities.Among the HF sample(n=16,889)53%were female and 23%were black.Race and gender differences in hospital costs were evaluated for the following three groups:(1)HF patients with depression/anxiety(HF+D);(2)HF-only patients without depression/anxiety(HFO);and(3)HF patients with other mental diagnoses(HF+M).Results:HF was significantly(p<0.000)higher among blacks compared to whites,and higher among males than females.Nearly 25%of HF patients had depression/anxiety(more whites and females were depressed).HF patients averaged more than 3 comorbidities(blacks had a greater number of comorbidities and hospitalization cost for the year).Costs were higher among HF+D patients compared to HFO patients.Among HF+D patients,costs were higher for black males compared with white males.These cost patterns prevailed largely because of higher comorbidities that required more re-admissions and longer hospital stays.Conclusion:Race and depression/anxiety are associated with increased hospitalization costs of HF patients.The higher costs among blacks reflect the higher burden of comorbidities,such as hypertension and diabetes,which calls for widespread dissemination,adoption,and implementation of proven interventions for the control of these comorbidities.

Smoking,depression,and hospital costs of respiratory cancers:Examining race and sex variation

Objective:To investigate the effect of smoking and depression on hospital costs for lung cancer(LC).Methods:We extracted data on depression,smoking history,demographics,and hospital charges for patients with respiratory cancers(ICD-9 codes 161-163,165)from the 2008 Tennessee Hospital Discharge Data System.The sample(n=6665)was mostly white(86%)and male(57%).Age-adjusted rates were developed in accordance with Centers for Disease Control and Prevention methods,and hospital costs were compared for patients with LC with versus without depression and a smoking history.Results:Three findings(P<0.001)emerged:(1)the LC rate was higher among blacks than among whites,and higher among men than among women;(2)while 66%of LC patients smoked(more men than women without racial variation),24%had depression(more females and whites were depressed);(3)the LC hospital cost was 54%higher than the non-LC hospital cost,and this cost doubled for patients with LC with depression and smoking versus those without such charac-teristics.Conclusion:While LC is more prevalent among blacks and men,depression is higher among female and white patients.Since depression with higher costs existed among LC patients,our find-ings point to(1)the possibility of cost savings by diagnosing and treating depression among LC patients,and(2)implementation of proven smoking cessation programs to reduce LC morbidity and hospital costs.