Inpatient charges and mental illness: Findings from the Nationwide Inpatient Sample 1999–2007

Inpatient costs related to mental illness are substantial, though declining as a percentage of overall mental health treatment costs. The public sector has become increasingly involved in funding and providing mental health services. Nationwide Inpatient Sample data for the years 1999–2007 were used to: 1) examine Medicare, Medicaid, and private insurance charges related to mental illness hospitalizations, including trends over time; and 2) examine trends in mental comorbidity with physical illness and its effect on charges. There were an estimated 12.4 million mental illness discharges during the 9-year period, with Medicare being the primary payer for 4.3 million discharges, Medicaid for 3.3 million, private insurance for 3.2 million, and 1.6 million for all other payers. Mean inflation-adjusted charges per hospitalization were US$17,528, US$15,651, US$10,539, and US$11,663, respectively. Charges to public sources increased for schizophrenia and dementia-related discharges, with little private/public change noted for mood disorders. Comorbid mood disorders increased dramatically from 1.5 million discharges in 1999 to 3.4 million discharges in 2007. Comorbid illness was noted in 14.0% of the 342 million inpatient discharges during the study period and was associated with increased charges for some medical conditions and decreased charges for other medical conditions

Assessing Depression-Related Mental Health Literacy among Young Adults

Background and Purpose: Young adults who are 18 to 25 years old have the highest prevalence of depression (10.9%). Depression is a risk factor for suicide. Mental health literacy (MHL) is a key component in assessing recognition and help-seeking for depression with suicidal ideation. This study investigated MHL as it relates to help-seeking for depression with suicidal ideation. Methods: A crosssectional survey design was used. Participants were young adults (n= 430, ages 18 to 24 years old) who lived, worked, and/or attended school in San Francisco, California. Reavley and colleagues’ MHL survey was modified and made available in English, Spanish, and Chinese. Results: Several background factors were positively, though weakly, correlated to MHL, based on the r coefficient. Significant factors were: being female [r=.12,

Religion, Acculturation, and Incarceration: Determinants of Substance Use among Hispanic Adults in the United States

Objective. The influence of religion, acculturation, and incarceration on substance abuse has been studied, though predominantly among adolescents. Little research exists on how such factors influence substance use among Hispanic adults. The objective of this study was to assess key determinants of substance use among Hispanic adults. Methods. Public access 2012 National Survey on Drug Use and Health was utilized. Univariate and multivariable logistic regression analyses were conducted while accounting for complex survey design to obtain population-weighted estimates. Receiver operator curve analysis was used to evaluate the relative contribution of each variable. Results. Importance of religious influence in life and Spanish language interview were associated with lower odds of substance use, while history of incarceration increased the likelihood of substance use among Hispanic adults. Other factors associated with lower odds were increasing age, being female, and currently married. Other factors associated with increased odds were high school graduate and some college in addition to living above the 200% federal poverty level. Discussion. Results from this study add to the limited body of the literature on determinants of substance use among Hispanic adults. Health education measures should target acculturated Hispanic adults and those with incarceration history to reduce substance use

Spatial patterns of epilepsy-related emergency department visits in California

Background. Socio-demographic factors are associated with increased emergency department (ED) use among patients with epilepsy. However, there has been limited spatial analysis of such visits.Design and methods. California ED visit at the patient ZIP Code level were examined using Kulldorf’s spatial scan statistic to identify clusters of increased risk for epilepsy-related visits. Logistic regression was used to examine the relative importance of patient socio-demographics, Census-based and hospital measures. Results. During 2009-2011 there were 29,715,009 ED visits at 330 hospitals, of which 139,235 (0.5%) had epilepsy (International Classification of Disease-9 345.xx) as the primary diagnosis. Three large urban clusters of high epilepsy-related ED visits were centred in the cities of Los Angeles, Oakland and Stockton and a large rural clus- ter centred in Kern County. No consistent pattern by age, race/ethnicity, household structure, and income was observed among all clusters. Regression found only the Los Angeles cluster significant after adjusting for other measures. Conclusions. Geospatial analysis within a large and geographically diverse region identified a cluster within its most populous city having an increased risk of ED visits for epilepsy independent of selected socio-demographic and hospital measures. Additional research is necessary to determine whether elevated rates of ED visits represent increased prevalence of epilepsy or an inequitable system of epilepsy care.</p

Inpatient charges and mental illness: Findings from the Nationwide Inpatient Sample 1999&amp;ndash;2007

Jim E Banta1, Ivorie Belk1, Kedon Newton1, Abdullah Sherzai21Department of Health Policy and Management, 2Memory and Aging Center, Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USAAbstract: Inpatient costs related to mental illness are substantial, though declining as a percentage of overall mental health treatment costs. The public sector has become increasingly involved in funding and providing mental health services. Nationwide Inpatient Sample data for the years 1999&amp;ndash;2007 were used to: 1) examine Medicare, Medicaid, and private insurance charges related to mental illness hospitalizations, including trends over time; and 2) examine trends in mental comorbidity with physical illness and its effect on charges. There were an estimated 12.4 million mental illness discharges during the 9-year period, with Medicare being the primary payer for 4.3 million discharges, Medicaid for 3.3 million, private insurance for 3.2 million, and 1.6 million for all other payers. Mean inflation-adjusted charges per hospitalization were US$17,528, US$15,651, US$10,539, and US$11,663, respectively. Charges to public sources increased for schizophrenia and dementia-related discharges, with little private/public change noted for mood disorders. Comorbid mood disorders increased dramatically from 1.5 million discharges in 1999 to 3.4 million discharges in 2007. Comorbid illness was noted in 14.0% of the 342 million inpatient discharges during the study period and was associated with increased charges for some medical conditions and decreased charges for other medical conditions.Keywords: hospital charges, comorbidity, mood disorders, dementia, schizophreni

Association between Acculturation and Binge Drinking among Asian-Americans: Results from the California Health Interview Survey

Objective. Evaluate the association between acculturation and binge drinking among six Asian-American subgroups. Methods. A cross-sectional analysis of public access adult portion of 2007, 2009, and 2011/2012 California Health Interview Survey data was conducted. Univariate and multivariable logistic regression analyses were utilized with any binge drinking in the past year as the outcome variable and language spoken at home and time in USA as proxy measures of acculturation. Results. A total of 1,631 Asian-Americans (N=665,195) were identified as binge drinkers. Binge drinking was positively associated with being first generation South Asian (OR=3.05, 95% CI=1.55, 5.98) and monolingual (English only) Vietnamese (OR=3.00; 95% CI=1.58, 5.70), especially among females. Other factors associated with increased binge drinking were being female (Chinese only), not being current married (South Asian only), and being an ever smoker (all subgroups except South Asians). Conclusion. First generation South Asians and linguistically acculturated Vietnamese, especially females, are at an increased risk of binge drinking. Future studies and preventive measures should address the cultural basis of such health risk behaviors among Asian-American adults

Religion, Acculturation, and Incarceration: Determinants of Substance Use among Hispanic Adults in the United States

Objective. The influence of religion, acculturation, and incarceration on substance abuse has been studied, though predominantly among adolescents. Little research exists on how such factors influence substance use among Hispanic adults. The objective of this study was to assess key determinants of substance use among Hispanic adults. Methods. Public access 2012 National Survey on Drug Use and Health was utilized. Univariate and multivariable logistic regression analyses were conducted while accounting for complex survey design to obtain population-weighted estimates. Receiver operator curve analysis was used to evaluate the relative contribution of each variable. Results. Importance of religious influence in life and Spanish language interview were associated with lower odds of substance use, while history of incarceration increased the likelihood of substance use among Hispanic adults. Other factors associated with lower odds were increasing age, being female, and currently married. Other factors associated with increased odds were high school graduate and some college in addition to living above the 200% federal poverty level. Discussion. Results from this study add to the limited body of the literature on determinants of substance use among Hispanic adults. Health education measures should target acculturated Hispanic adults and those with incarceration history to reduce substance use

Burden of Mental Illness among Primary HIV Discharges: A Retrospective Analysis of Inpatient Data

Background: Empirical evidence demonstrates the substantial burden of mental illness among people living with HIV and AIDS (PLWHA). Current literature also notes the co-morbidity of these two illnesses and its impact on quality of life and mortality. However, little evidence exists on patient outcomes, such as hospital length of stay or post-discharge status. Methods: A retrospective analysis of National Inpatient Sample data was conducted. The study population was defined as discharges having a primary diagnosis of HIV based on International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes in primary diagnosis field. Clinical Classification Software (CCS) codes are used to identify comorbid mental illness. Length of stay was defined as number of days between hospital admission and discharge. Disposition (or post-discharge status) was defined as routine versus not routine. Patient and hospital characteristics were used as control variables. All regression analyses were survey-weighted and adjusted for control variables. Results: The weighted population size (N) for this study was 26,055 (n = 5211). Among primary HIV discharges, presence of any mental illness as a secondary discharge was associated with 12% higher LOS, when compared to a lack of such comorbidity (incidence rate ratio [IRR] = 1.12, 95% confidence interval [CI] = 1.05, 1.22, p &lt; 0.01). Likewise, among primary HIV discharges, those with mental illness had a 21% lower routine disposition, when compared to those without any mental illness (OR = 0.79, 95% CI = 0.68, 0.91, p &lt; 0.001). Conclusion: Our results highlight the need for improved mental health screening and coordinated care to reduce the burden of mental illness among HIV discharges