Background
Methods
Data sources
Measures
Exposure
Outcomes
Covariates
Statistical analysis
Mortality models
Utilization models
Results
Variables | No infection | Sepsis | Pneumonia | CLABSI | VAP | Between group difference | ||||
---|---|---|---|---|---|---|---|---|---|---|
(N = 14894) | (N = 1062) | (N = 1802) | (N = 42) | (N = 52) | ||||||
Age (mean) | 73.84 | 74.14 | 73.93 | 72.64 | 74.92 | |||||
Female (%) | 48.60 | 49.90 | 50.30 | 57.10 | 36.50 | |||||
Race | ||||||||||
White (%) | 88.80 | 86.60 |
*
| 87.60 | 90.50 | 88.50 | ||||
Black (%) | 8.20 | 10.40 |
*
| 9.00 | 9.50 | 9.60 | ||||
Other (%) | 3.10 | 3.00 | 3.40 | 0.00 | 1.90 | |||||
Dual Eligible (%) | 16.30 | 21.30 |
**
| 23.10 |
**
| 21.40 | 11.50 |
††
| ||
No. ACCs (mean) | 4.75 | 5.75 |
**
| 5.10 |
**
| 5.67 |
**
| 4.89 |
††
| |
Days alive during follow-up (mean) | 1246 1 | 869 3 |
**
| 877 3 |
**
| 883 8 |
**
| 937 1 |
*
|
††
|
Inpatient admissions (mean) | ||||||||||
Year 1 | 1.19 | 1.45 |
**
| 1.35 |
**
| 1.64 | 1.40 |
††
| ||
Year 2 | 0.87 | 1.10 |
**
| 1.13 |
**
| 0.88 | 0.63 |
††
| ||
Year 3 | 0.81 | 0.88 | 0.96 |
**
| 1.40 | 1.04 |
†
| |||
Year 4 | 0.78 | 0.80 | 0.93 |
**
| 0.94 | 0.68 | ||||
Year 5 | 0.73 | 0.74 | 0.86 |
*
| 0.50 | 0.86 | ||||
Outpatient visits (mean) | ||||||||||
Year 1 | 16.65 | 13.12 |
**
| 12.94 |
**
| 13.02 | 12.89 |
††
| ||
Year 2 | 15.85 | 13.87 |
**
| 14.30 |
**
| 12.96 | 13.10 |
††
| ||
Year 3 | 15.77 | 14.59 | 14.12 |
**
| 14.90 | 12.41 |
††
| |||
Year 4 | 15.49 | 14.49 | 13.70 |
**
| 12.47 | 12.46 |
†
| |||
Year 5 | 14.92 | 13.41 | 13.83 | 12.94 | 11.19 | |||||
Emergency Department visits (mean) | ||||||||||
Year 1 | 1.33 | 1.53 |
*
| 1.44 | 1.19 | 1.39 | ||||
Year 2 | 1.13 | 1.39 | 1.34 |
*
| 0.46 | 0.57 | ||||
Year 3 | 1.09 | 1.24 | 1.14 | 1.25 | 1.22 | |||||
Year 4 | 1.10 | 1.08 | 1.12 | 1.06 | 0.59 | |||||
Year 5 | 1.04 | 0.98 | 1.08 | 0.50 | 0.76 | |||||
Long-term care admissions (mean) | ||||||||||
Year 1 | 2.18 | 5.04 |
**
| 3.93 |
**
| 4.43 | 4.04 |
††
| ||
Year 2 | 1.62 | 3.89 |
**
| 3.17 |
**
| 2.58 | 2.13 |
††
| ||
Year 3 | 1.68 | 3.87 |
**
| 2.94 |
**
| 2.50 | 3.93 |
††
| ||
Year 4 | 1.88 | 3.39 |
**
| 3.76 |
**
| 3.35 | 4.18 |
††
| ||
Year 5 | 1.90 | 3.60 |
**
| 2.98 |
**
| 5.69 |
*
| 4.05 |
††
| |
Home care visits (mean) | ||||||||||
Year 1 | 0.34 | 0.60 |
**
| 0.40 | 0.36 | 0.23 | ||||
Year 2 | 0.29 | 0.67 |
**
| 0.45 | 1.50 |
*
| 0.40 |
††
| ||
Year 3 | 0.26 | 0.60 |
**
| 0.47 |
**
| 0.60 | 0.11 |
††
| ||
Year 4 | 0.31 | 0.73 |
**
| 0.50 |
*
| 0.06 | 0.00 |
††
| ||
Year 5 | 0.30 | 0.64 |
**
| 0.39 | 0.00 | 0.10 |
Survival models
Variable | Cox proportional hazard model no frailty | Weibull model gamma frailty | ||||
---|---|---|---|---|---|---|
Hazard ratio | 95 % CI | P Value | Hazard ratio | CI | P Value | |
Infection (reference = No Infection)
| ||||||
Sepsis
| 1.36 | 1.20-1.54 | <0.01 | 1.39 | 1.22-1.59 | <0.01 |
Sepsis x Year 1
| 1.21 | 1.04-1.42 | 0.02 | 1.17 | 1.00-1.37 | 0.05 |
Pneumonia
| 1.55 | 1.42-1.70 | <0.01 | 1.58 | 1.42-1.76 | <0.01 |
Pneumonia x Year 1
| 1.15 | 1.02-1.30 | 0.02 | 1.11 | 0.98-1.25 | 0.11 |
Sepsis & Pneumonia
| 0.66 | 0.55-0.80 | <0.01 | 0.66 | 0.55-0.80 | <0.01 |
Gender (reference = Male)
| ||||||
Female
| 0.89 | 0.85-0.94 | <0.01 | 0.89 | 0.85-0.94 | <0.01 |
Race (reference = White)
| ||||||
Black
| 1.04 | 0.96-1.13 | 0.33 | 1.04 | 0.96-1.13 | 0.34 |
Other
| 0.96 | 0.84-1.09 | 0.49 | 0.95 | 0.84-1.08 | 0.46 |
Age Group (reference < 50)
| ||||||
50 to 64
| 1.76 | 1.49-2.08 | <0.01 | 1.75 | 1.48-2.07 | <0.01 |
65 to 74
| 2.07 | 1.77-2.41 | <0.01 | 2.06 | 1.76-2.41 | <0.01 |
75 to 84
| 3.12 | 2.67-3.64 | <0.01 | 3.10 | 2.64-3.64 | <0.01 |
85 to 94
| 5.25 | 4.47-6.16 | <0.01 | 5.21 | 4.36-6.21 | <0.01 |
95 and above
| 8.38 | 6.68-10.52 | <0.01 | 8.26 | 6.47-10.55 | <0.01 |
Insurance (reference = non Medicaid)
| ||||||
Medicaid
| 1.22 | 1.14-1.30 | <0.01 | 1.22 | 1.14-1.30 | <0.01 |
Number of subjects
| 17537 | 17537 | ||||
Number of failures
| 9694 | 9694 | ||||
Log pseudolikelihood
| −89334.21 | −26182.6 |
Utilization models
IR | Sepsis | IR | Pneumonia | |||||
---|---|---|---|---|---|---|---|---|
Model 1 | IR | Model 2 | Model 1 | IR | Model 2 | |||
P | P | P | P | |||||
Inpatient Admissions
| ||||||||
Year 1 |
1.40
|
<0.01
| 1.07 | 0.12 |
1.30
|
<0.01
| 1.01 | 0.68 |
Year 2 |
1.17
|
0.04
| 1.06 | 0.42 |
1.25
|
<0.01
| 1.09 | 0.06 |
Year 3 | 1.07 | 0.50 | 0.97 | 0.67 |
1.26
|
<0.01
| 1.08 | 0.15 |
Year 4 | 0.95 | 0.64 | 0.92 | 0.40 |
1.24
|
<0.01
| 1.09 | 0.17 |
Year 5 | 1.00 | 0.99 | 0.89 | 0.21 | 1.12 | 0.17 | 1.11 | 0.20 |
Outpatient Visits
| ||||||||
Year 1 |
0.94
|
0.05
|
0.91
|
0.01
|
0.95
|
0.03
|
0.94
|
0.01
|
Year 2 | 0.92 | 0.07 |
0.91
|
0.05
| 0.96 | 0.24 |
0.94
|
0.04
|
Year 3 | 0.98 | 0.68 | 0.96 | 0.50 | 1.00 | 0.93 | 0.99 | 0.68 |
Year 4 | 0.95 | 0.39 | 0.97 | 0.55 | 0.94 | 0.13 | 0.94 | 0.11 |
Year 5 | 0.93 | 0.27 | 0.95 | 0.37 | 0.95 | 0.25 | 0.95 | 0.24 |
Emergency Department Visits
| ||||||||
Year 1 |
1.28
|
<0.01
| 0.97 | 0.50 |
1.29
|
<0.01
| 1.00 | 0.94 |
Year 2 | 1.13 | 0.15 | 1.01 | 0.85 |
1.17
|
0.01
| 0.99 | 0.84 |
Year 3 | 1.19 | 0.10 | 1.06 | 0.48 |
1.18
|
0.02
| 1.02 | 0.66 |
Year 4 | 0.98 | 0.87 | 0.97 | 0.74 | 1.10 | 0.21 | 0.93 | 0.20 |
Year 5 | 0.95 | 0.62 | 0.94 | 0.41 | 1.02 | 0.85 | 0.92 | 0.16 |
Long-term Care Visits
| ||||||||
Year 1 |
2.67
|
<0.01
|
2.15
|
<0.01
|
2.16
|
<0.01
|
1.62
|
<0.01
|
Year 2 |
2.01
|
<0.01
|
2.29
|
<0.01
|
1.71
|
<0.01
|
1.50
|
<0.01
|
Year 3 |
1.81
|
<0.01
|
2.20
|
<0.01
|
1.60
|
<0.01
| 1.24 | 0.09 |
Year 4 |
1.63
|
0.01
|
1.86
|
<0.01
|
1.89
|
<0.01
|
1.50
|
0.01
|
Year 5 |
1.93
|
<0.01
|
1.97
|
<0.01
| 1.14 | 0.49 | 1.16 | 0.41 |
Home Care Visits
| ||||||||
Year 1 | 1.26 | 0.33 | 1.41 | 0.22 | 1.33 | 0.09 | 1.35 | 0.08 |
Year 2 |
2.15
|
0.01
|
2.02
|
0.02
| 1.39 | 0.10 | 1.35 | 0.16 |
Year 3 |
1.96
|
0.05
|
2.37
|
0.02
|
1.80
|
0.01
|
1.72
|
0.01
|
Year 4 |
2.22
|
0.01
|
2.74
|
<0.01
| 1.54 | 0.07 | 1.49 | 0.10 |
Year 5 |
2.27
|
0.02
|
2.51
|
0.01
| 1.41 | 0.17 | 1.40 | 0.15 |