Duharte, Maria

Abstract Background Despite a total decrease in age-adjusted mortality rate (AAMR) for HIV across all demographic variables, a multitude of factors have accounted for this cumulative effect of reduction in AAMR, including HIV-related hospitalizations, as 59% of these deaths occur in a medical facility. This study’s main objective is to provide insights from the national in-patient database for the recent years regarding the trends of HIV-associated in-hospital mortality and their healthcare resource utilization.Figure 1:(A). shows age-distribution of HIV-related hospitalizations (n=289,095); (B). gender; (C). age-groups; (D). racial/ethnic groups; (E). Trends in age-adjusted mortality rates among gender; (F). Trends in age-adjusted mortality rates among racial/ethnic groups.(A). Histogram (age).(B). Pie-chart (frequency).(C). Distribution dot-plot (horizontal).(D). Bar graph (vertical).(E). Line graph (two-groups).(F). Line graph (four-groups).Figure 2:Trend analysis for crude mortality of in-hospital HIV mortality among gender (A), race (B); inflation-adjusted hospitalization cost from 2016-2022 among gender (C), and race (D); and length of hospital stay among gender (E) and race (F).The Cochrane-Armitage test is used for crude mortality rate trend analysis for the years 2016 up to 2022.The Jonckheere-Terpstra test is used for non-parametric distribution of trends in length of stay and hospitalization costs (inflation-adjusted). Methods The National Inpatient Sample (NIS) database was searched from 2016 to 2022 to identify patients with HIV (ICD-10 Codes: B20-B24). Hospital discharge weights for national representation were utilized. Baseline social and demographic characteristics along with hospital-level variables were analyzed subsequently using the odds ratio with multivariate regression analysis for mortality adjusted with age. Secondary outcomes included length of hospital stay and inflation-adjusted costs. For cost-based analysis, inflation adjustment was performed according to the inflation index for the Medical Care Consumer Price Index (CPI).Figure 3:A-Univariate analysis of sociodemographic variables associated with in-hospital mortality with HIV; B-Significant predictors of in-hospital mortality with HIV in patients with comorbidities; C- Top 20 listed primary causes of admission stratified by ICD-10 codes in HIV patients.Top 20 listed primary causes of hospitalization in HIV patients from the year 2016 to 2022:1. B20 = HIV-related conditions.2. A41.9 = Sepsis, unspecified organism.3. J18.9 = Pneumonia, unspecified organism.4. N17.9 = Acute kidney failure, unspecified.5. J44.1 = Chronic obstructive pulmonary disease with (acute) exacerbation.6. U07.1 = COVID-19 infection.7. Z51.11 = Encounter for antineoplastic chemotherapy.8. I13.0 = Hypertensive heart and chronic kidney disease (CKD) with heart failure and stage 1 through stage 4 CKD.9. I10.0 = Hypertensive heart disease with heart failure.10. I21.4 = Non-ST elevation (NSTEMI) myocardial infarction.11. A41.89 = Other specified sepsis.12. I13.2 = Hypertensive heart and chronic kidney disease (CKD) with heart failure and with stage 5 CKD, or end-stage renal disease.13. F25.0 = Schizoaffective disorder, bipolar type.14. F33.2 = Major depressive disorder, recurrent severe without psychotic features.15. J96.01 = Acute respiratory failure with hypoxia.16. F10.239 Alcohol dependence with withdrawal, unspecified.17. O98.72 = HIV disease complicating childbirth.18. F25.9 = Schizoaffective disorder, unspecified.19. I12.0 = Hypertensive chronic kidney disease (CKD) with stage 5 (CKD) or end-stage renal disease.20. K52.9 = Noninfective gastroenteritis and colitis, unspecified.Table 1:Baseline characteristics of the study population.ED: emergency; HMO: health maintenance organization; DRG: diagnosis related groups; LOS: length of stay; SNF: skilled nursing facility; AMA: against medical device; NCHS: National Center for Health Statistics. Results A total of 289,095 HIV-related hospitalizations were included, which represents a weighted size of 1,445,475 hospital discharges. The mean age was 50.24 years, with 68.3% males and 51.85% African Americans. A total of 2.59% in-hospital deaths occurred; AAMR was 7029 per 100,000 hospitalizations in males, which was higher than females (5644 per 100,000). AAMR was found to be highest in the Hispanic population, at 8184 per 100,000. Males had a 3% annual percent change from 2016 to 2022, while trends show an increase in deaths in other races, like Asians/Pacific Islanders/Natives. Most deaths occurred in the West region (OR=1.43), non-metropolitan areas (OR=1.40), and medium-large bed-size hospitals (OR=1.28). Conclusion HIV-related in-hospital mortality has posed a significant challenge across various demographic factors. Utilizing mortality data from large databases can serve as a valuable screening tool for targeted public health surveillance and allocation of resources to obtain further development of tailored health programs and interventions aimed particularly at allocation of resources in reducing the impact of HIV-related deaths. Disclosures All Authors: No reported disclosures

Abstract Background Clostridium difficile infection (CDI) remains a significant public health concern in the United States, contributing to considerable morbidity and mortality, particularly among hospitalized and elderly populations. This study examines the temporal trends in CDI-related mortality across the United States over recent decades.Figure 1A:Mortality trends among gender; B: Race; C: US Census Region; D: Metropolitan areas. Mortality ratio (Gender): Female = 58.15% Male = 41.85% Mortality ratio (Race): Hispanic = 5.53% Whites = 83.92% Blacks = 8.12% Others = 2.22% Mortality ratio (US Census Region): Northeast = 22.18% Midwest = 24.36% South = 33.13% West = 20.33% Mortality ratio (Metropolitan): Metropolitan areas: 83.78% Non-metropolitan areas: 16.22%Figure 2A:Trends in mortality rates caused by Clostridium Difficile in United States from 1999-2020; and B: from 2021-2023. Top 90th percentile States (crude mortality rate per 100,000 population): Rhode Island: 6.55 Maine: 4.61 Ohio: 4.58 Vermont: 4.21 West Virginia: 4.18 Missouri: 4.11 Bottom 10th percentile States (crude mortality rate per 100,000 population): Georgia: 1.59 Mississippi: 1.49 Louisiana: 1.32 Utah: 1.26 Alaska: 0.96 Hawaii: 0.77 Methods In CDC WONDER analysis, we used total US residents of any age from all 50 states who died due to CDI spanning from the years 1999-2023. The dataset employed demographic attributes, place of death, state-level information, as well as classification into census regions, and the distinction between metropolitan and non-metropolitan localities. The ethnic/racial groups used in our study were classified as Hispanic, Black/African American, White, and others (including American Indian/Alaskan Native, Asian/Pacific Islander) individuals as indicated on the death certificates. US Census regions were categorized into Northeast, Midwest, South, and West based on the definitions provided by the Census Bureau.Figure 3:Place of death among individuals infection with clostridium difficile. Place of Death: Medical Facility - Inpatient: 71.22% Medical Facility - Outpatient or ER: 1.56% Medical Facility - Dead on Arrival: 0.06% Medical Facility - Status unknown: 0.03% Decedent's home: 5.52% Hospice facility: 4.64% Nursing home/long term care: 15.03% Other: 1.72% Place of death unknown: 0.22%Figure 4:Crude mortality rate among States. Crude mortality rate is represented per 100,000 population from the years 1999 to 2023. Results There were a total of 216,311 deaths associated with CDI over the study span. Out of them, 58.1% were females, 41.9% were males, 83.9% were White individuals, 8.12% were Black/African Americans, 5.53% were Hispanics, and 2.22% belonged to other racial groups. About 33% (one-thirds) of the deaths occured in South region followed by 24.4% in Midwest, 22.2% in Northeast and 20.3% in West region. According to NCHS rural-urban scheme classification, 83.8% deaths occured in metropolitan areas and the rest 16.2% in non-metropolitan areas. Conclusion National surveillance data indicate a marked increase in CDI-associated deaths during the early 2000s, largely driven by the emergence of hypervirulent strains and increased antibiotic resistance. However, recent years have shown a gradual decline in mortality rates, attributed to improved infection control practices, antimicrobial stewardship programs, and heightened public awareness. Despite these gains, disparities persist among racial, geographic, and age-specific subgroups, highlighting the need for targeted interventions. This underscores the evolving landscape of CDI mortality and the importance of sustained preventive strategies to further reduce the burden of this infection. Disclosures All Authors: No reported disclosures