美国成人胸膜疾病的流行病学。

Epidemiology of Adult Pleural Disease in the United States.

机构信息

Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH.

Education Institute, Cleveland Clinic Foundation, Cleveland, OH.

出版信息

Chest. 2021 Oct;160(4):1534-1551. doi: 10.1016/j.chest.2021.05.026. Epub 2021 May 20.

DOI:10.1016/j.chest.2021.05.026

PMID:34023322

Abstract

BACKGROUND

Comprehensive US epidemiologic data for adult pleural disease are not available.

RESEARCH QUESTION

What are the epidemiologic measures related to adult pleural disease in the United States?

STUDY DESIGN AND METHODS

Retrospective cohort study using Healthcare Utilization Project databases (2007-2016). Adults (≥ 18 years of age) with malignant pleural mesothelioma, malignant pleural effusion, nonmalignant pleural effusion, empyema, primary and secondary spontaneous pneumothorax, iatrogenic pneumothorax, and pleural TB were studied.

RESULTS

In 2016, ED treat-and-discharge (T&D) visits totaled 42,215, accounting for charges of $286.7 million. In 2016, a total of 361,270 hospitalizations occurred, resulting in national costs of $10.1 billion. A total of 64,174 readmissions contributed $1.16 billion in additional national costs. Nonmalignant pleural effusion constituted 85.5% of ED T&D visits, 63.5% of hospitalizations, and 66.3% of 30-day readmissions. Contemporary sex distribution (male to female ratio) in primary spontaneous pneumothorax (2.1:1) differs from older estimates (6.2:1). Decadal analyses of annual hospitalization rates/100,000 adult population (2007 vs 2016) showed a significant (P < .001) decrease for malignant pleural mesothelioma (1.3 vs 1.09, respectively), malignant pleural effusion (33.4 vs 31.9, respectively), iatrogenic pneumothorax (17.9 vs 13.9, respectively), and pleural TB (0.20 vs 0.09, respectively) and an increase for empyema (8.1 vs 11.1, respectively) and nonmalignant pleural effusion (78.1 vs 100.1, respectively). Empyema hospitalizations have high costs per case ($38,591) and length of stay (13.8 days). The mean proportion of readmissions attributed to a pleural cause varied widely: malignant pleural mesothelioma, 49%; malignant pleural effusion, 45%; nonmalignant pleural effusion, 31%; empyema, 27%; primary spontaneous pneumothorax, 27%; secondary spontaneous pneumothorax, 27%; and iatrogenic pneumothorax, 20%. Secondary spontaneous pneumothorax had the shortest time to readmission in 2016 (10.3 days, 95% CI, 8.8-11.8 days).

INTERPRETATION

Significant epidemiologic trends and changes in various pleural diseases were observed. The analysis identifies multiple opportunities for improvement in management of pleural diseases.

摘要

背景

美国尚无成人胸膜疾病的综合流行病学数据。

研究问题

美国与成人胸膜疾病相关的流行病学指标有哪些？

研究设计和方法

使用医疗保健利用项目数据库（2007-2016 年）进行回顾性队列研究。研究对象为患有恶性胸膜间皮瘤、恶性胸腔积液、非恶性胸腔积液、脓胸、原发性和继发性自发性气胸、医源性气胸和胸膜结核的成年人（≥18 岁）。

结果

2016 年，急诊科治疗后离院（T&D）就诊共 42215 例，费用 2.867 亿美元。2016 年，共有 361270 例住院治疗，导致国家花费 101 亿美元。共有 64174 例再入院，导致国家额外花费 11.6 亿美元。非恶性胸腔积液占急诊科 T&D 就诊的 85.5%、住院治疗的 63.5%和 30 天再入院的 66.3%。原发性自发性气胸的当代性别分布（男女比例）为 2.1:1，与旧的估计值（6.2:1）不同。对 2007 年和 2016 年每年每 10 万成人人群的住院率/100000 进行十年期分析，恶性胸膜间皮瘤（分别为 1.3 与 1.09）、恶性胸腔积液（分别为 33.4 与 31.9）、医源性气胸（分别为 17.9 与 13.9）和胸膜结核（分别为 0.20 与 0.09）的住院率显著下降（均 P<.001），脓胸（分别为 8.1 与 11.1）和非恶性胸腔积液（分别为 78.1 与 100.1）的住院率则显著上升。脓胸的住院治疗费用高（每个病例 38591 美元），住院时间长（13.8 天）。胸膜疾病再入院的比例差异很大：恶性胸膜间皮瘤为 49%，恶性胸腔积液为 45%，非恶性胸腔积液为 31%，脓胸为 27%，原发性自发性气胸为 27%，继发性自发性气胸为 27%，医源性气胸为 20%。2016 年，继发性自发性气胸的再入院时间最短（10.3 天，95%CI 8.8-11.8 天）。