Trends in mortality, length of stay, and inpatient charges among tuberculosis hospitalizations with and without coexisting diabetes, US, 2000 - 2011 Open Access

Abstract

Background: Tuberculosis (TB) patients with diabetes mellitus (DM) may have poorer outcomes and a higher risk of death than those without DM.This study used a national sample to investigate trends in and compare inpatient mortality and healthcare utilization among hospitalized TB patients with and without DM.

Methods: A cohort of TB hospitalizations was constructed using data from the Nationwide Inpatient Sample during the years 2000 through 2011. Differences in the proportion of all-cause inpatient deaths, average length of stay (LOS), and average inpatient charges between primary TB hospitalizations with and without DM were compared using the t test. Trends in TB-DM hospitalizations, mortality, LOS, and charges were analyzed by the Cochran-Armitage test for trend. Bivariate analysis was done to identify crude predictors of mortality among primary TB hospitalizations.

Results: There was a total of 102,072 primary TB hospitalizations during the study period; 16,796 (16.5%) had comorbid DM. The rate of primary TB hospitalizations without DM decreased by 50% over the study period, whereas the rate of primary TB hospitalizations with DM increased by 27.6% (p < 0.001). TB hospitalizations with DM were an average of 1.5 days longer than those without DM (p = 0.003). There was a positive trend in mean charges incurred among TB hospitalizations with DM, from $53,460 to $84,338 (p < 0.001). On average, 3.8% of TB hospitalizations without DM died per year, compared with 4.08% of TB hospitalizations with DM per year (p = 0.49). There was no significant trend in average LOS (p = 0.44) or average mortality (p = 0.49) per year. In bivariate analyses, DM was not associated with an increased risk of inpatient death among hospitalized TB patients (p = 0.57).

Conclusions: The findings suggest that coexisting DM among hospitalized TB patients is not associated with increased mortality, but may result in increased healthcare utilization as measured by LOS and inpatient charges. Inpatient charges among TB patients hospitalized with DM increased 5.2% annually, illustrating the potential economic burden placed on the US healthcare system when the two conditions coexist.

Table of Contents

Chapter I: Literature Review. 1

Background. 2

Methods. 15

Chapter II: Manuscript. 20

Abstract. 22

Introduction. 24

Methods. 26

Results. 29

Discussion. 34

References. 39

Tables. 44

Figures. 53

Chapter III: Summary. 57

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Tuberculosis Trend Diabetes Diabetes mellitus Hospitalization
Committee Chair / Thesis Advisor	McGowan Jr., John E, Emory University
Committee Members	Pearson, Michele, Centers for Disease Control and Prevention
Partnering Agencies	CDC

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