Hospitalization of the Elderly in the United States for Nonspecific Gastrointestinal Diseases: A Search for Etiological Clues

Chui, Kenneth; Jagai, Jyotsna S.; Griffiths, Jeffrey K.; Naumova, Elena N.

doi:10.2105/ajph.2010.300096

Cited by 28 publications

(34 citation statements)

References 33 publications

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“…Our study estimated that norovirus was responsible for 17% of all AGE hospital discharges in Europe from 2004 through 2015. These results are in line with the ndings of a large systematic literature review that estimated that norovirus was associated with 18% [95% CI, 17-20] of all diarrheal disease worldwide in any setting, and 17% [95% CI, [15][16][17][18][19] speci cally in in-patient settings [21].…”

Section: Discussionsupporting

confidence: 86%

“…Since norovirus disease is rarely recorded, coded norovirus discharges were not included in the equation. Instead, and as previously applied in other studies [6][7][8][15][16][17], NGE discharges were estimated for each month by calculating the difference between observed cause-unspeci ed and model-predicted counts, i.e. the model residuals r x,t = N_NOS x,t -E(N_NOS x,t ), assuming that any remaining seasonality not otherwise captured in the model was due to norovirus.…”

Section: Statistical Analysis and Modellingmentioning

confidence: 99%

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Model Estimates of Hospitalization Discharge Rates for Norovirus Gastroenteritis in Europe, 2004-2015

Negro‐Calduch¹,

Cattaert²,

Verstraeten³

2020

Preprint

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Abstract Background: Norovirus is an important cause of acute gastroenteritis globally. However, norovirus is rarely laboratory confirmed or recorded explicitly as a cause of hospitalization. In recent years, there has been an interest in using medical databases and indirect modelling methods to estimate the incidence of norovirus gastroenteritis. The objective of this study was to estimate the incidence of hospitalizations for norovirus gastroenteritis in Europe (2004- 2015) using nationwide in-patient discharge records from different European countries.Methods: National hospital discharge registers in all 28 European Union countries (at that time) and all 4 European Free Trade Association countries were contacted and invited to participate in the study. Discharges with ICD9/ICD10 codes for acute gastroenteritis (AGE) as first-listed (principal) diagnosis were extracted to assess hospitalization rates for AGE and norovirus gastroenteritis (NGE), overall, by age group, country, month, and seasonal year. To estimate NGE hospital discharge rates, a statistical model, based on the temporal patterns of occurrence of AGE, was used. Results: Data were available from 15 countries, representing 68% of the total population in Europe. Only 24.4% of all AGE discharges were coded as cause-specified. We estimated that between 2004 and 2015, the overall rate of NGE hospital discharges in Europe was 3.9 per 10,000 person-years, ranging from 1.2 (Portugal) to 10.7 (Lithuania). Norovirus was predicted to be responsible for 17% of all AGE hospital discharges in Europe in this period. Norovirus affects individuals of all ages, but NGE discharge rates were highest in children <5 years (24.8 per 10,000 person-years), and adults aged ≥80 years (10.7 per 10,000 person-years). Conclusion: We estimated that 1 in 400 hospitalizations in Europe can be attributed to Norovirus. In the absence of routine norovirus testing and recording in hospital settings, modelling methods are useful resources to estimate the incidence of norovirus gastroenteritis.

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Section: Discussionsupporting

confidence: 86%

Section: Statistical Analysis and Modellingmentioning

confidence: 99%

Model Estimates of Hospitalization Discharge Rates for Norovirus Gastroenteritis in Europe, 2004-2015

Negro‐Calduch¹,

Cattaert²,

Verstraeten³

2020

Preprint

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“…This may reduce the magnitude of the hydro-meteorological/diarrhea relationship because microbiological agents interact with weather factors [21]. Compilation of cases with multiple causal agents may also distort the assessment of peak timing [84,85], however a distortion of the assessment of the peak timing does not really affect our conclusion here that the 1 st peak of diarrhea is triggered in the dry season and that the 2 nd peak is triggered in the wet season. Finally, this study was limited in analyzing the sensitivity of some potential confounding factors such as household economic level, vaccination coverage, immune system and dietary habits due to a lack of data on these factors [52].…”

Section: Discussionmentioning

confidence: 99%

Hydrological Regime and Water Shortage as Drivers of the Seasonal Incidence of Diarrheal Diseases in a Tropical Montane Environment

Boithias

Choisy

Souliyaseng³

et al. 2016

PLoS Negl Trop Dis

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BackgroundThe global burden of diarrhea is a leading cause of morbidity and mortality worldwide. In montane areas of South-East Asia such as northern Laos, recent changes in land use have induced increased runoff, soil erosion and in-stream suspended sediment loads, and potential pathogen dissemination. To our knowledge, few studies have related diarrhea incidences to catchment scale hydrological factors such as river discharge, and loads of suspended sediment and of Fecal Indicator Bacteria (FIB) such as Escherichia coli, together with sociological factors such as hygiene practices. We hypothesized that climate factors combined with human behavior control diarrhea incidence, either because higher rainfall, leading to higher stream discharges, suspended sediment loads and FIB counts, are associated with higher numbers of reported diarrhea cases during the rainy season, or because water shortage leads to the use of less safe water sources during the dry season. Using E. coli as a FIB, the objectives of this study were thus (1) to characterize the epidemiological dynamics of diarrhea in Northern Laos, and (2) to identify which hydro-meteorological and sociological risk factors were associated with diarrhea epidemics.MethodsConsidering two unconnected river catchments of 22 and 7,448 km2, respectively, we conducted a retrospective time series analysis of meteorological variables (rainfall, air temperature), hydrological variables (discharge, suspended sediments, FIB counts, water temperature), and the number of diarrheal disease cases reported at 6 health centers located in the 5 southern districts of the Luang Prabang Province, Lao PDR. We also examined the socio-demographic factors potentially affecting vulnerability to the effect of the climate factors, such as drinking water sources, hygiene habits, and recreational water exposure.ResultsUsing thus a mixed methods approach, we found E. coli to be present all year long (100–1,000 Most Probable Number or MPN 100 mL-1) indicating that fecal contamination is ubiquitous and constant. We found that populations switch their water supply from wells to surface water during drought periods, the latter of which appear to be at higher risk of bacterial contamination than municipal water fountains. We thus found that water shortage in the Luang Prabang area triggers diarrhea peaks during the dry and hot season and that rainfall and aquifer refill ends the epidemic during the wet season. The temporal trends of reported daily diarrhea cases were generally bimodal with hospital admissions peaking in February-March and later in May-July. Annual incidence rates were higher in more densely populated areas and mostly concerned the 0–4 age group and male patients.ConclusionsWe found that anthropogenic drivers, such as hygiene practices, were at least as important as environmental drivers in determining the seasonal pattern of a diarrhea epidemic. For diarrheal disease risk monitoring, discharge or groundwater level can be considered as relevant proxies. These variables should be mon...

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“…The significant potential of this data repository for conducting a broad range of investigations in environmental epidemiology at the local and nationwide has been widely demonstrated. In our research, we explored CMS data to describe the effects of drinking water contamination on vulnerable population51, examined the emerging trends5253, seasonal patterns545556, and nationwide spatio-temporal synchronization in hospitalizations due to infectious agents56. This data source also allowed us to estimate immediate direct medical expenses associated with hospitalizations directly related to environmental heat exposure.…”

Section: Discussionmentioning

confidence: 99%

Heat-Related Hospitalizations in Older Adults: An Amplified Effect of the First Seasonal Heatwave

Liss

Chui

et al. 2017

Sci Rep

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Older adults are highly vulnerable to the detriment of extreme weather. The rapid non-linear increase in heat-related morbidity is difficult to quantify, hindering the attribution of direct effects of exposure on severe health outcomes. We examine the effects of ambient temperatures on heat-related hospitalizations (HH) among the elderly in presence of strong seasonality and by assessing the effects caused by the first and subsequent seasonal heatwaves. We empirically derived the thresholds for a heatwave episode in Boston MSA based on 16 years of daily observations. We compared the health risks of heatwaves using the proposed and four alternative definitions. 701 cases of HH in older residents of Boston area were examined using harmonic regression models, designed to capture the non-linear effects of ambient temperatures and heatwave episodes when the night-time temperature is above 65.5 °F for 3 consecutive nights. The overall relative risk of HH associated with a heatwave episode was 6.9 [95%CI:4.8–9.8]. The relative risk of HH associated with the first heatwave increases up to 13.3 [95%CI:7.4–24.0]. The risk declined to 3.7 [95%CI:2.4–5.8] for the subsequent heatwave. Four other commonly used heatwave definitions confirmed these findings. Public health actions have to target the first heatwave to maximize the impact of preventive measures.

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Hospitalization of the Elderly in the United States for Nonspecific Gastrointestinal Diseases: A Search for Etiological Clues

Cited by 28 publications

References 33 publications

Model Estimates of Hospitalization Discharge Rates for Norovirus Gastroenteritis in Europe, 2004-2015

Model Estimates of Hospitalization Discharge Rates for Norovirus Gastroenteritis in Europe, 2004-2015

Hydrological Regime and Water Shortage as Drivers of the Seasonal Incidence of Diarrheal Diseases in a Tropical Montane Environment

Heat-Related Hospitalizations in Older Adults: An Amplified Effect of the First Seasonal Heatwave

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