Shah Vrusha K, Desai Amar D, Lipner Shari R
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Rutgers New Jersey Medical School, Newark, NJ, USA.
Dermatol Pract Concept. 2024 Apr 1;14(2):e2024074. doi: 10.5826/dpc.1402a74.
Onychomycosis, a fungal nail infection, is associated with significant morbidity and negative impact on quality of life. Therefore, understanding associated risk factors may inform onychomycosis screening guidelines.
This retrospective study investigated common demographic and comorbidity risk factors among hospitalized patients using the National Inpatient Sample.
The 2003-2014 National Inpatient Sample (NIS) database was used to identify onychomycosis cases and age and sex matched controls in a 1:2 ratio. Chi-square tests and T-tests for independent samples were utilized to compare categorical and continuous patient factors. Demographic and comorbidity variables significant (P < 0.05) on univariate analysis were analyzed via a multivariate regression model with Bonferroni correction (P < 0.0029).
119,662 onychomycosis cases and 239,324 controls were identified. Compared to controls, onychomycosis patients frequently were White (69.0% versus 68.0%; P < 0.001), Black (17.9% versus 5.8%; P < 0.0001), and insured by Medicare or Medicaid (80.1% versus 71.1%; P < 0.0001). Patients had greater hospital stays (9.69 versus 5.39 days; P < 0.0001) and costs ($39,925 versus $36,720; P < 0.001) compared to controls. On multivariate analysis, onychomycosis was commonly associated with tinea pedis (odds ratio [OR]: 111.993; P < 0.0001), human immunodeficiency virus (OR: 4.372; P < 0.001), venous insufficiency (OR: 6.916; P < 0.0001), and psoriasis (OR: 3.668; P < 0.001).
Onychomycosis patients had longer hospital stays and greater costs compared to controls. Black patients were disproportionately represented among cases compared to controls. Onychomycosis was associated with tinea pedis, venous insufficiency, human immunodeficiency virus, psoriasis, obesity (body mass index [BMI] ≥ 30 kg/m), peripheral vascular disease, and diabetes with chronic complications, suggesting that inpatients with onychomycosis should be screened for these conditions.
甲癣是一种指甲真菌感染，与严重的发病率以及对生活质量的负面影响相关。因此，了解相关风险因素可能为甲癣筛查指南提供依据。
这项回顾性研究利用全国住院患者样本调查了住院患者中常见的人口统计学和合并症风险因素。
使用2003 - 2014年全国住院患者样本（NIS）数据库，以1:2的比例识别甲癣病例以及年龄和性别匹配的对照。采用卡方检验和独立样本t检验来比较分类和连续的患者因素。单因素分析中具有显著意义（P < 0.05）的人口统计学和合并症变量通过带有Bonferroni校正（P < 0.0029）的多变量回归模型进行分析。
共识别出119,662例甲癣病例和239,324例对照。与对照相比，甲癣患者多为白人（69.0%对68.0%；P < 0.001）、黑人（17.9%对5.8%；P < 0.0001），且由医疗保险或医疗补助承保（80.1%对71.1%；P < 0.0001）。与对照相比，患者的住院时间更长（9.69天对5.39天；P < 0.0001），费用更高（39,925美元对36,720美元；P < 0.001）。多变量分析显示，甲癣通常与足癣（优势比[OR]：111.993；P < 0.0001）、人类免疫缺陷病毒（OR：4.372；P < 0.001）、静脉功能不全（OR：6.916；P < 0.0001）和银屑病（OR：3.668；P < 0.001）相关。
与对照相比，甲癣患者的住院时间更长，费用更高。与对照相比，黑人患者在病例中的占比过高。甲癣与足癣、静脉功能不全、人类免疫缺陷病毒、银屑病、肥胖（体重指数[BMI]≥30 kg/m²）、外周血管疾病以及伴有慢性并发症的糖尿病相关，这表明应对甲癣住院患者进行这些疾病的筛查。
