The Effect of Body Mass Index on Outcomes of In-Hospital Mortality, Hospital Utilization and Costs in Acute Kidney Injury Hospitalizations: An Analysis of the HCUP NIS Data
Issue Date
2021Keywords
Acute Kidney Injury HospitalizationBody Mass Index
HCUP NIS DATA
Hospital Cost
Hospital Utilization
Mortality
Advisor
Calhoun, ElizabethOjo, Akinlolu
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The University of Arizona.Rights
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.Embargo
Release after 06/07/2022Abstract
High and low Body Mass Index (BMI) are considered independent risk factors for mortality, longer lengths of hospital stay (LOS), and higher hospital cost compared to normal BMI even in Acute Kidney Injury patients (AKI). Race and ethnicity may play a role in modifying the outcomes. The aim of this study was to examine the relationship between BMI and all cause in-hospital mortality, hospital length of stay and hospital cost amongst AKI hospitalizations and to further assess in relation to race and ethnicity. The study used discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality from 2013 through 2017. The design was a retrospective cohort study. AKI related hospitalizations in adult patients were identified using the ICD 9-CM and ICD 10-CM revision diagnostic codes. The BMI, the exposure of interest was classified into seven categories. Interaction was assessed between BMI and race for all the outcomes. A total of 679,756 patients with AKI related hospitalizations were analyzed. Compared to BMI 19-24.9kg/m 2, the adjusted risks of in-hospital mortality were, 1.28 (95%CI: 1.23-1.33), 0.71(95%CI: 0.67, 0.74), 0.54 (95%CI: 0.51, 0.56), 0.50 (95%CI: 0.48, 0.53), 0.56 (95%CI: 0.54, 0.58), 0.68 (95%CI: 0.64, 0.70) in the BMI categories, <19, 25-29.9, 30-34.9, 35-39.9, 40-49.9 and 50&above kg/m2 respectively. The risks were significantly different in the BMI categories. The median length of hospital stays tended to be higher in the BMI < 19 kg/m2 (6 IQR: 4,10 days), and in the BMI >50 & above kg/m2 (6 IQR: 4,10 days) while the median hospital cost was highest in the > 50 kg/m2 BMI category (12,643.97 IQR:7,253.18-23,630.4 USD). Significant interactions between BMI and race were observed for mortality, LOS, and Hospital cost. This large and nationally representative sample of hospitals in the USA, provided further evidence for the obesity paradox, which whether due to plausible biological reactions or to methodological errors still remains controversial. Estimating LOS and hospital costs of AKI hospitalizations according to BMI and with race/ethnicity in view, are important to the payers of healthcare, employers, and government agencies to determine the cost effectiveness of processes and interventions that may reduce poor outcomes.Type
textElectronic Dissertation
Degree Name
Ph.D.Degree Level
doctoralDegree Program
Graduate CollegeClinical Translational Sciences
Degree Grantor
University of ArizonaCollections
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