S1293 Prevalence and Trends in Hospitalizations for Suicidal Ideation, Suicide, and Self-Inflicted Harm Among Patients With Cirrhosis: A Nationwide Analysis
Notice bibliographique
Résumé
Introduction: Chronic illnesses have been associated with suicidal ideation (SI), suicide and self-inflicted harm (S/SIH). However, suicidality in patients with cirrhosis is understudied. We sought to describe trends, predictors, and outcomes of SI and S/SIH among hospitalized patients with cirrhosis, using a nationally representative dataset. Methods: Using the 2007-2014 Nationwide Inpatient Sample, we determined trends in cirrhosis-related SI and S/SIH hospitalizations. We compared baseline characteristics between patients with cirrhosis hospitalized with SI and S/SIH vs. those without suicidality. Multivariable regression analysis was used to identify patient-level predictors of SI and S/SIH. We also compared outcomes including all-cause inpatient mortality, hospital length of stay (LOS), and costs Results: Suicidal ideation and S/SIH-related hospitalizations accounted for 1.2% of all cirrhosis admissions. Hospitalizations for SI increased steadily while those for S/SIH decreased after peaking in 2010 (Figure). The majority of SI and S/SIH hospitalizations occurred in men, Medicaid patients, and among individuals with depression and anxiety [Table]. On multivariable analysis, older age (adjusted odds ratio [aOR] 0.12, 95% Confidence Interval [C.I.] 0.1-0.13), female sex (aOR =0.77, 95%CI= 0.78-0.81), and private payer status (aOR =0.58, 95%CI= 0.54-0.63) were associated with lower odds of SI and S/SIH. Blacks (aOR=0.55, 95%CI=0.5-0.6) and Hispanics (OR=0.63, 95%CI= 0.57-0.7) had significantly lower odds of suicidality compared to White patients. While patients from lower ecological socioeconomic groups, those on Medicaid (aOR=1.21, 95%CI=1.13-1.29), and those with comorbid depression (aOR=1.63, 95%CI=1.52-1.75) and anxiety (aOR=2.58, 95%CI=2.41-2.76) had higher adjusted odds of suicidality. All-cause inpatient mortality was lowest among patients with SI (0.6%) compared to those with S/SIH (2.7%). In addition, patients with SI had longer LOS than those without SI (6.7 vs 6.0 days, p=0.012). Hospital costs were also significantly lower for those with SI ($8270) compared to those with S/SIH ($12376) [Table]. Conclusion: In this nationally representative cohort, we observed a rising trend in suicidal ideation among patients with cirrhosis especially patients who were younger, White, from lower socioeconomic backgrounds, with comorbid anxiety and depression. Hospitalizations for suicide and self-inflicted harm appeared to be on the downtrend.Figure 1.: Suicidal ideation and S/SIH-related hospitalizations Table 1. - Baseline characteristics of patients with cirrhosis hospitalized for suicidal ideation, suicide and self-inflicted harm None Suicidal ideation Suicide and self-inflicted harm P-value Weighted, n 3990744 35759 11245 Age in years, mean (SD) 58.4 (0.06) 50.7 (0.13) 49.3 (0.21) < 0.001 Age groups < 0.001 18-39 204102 (5.1%) 3997 (11.2%) 1559 (13.9%) 40-64 2636301 (66.1%) 29648 (82.9%) 9187 (81.7%) 65-74 716164 (17.9%) 1747 (4.9%) 411 (3.7%) ≥75 434176 (10.9%) 367 (1.0%) 87 (0.8%) Sex < 0.001 Male 2446171 (61.3%) 24931 (69.7%) 6884 (61.2%) Female 1544233 (38.7%) 10823 (30.3%) 4360 (38.8%) Race < 0.001 White 2370145 (59.4%) 23702 (66.3%) 7686 (68.3%) Black/African American 392633 (9.8%) 2702 (7.6%) 628 (5.6%) Hispanic 620323 (15.5%) 4491 (12.6%) 1210 (10.8%) Others/Missing 607642 (15.2%) 4863 (13.6%) 1721 (15.3%) Primary payer < 0.001 Medicare 1714242 (43.1%) 10978 (30.8%) 3247 (29.0%) Medicaid 895128 (22.5%) 13167 (36.9%) 3703 (33.0%) Private insurance 865167 (21.7%) 5079 (14.3%) 2055 (18.3%) Self-pay 302638 (7.6%) 3874 (10.9%) 1317 (11.7%) No charge 34306 (0.9%) 499 (1.4%) 193 (1.7%) Other 169630 (4.3%) 2040 (5.7%) 699 (6.2%) Hospital size 0.389 Small 460791 (11.6%) 4277 (12.0%) 1232 (11.0%) Medium 984649 (24.8%) 8529 (24.0%) 3029 (27.2%) Large 2522795 (63.6%) 22709 (63.9%) 6889 (61.8%) Income < 0.001 Q1 1292454 (33.5%) 13066 (38.4%) 3819 (35.4%) Q2 1021754 (26.5%) 8568 (25.2%) 3091 (28.7%) Q3 875772 (22.7%) 7368 (21.7%) 2341 (21.7%) Q4 664196 (17.2%) 4999 (14.7%) 1527 (14.2%) Comorbidity index < 0.001 0 30683 (0.8%) 19 (0.1%) 11 (0.3%) 1-3 1428084 (35.8%) 13287 (37.2%) 2835 (25.2%) >3 2531977 (63.4%) 22453 (62.8%) 8409 (74.8%) Depression 468865 (11.7%) 7357 (20.6%) 3047 (27.1%) < 0.001 Anxiety 246203 (6.2%) 6831 (19.1%) 1768 (15.7%) < 0.001 All-cause inpatient mortality 251739 (6.3%) 223 (0.6%) 300 (2.7%) < 0.001 Length of stay (in days) 6.0 (0.02) 6.7 (0.09) 5.6 (0.16) 0.012 s 15409 8270 12376 < 0.001
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».