Different populations and areas of the world experienced diverse COVID-19 hospitalization and mortality rates. Claims data is a systematically recorded source of hospitalized patients' information ...that could be used to evaluate the disease management course and outcomes. We aimed to investigate the hospitalization and mortality patterns and associated factors in a huge sample of hospitalized patients.
In this retrospective registry-based study, we utilized claim data from the Iran Health Insurance Organization (IHIO) consisting of approximately one million hospitalized patients across various hospitals in Iran over a 26-month period. All records in the hospitalization dataset with ICD-10 codes U07.1/U07.2 for clinically/laboratory confirmed COVID-19 were included. In this study, a case referred to one instance of a patient being hospitalized. If a patient experienced multiple hospitalizations within 30 days, those were aggregated into a single case. However, if hospitalizations had longer intervals, they were considered independent cases. The primary outcomes of study were general and intensive care unit (ICU) hospitalization periods and case fatality rate (CFR) at the hospital. Besides, various demographic and hospitalization-associated factors were analyzed to derive the associations with study outcomes using accelerated failure time (AFT) and logistic regression models.
A total number of 1 113 678 admissions with COVID-19 diagnosis were recorded by IHIO during the study period, defined as 917 198 cases, including 51.9% females and 48.1% males. The 61-70 age group had the highest number of cases for both sexes. Among defined cases, CFR was 10.36% (95% CI: 10.29-10.42). The >80 age group had the highest CFR (26.01% 95% CI: 25.75-26.27). The median of overall hospitalization and ICU days were 4 (IQR: 3-7) and 5 (IQR: 2-8), respectively. Male patients had a significantly higher risk for mortality both generally (odds ratio (OR) = 1.36 1.34-1.37) and among ICU admitted patients (1.12 1.09-1.12). Among various insurance funds, Foreign Citizens had the highest risk of death both generally (adjusted OR = 2.06 1.91-2.22) and in ICU (aOR = 1.71 1.51-1.92). Increasing age groups was a risk of longer hospitalization, and the >80 age group had the highest risk for overall hospitalization period (median ratio = 1.52 1.51-1.54) and at ICU (median ratio = 1.17 1.16-1.18). Considering Tehran as the reference province, Sistan and Balcuchestan (aOR = 1.4 1.32-1.48), Alborz (aOR = 1.28 1.22-1.35), and Khorasan Razavi (aOR = 1.24 1.20-1.28) were the provinces with the highest risk of mortality in hospitalized patients.
Hospitalization data unveiled mortality and duration associations with variables, highlighting provincial outcome disparities in Iran. Using enhanced registry systems in conjunction with other studies, empowers policymakers with evidence for optimizing resource allocation and fortifying healthcare system resilience against future health challenges.
Background: According to previous reports, between 2%-5% of multiple sclerosis (MS) cases occur before the age of 16 years. Objectives: This study aims to investigate the clinical and ...epidemiological features of MS in Iranian children to provide diagnostic criteria for policymakers and physicians. Methods: This study objectives are achieved in two phases. The first phase was conducted and the second phase is underway. The first phase was performed in one year to design and finalize a pediatric MS registry software. For this reason, all variables and registration methods were determined. The second phase which has been started since 2016 consists of a routine data registry in the national phase. The project information, including all cases, epidemiological, clinical, and diagnostic factors is being reported based on different geographical areas of Iran. Results: We registered 932 cases with MS since 2017, of whom 74.4% were girls. There was no significant difference in mean age between girls and boys with MS (mean difference=0.73 years, P=0.133). Most of the children who were diagnosed were between the ages of 15 to 18 years (52.4%). Conclusions: The registry for MS in children in Iran can improve the knowledge of health policymakers on the incidence of MS in children throughout the country, the first and most common symptoms of MS in children, raising physicians’ awareness about early diagnosis and treatment that consequently reduce the economic, psychological, and psychological burden of the disease.
The burden of disease based on disability-adjusted life years (DALYs) is one of the internationally accepted metrics for assessing the impact of a disease or injury on population health. This study ...aimed to provide evidence of the burden of COVID-19 on health in Iran based on hospital-level data from the Iran Health Insurance Organization (IHIO), which covers almost half of the country's population.BACKGROUNDThe burden of disease based on disability-adjusted life years (DALYs) is one of the internationally accepted metrics for assessing the impact of a disease or injury on population health. This study aimed to provide evidence of the burden of COVID-19 on health in Iran based on hospital-level data from the Iran Health Insurance Organization (IHIO), which covers almost half of the country's population.The data of all IHIO enrollees who were referred to hospitals across the country from the beginning of the COVID-19 pandemic (February 2020) to December 30, 2021, with assigned diagnosis codes of COVID-19, were extracted from the hospital information processing system. The DALYs due to COVID-19 were estimated using the standard approach of the World Health Organization and the European Burden of Disease Network guideline.METHODSThe data of all IHIO enrollees who were referred to hospitals across the country from the beginning of the COVID-19 pandemic (February 2020) to December 30, 2021, with assigned diagnosis codes of COVID-19, were extracted from the hospital information processing system. The DALYs due to COVID-19 were estimated using the standard approach of the World Health Organization and the European Burden of Disease Network guideline.In the years 2020 and 2021, among a population of about 42 million people, 1,040,367 individuals were admitted to the hospital due to COVID-19 infection, of whom 73% were hospitalized (760,963 patients). The total estimated DALYs for these two years were 665,823 and 928,393, respectively (1,603 and 2,234 per 100,000 population). 99.7% of DALYs were attributed to years of life lost due to premature death (YLLs). The share of the disease burden in the age groups of under 20 years, 20-49 years, 50-80 years, and over 80 years was 6.6%, 26.4%, 58.4%, and 8.6%, respectively.RESULTSIn the years 2020 and 2021, among a population of about 42 million people, 1,040,367 individuals were admitted to the hospital due to COVID-19 infection, of whom 73% were hospitalized (760,963 patients). The total estimated DALYs for these two years were 665,823 and 928,393, respectively (1,603 and 2,234 per 100,000 population). 99.7% of DALYs were attributed to years of life lost due to premature death (YLLs). The share of the disease burden in the age groups of under 20 years, 20-49 years, 50-80 years, and over 80 years was 6.6%, 26.4%, 58.4%, and 8.6%, respectively.Based on the hospital-level data estimates, COVID-19 has had a significant burden on health in Iran. COVID-19 was identified as the fifth leading cause of disease burden in Iran during the study period, ranking after cardiovascular diseases, psychological disorders, neoplasms, and musculoskeletal disorders. Additionally, COVID-19 was the third major cause of death, following cardiovascular diseases and neoplasms. Policymaking and the implementation of comprehensive programs to enhance the response of the health system and society to outbreaks of emerging and re-emerging infectious diseases are of utmost importance.CONCLUSIONSBased on the hospital-level data estimates, COVID-19 has had a significant burden on health in Iran. COVID-19 was identified as the fifth leading cause of disease burden in Iran during the study period, ranking after cardiovascular diseases, psychological disorders, neoplasms, and musculoskeletal disorders. Additionally, COVID-19 was the third major cause of death, following cardiovascular diseases and neoplasms. Policymaking and the implementation of comprehensive programs to enhance the response of the health system and society to outbreaks of emerging and re-emerging infectious diseases are of utmost importance.
Concerns about the role of chronically used medications in the clinical outcomes of the coronavirus disease 2019 (COVID-19) have remarkable potential for the breakdown of non-communicable diseases ...(NCDs) management by imposing ambivalence toward medication continuation. This study aimed to investigate the association of single or combinations of chronically used medications in NCDs with clinical outcomes of COVID-19.
This retrospective study was conducted on the intersection of two databases, the Iranian COVID-19 registry and Iran Health Insurance Organization. The primary outcome was death due to COVID-19 hospitalization, and secondary outcomes included length of hospital stay, Intensive Care Unit (ICU) admission, and ventilation therapy. The Anatomical Therapeutic Chemical (ATC) classification system was used for medication grouping. The frequent pattern growth algorithm was utilized to investigate the effect of medication combinations on COVID-19 outcomes.
Aspirin with chronic use in 10.8% of hospitalized COVID-19 patients was the most frequently used medication, followed by Atorvastatin (9.2%) and Losartan (8.0%). Adrenergics in combination with corticosteroids inhalants (ACIs) with an odds ratio (OR) of 0.79 (95% confidence interval: 0.68-0.92) were the most associated medications with less chance of ventilation therapy. Oxicams had the least OR of 0.80 (0.73-0.87) for COVID-19 death, followed by ACIs 0.85 (0.77-0.95) and Biguanides 0.86 (0.82-0.91).
The chronic use of most frequently used medications for NCDs management was not associated with poor COVID-19 outcomes. Thus, when indicated, physicians need to discourage patients with NCDs from discontinuing their medications for fear of possible adverse effects on COVID-19 prognosis.
ObjectivesTo determine the effectiveness of Rituximab (RTX) therapy as the first therapeutic choice for the long-term prevention of secondary relapse in children with Autoimmue Neurological Disease ...(AIND) that had relapse after primary treatment with immunosuppressive agents other than RTX.Materials & MethodsWe conducted a single-center retrospective study of 9 consecutive pediatric patients (≤ 18 years old) registered on Autoimmune and Demyelinating Disorders Database (ADDD) of Mofid Children Hospital, from 2012 to 2016 and experienced relapse following therapeutic interventions with immunosuppressive agents other than RTX. Result A remarkable reduction of 94.13% (p=0.015) occurred in annualized relapse rate (ARR) as a clinical indicator of therapeutic efficacy comparing before and after initiating RTX therapy.Conclusion Rituximab is an effective drug in relapse prevention of AIND when administrated to patients for whom initial treatment with other immunosuppressive agents fail.POWER OF EVIDENCE: This study represents Class IV evidence that RTX therapy significantly reduces ARR in pediatric AIND including DDCNS.
Different medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and ...outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran.
We retrieved hospitalized patients' data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020-2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models.
During the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55.84% 95% CI: 55.74-55.94), corticosteroids (54.14% 54.04-54.24), and antibiotics (42.22% 42.12-42.32) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 0.94-0.95) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 95%CI, 0.73-0.76), corticosteroids (0.97 0.95-0.99), antivirals (0.82 0.80-0.83), and ACE inhibitor/ARB (0.79 0.77-0.80) were significantly associated with lower mortality.
Over 2 years of investigation, antithrombotics, corticosteroids, and antibiotics were the top medications for hospitalized patients with COVID-19. Trends in medication prescription varied based on various factors across the country. Medication prescriptions could potentially significantly impact the trends of mortality and hospitalization during epidemics, thereby affecting both health and economic burdens.
Movement disorders are common neurologic disturbances in childhood. There are two major types of movement disorders. Hypokinetic disorders are with paucity of voluntary movements and are very ...uncommon in pediatric age group. Hyperkinetic movement abnormalities are very common in children and defined as abnormal repetitive involuntary movements. Movement disorders in childhood and even in adolescents are different in etiology, timing, treatment and prognosis versus adulthood movement abnormalities. In this brief article, we reviewed common types of hyperkinetic abnormal movements in children and adolescents with emphasis on etiologies, new classifications and recent treatment strategies.
Movement disorders are common neurologic disturbances in childhood. There are two major types of movement disorders. Hypokinetic disorders are with paucity of voluntary movements and are very ...uncommon in pediatric age group. Hyperkinetic movement abnormalities are very common in children and defined as abnormal repetitive involuntary movements. Movement disorders in childhood and even in adolescents are different in etiology, timing, treatment and prognosis versus adulthood movement abnormalities. In this brief article, we reviewed common types of hyperkinetic abnormal movements in children and adolescents with emphasis on etiologies, new classifications and recent treatment strategies.
Systemic lupus erythematosus (SLE) is an autoimmune disease which involves multiple organs, including peripheral nervous system.
We describe a 12-year-old boy with progressively worsening ...neurological symptoms as first manifestation. Legs pain, loss of balance, and lower extremity weakness were the reason for his admission in neurologic ward. The patient was started on intravenous immunoglobulin therapy due to the possibility of Guillain-Barre syndrome and acute inflammatory demyelinating polyneuropathy (AIDP). However, there was no appropriate response and he developed recurrent attacks of polyneuropathy again with diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). Then, he received intravenous pulse of methylprednisolone for 5 consecutive days followed by oral prednisolone for 3 months. One month after withdrawal of corticosteroid he admitted again with the same manifestations. Rheumatologic workup revealed the presence of leukopenia, hemolytic anemia, hematuria, proteinuria, positive antinuclear antibodies, and ds-DNA antibodies. On the basis of the American College of Rheumatology and Systemic Lupus International Collaborating Clinics Classification Criteria for SLE, the patient had underlying diagnosis of SLE. Eventually, he was treated by the pulse of methylprednisolone and cyclophosphamide, and oral hydroxychloroquine and prednisolone. His neurological and physical symptoms improved and complete neurological recovery occurred several months later.
SLE and AIDP/CIDP are different entities, but ADP/CIDP can be part of the neurologic manifestations of the SLE. Although the association between AIDP/CIDP and SLE is very rare especially as a first manifestation of SLE, it should be early recognized for rapid appropriate treatment.
The inappropriate use and overprescription of antibiotics pose a global health threat, particularly contributing to antimicrobial resistance. This study aims to evaluate antibiotic prescription ...prevalence in Iranian outpatients using the defined daily doses (DDD) and Access, Watch, and Reserve classification systems.
This retrospective study analyzed electronic prescriptions for systemic antibiotics in Tehran, Iran, from March 2022 to March 2023. The data were obtained from the Iranian Health Insurance Organization and processed using the Cross-Industry Standard Process. Descriptive statistics and DDD per 1,000 inhabitants per day were calculated.
A total of 817,178 antibiotic prescriptions were analyzed, with a sex distribution of 57.43% female and a median age of 48 years. On average, each patient received 1.89 antibiotics per prescription. Over 63% of antibiotics were classified in the "Watch" category, with Azithromycin being the most commonly prescribed (27.56%). The total DDD per 1,000 inhabitants per day was 4.99, with general practitioners accounting for 58.02% of the prescriptions, primarily prescribing Azithromycin.
The study emphasizes the high use of Watch group antibiotics, indicating a need for improved prescribing practices. Education on antibiotic stewardship and stricter guidelines are necessary to combat antimicrobial resistance. Continuous monitoring is crucial to optimize antibiotic use in outpatient settings in Iran.
•Inappropriate antibiotic use leads to drug resistance and financial strain.•Azithromycin was the most frequently prescribed antibiotic.•Sixty-three percent of prescribed antibiotics belonged to the Watch category.•Targeted therapies and regular monitoring are necessary to optimize antibiotic use.•Educating prescribers on antibiotic stewardship is a priority.
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