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Risk factors for hospitalisation and associated costs among patients with hepatitis A associated with imported pomegranate arils, United States, 2013.
Public Health. 2016 Jul; 136:144-51.PH

Abstract

OBJECTIVES

To assess hospitalisation risk factors and economic effects associated with a multistate hepatitis A outbreak in 2013.

STUDY DESIGN

Retrospective case series.

METHODS

Eligible outbreak-related cases confirmed by September 1, 2013, were defined as acute hepatitis symptoms and positive IgM anti-hepatitis A during March 15-August 12 among patients who consumed the food vehicle or had the outbreak genotype. We reviewed medical records, comparing demographic and clinical characteristics among hospitalized and non-hospitalized patients; we used logistic regression analysis to identify factors associated with hospitalization. We interviewed patients regarding symptom duration and healthcare usage and estimated per-patient and total costs. Health departments reported outbreak-related personnel hours.

RESULTS

Medical records were reviewed for 147/159 (92%) eligible patients; median age was 48 (range: 1-84) years, and 64 (44%) patients were hospitalized. Having any chronic medical condition was independently associated with hospitalisation (odds ratio, 3.80; 95% confidence interval, 1.68-8.62). Interviews were completed for 114 (72%) eligible patients; estimated per-patient cost of healthcare and productivity loss was $13,467 for hospitalized and $2138 for non-hospitalized patients and $1,304,648 for all 165 outbreak-related cases. State and local public health personnel expenditures included 82 h and $3221/outbreak-related case.

CONCLUSIONS

Hospitalisations in this outbreak were associated with chronic medical conditions and resulted in substantial healthcare usage and lost productivity. These data can be used to inform future evaluation of expansion of hepatitis A vaccination recommendations to include adults with chronic medical conditions.

Authors+Show Affiliations

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Colorado Department of Public Health and Environment, Denver, CO, USA. Electronic address: Erin.Epson@cdph.ca.gov.Colorado Department of Public Health and Environment, Denver, CO, USA.California Department of Public Health, Richmond, CA, USA.California Department of Public Health, Richmond, CA, USA.Arizona Department of Health Services, Phoenix, AZ, USA.New Mexico Department of Health, Santa Fe, NM, USA.Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; New Mexico Department of Health, Santa Fe, NM, USA.County of San Diego Health and Human Services Agency, San Diego, CA, USA; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA; Los Angeles County Department of Public Health, Acute Communicable Disease Control Program, Los Angeles, CA, USA.Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA.Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA.Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: pspradling@cdc.gov.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27156991

Citation

Epson, E E., et al. "Risk Factors for Hospitalisation and Associated Costs Among Patients With Hepatitis a Associated With Imported Pomegranate Arils, United States, 2013." Public Health, vol. 136, 2016, pp. 144-51.
Epson EE, Cronquist A, Lamba K, et al. Risk factors for hospitalisation and associated costs among patients with hepatitis A associated with imported pomegranate arils, United States, 2013. Public Health. 2016;136:144-51.
Epson, E. E., Cronquist, A., Lamba, K., Kimura, A. C., Hassan, R., Selvage, D., McNeil, C. S., Varan, A. K., Silvaggio, J. L., Fan, L., Tong, X., & Spradling, P. R. (2016). Risk factors for hospitalisation and associated costs among patients with hepatitis A associated with imported pomegranate arils, United States, 2013. Public Health, 136, 144-51. https://doi.org/10.1016/j.puhe.2016.03.027
Epson EE, et al. Risk Factors for Hospitalisation and Associated Costs Among Patients With Hepatitis a Associated With Imported Pomegranate Arils, United States, 2013. Public Health. 2016;136:144-51. PubMed PMID: 27156991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for hospitalisation and associated costs among patients with hepatitis A associated with imported pomegranate arils, United States, 2013. AU - Epson,E E, AU - Cronquist,A, AU - Lamba,K, AU - Kimura,A C, AU - Hassan,R, AU - Selvage,D, AU - McNeil,C S, AU - Varan,A K, AU - Silvaggio,J L, AU - Fan,L, AU - Tong,X, AU - Spradling,P R, Y1 - 2016/05/04/ PY - 2015/09/04/received PY - 2016/03/22/revised PY - 2016/03/25/accepted PY - 2016/5/10/entrez PY - 2016/5/10/pubmed PY - 2017/3/31/medline KW - Disease outbreaks KW - Health economics and organizations KW - Hepatitis A SP - 144 EP - 51 JF - Public health JO - Public Health VL - 136 N2 - OBJECTIVES: To assess hospitalisation risk factors and economic effects associated with a multistate hepatitis A outbreak in 2013. STUDY DESIGN: Retrospective case series. METHODS: Eligible outbreak-related cases confirmed by September 1, 2013, were defined as acute hepatitis symptoms and positive IgM anti-hepatitis A during March 15-August 12 among patients who consumed the food vehicle or had the outbreak genotype. We reviewed medical records, comparing demographic and clinical characteristics among hospitalized and non-hospitalized patients; we used logistic regression analysis to identify factors associated with hospitalization. We interviewed patients regarding symptom duration and healthcare usage and estimated per-patient and total costs. Health departments reported outbreak-related personnel hours. RESULTS: Medical records were reviewed for 147/159 (92%) eligible patients; median age was 48 (range: 1-84) years, and 64 (44%) patients were hospitalized. Having any chronic medical condition was independently associated with hospitalisation (odds ratio, 3.80; 95% confidence interval, 1.68-8.62). Interviews were completed for 114 (72%) eligible patients; estimated per-patient cost of healthcare and productivity loss was $13,467 for hospitalized and $2138 for non-hospitalized patients and $1,304,648 for all 165 outbreak-related cases. State and local public health personnel expenditures included 82 h and $3221/outbreak-related case. CONCLUSIONS: Hospitalisations in this outbreak were associated with chronic medical conditions and resulted in substantial healthcare usage and lost productivity. These data can be used to inform future evaluation of expansion of hepatitis A vaccination recommendations to include adults with chronic medical conditions. SN - 1476-5616 UR - https://www.unboundmedicine.com/medline/citation/27156991/Risk_factors_for_hospitalisation_and_associated_costs_among_patients_with_hepatitis_A_associated_with_imported_pomegranate_arils_United_States_2013_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0033-3506(16)30014-2 DB - PRIME DP - Unbound Medicine ER -