Malnutrition in hospitalized adults in the United States, 2016–2019

IF 2.4 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine Pub Date : 2024-07-09 DOI:10.1002/jhm.13456

Ajay Bhasin MD, Lynn Huang MS, Meng-Shoiu Shieh PhD, Penelope Pekow PhD, Peter K. Lindenauer MD, MS, Tara Lagu MD, MPH

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引用次数: 0

Abstract

Background

Malnutrition in hospitalized patients is associated increased length of stay, cost, readmission, and death. No recent studies have examined trends in prevalence or outcomes of hospitalized patients with a diagnosis of malnutrition.

Objectives

To study the prevalence of malnutrition diagnostic codes and associated hospital outcomes in the United States between 2016 and 2019.

Methods

We conducted a retrospective trends study to identify use of malnutrition codes in hospitalizations in the National Inpatient Sample between 2016 and 2019. We used direct standardization by logistic regression to adjust outcomes of percutaneous gastrostomy tube placement, mechanical ventilation, and death for age, Gagne comorbidity score, and sex. We then used linear regression to test for trends over time by malnutrition type.

Results

Across all hospitalizations, codes for diagnoses of nonsevere malnutrition and severe malnutrition were present in 3.7% and 4.1% of hospitalizations, respectively. Codes for any malnutrition increased over time, from 6.6% in 2016 to 8.6% in 2018 (p = .03). Codes for severe malnutrition increased from 3.3% to 4.7% (p = .01). Among hospitalizations with coded severe malnutrition diagnoses, there was a statistically significant decrease in adjusted rate of death over time (−0.54% per year, p = .03) which was not seen in hospitalizations without coded malnutrition diagnoses.

Conclusions

Use of malnutrition diagnosis codes increased significantly from 2016 to 2019. During this time, mortality among hospitalizations with a diagnosis code for severe malnutrition decreased. Though the increased prevalence of malnutrition codes may represent a change in the clinical characteristics of hospitalized patients, the decline in mortality suggests some of the increase may be due to lower threshold for coding and assignment of the diagnosis to less ill patients.

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2016-2019 年美国住院成人营养不良情况。

背景：住院患者营养不良与住院时间延长、费用增加、再次入院和死亡有关。近期没有研究对诊断为营养不良的住院病人的患病率或预后趋势进行调查：研究美国 2016 年至 2019 年期间营养不良诊断代码的流行率及相关住院结果：我们进行了一项回顾性趋势研究，以确定 2016 年至 2019 年间全国住院病人样本中住院病人使用营养不良代码的情况。我们通过逻辑回归直接标准化经皮胃造瘘管置入、机械通气和死亡的结果，并根据年龄、加涅合并症评分和性别进行调整。然后，我们使用线性回归来检验营养不良类型随时间变化的趋势：在所有住院病例中，分别有 3.7% 和 4.1% 的住院病例存在非严重营养不良和严重营养不良的诊断代码。任何营养不良的代码随着时间的推移而增加，从2016年的6.6%增加到2018年的8.6%（p = .03）。重度营养不良的编码从 3.3% 增加到 4.7%（p = .01）。在有严重营养不良诊断编码的住院患者中，调整后的死亡率随着时间的推移出现了统计学意义上的显著下降（每年-0.54%，p = .03），这在没有营养不良诊断编码的住院患者中是看不到的：从 2016 年到 2019 年，营养不良诊断代码的使用显著增加。在此期间，带有严重营养不良诊断代码的住院患者死亡率有所下降。虽然营养不良代码使用率的增加可能代表了住院患者临床特征的变化，但死亡率的下降表明，部分增加可能是由于编码阈值降低以及将诊断分配给病情较轻的患者所致。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.