Showing papers by "Susan D. Hillis published in 2008"

An Enhanced Method for Identifying Obstetric Deliveries: Implications for Estimating Maternal Morbidity

Abstract: Objectives The accuracy of maternal morbidity estimates from hospital discharge data may be influenced by incomplete identification of deliveries. In maternal/infant health studies, obstetric deliveries are often identified only by the maternal outcome of delivery code (International Classification of Diseases code = V27). We developed an enhanced delivery identification method based on additional delivery-related codes and compared the performance of the enhanced method with the V27 method in identifying estimates of deliveries as well as estimates of maternal morbidity. Methods The enhanced and standard V27 methods for identifying deliveries were applied to data from the 1998–2004 Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationwide representative survey of U.S. hospitalizations. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to examine predictors of deliveries not identified using the V27 method. Results The enhanced method identified 958,868 (3.4%) more deliveries than the 27,128,539 identified using the V27 code alone. Severe complications including major puerperal infections (OR = 3.1, 95% CI 2.8–3.4), hysterectomy (OR = 6.0, 95% CI 5.3–6.8), sepsis (OR = 11.9, 95% CI 10.3–13.6) and respiratory distress syndrome (OR = 16.6, 95% CI 14.4–19.2) were strongly associated with deliveries not identified by the V27 method. Nationwide prevalence rates of severe maternal complications were underestimated with the V27 method compared to the enhanced method, ranging from 9% underestimation for major puerperal infections to 40% underestimation for respiratory distress syndrome. Conclusion Deliveries with severe obstetric complications may be more likely to be missed using the V27 code. Researchers should be aware that selecting deliveries from hospital stay records by V27 codes alone may affect the accuracy of their findings.

Inpatient Hysterectomy Surveillance in the United States, 2000-2004

Abstract: More than a half million hysterectomies are done each year in the United States, where an estimated 20 million women have had the operation. Although effective in relieving symptoms caused by benign gynecological disorders, concern persists about possible adverse outcomes such as incontinence, diminished sexual function, and earlier menopause. There also is concern that too many hysterectomies are being performed. This study was an attempt to define recent trends in the rate of hysterectomy and indications for its use. Data on hysterectomy hospitalizations in the years 2000-2004 were taken from the National Hospital Discharge Survey. The overall rate of hysterectomy during the 5-year period under review was 5.4 per 1000 women per year. During this period, there was a small but statistically significant decline in the rate from 5.4 to 5.1 per 1000. Just over two-thirds of operations (67.9%) were done abdominally, and this figure remained stable during the study period. Nearly one-third of vaginal hysterectomies were done laparoscopically. The only substantial change in hysterectomy rates was a decrease in women aged 50 to 54 years. Geographic changes were seen, with the highest rate for women living in the South and the lowest for those in the Northeast. The most common indication for hysterectomy was uterine leiomyoma. The proportion of operations done for this reason decreased from 44.2% in 2000 to 38.7% in 2004. Bilateral oophorectomy accompanied 54% of hysterectomies; this figure declined from 55.1% in 2000 to 49.5% in 2004.

Methamphetamine Use Is Independently Associated With Recent Risky Sexual Behaviors and Adolescent Pregnancy

Abstract: BACKGROUND: Lifetime methamphetamine use among adolescents is estimated to be between 5% and 10%. Youth substance use in general is known to be associated with risky sexual behaviors, but the effect of methamphetamine use on recent risky sexual behaviors and adolescent pregnancy has received little attention. The purpose of this analysis was to evaluate the association between lifetime methamphetamine use and recent (past 3 months) risky sexual behaviors and lifetime adolescent pregnancy, adjusting for other substance use. METHODS: We analyzed data from the 2003 National Youth Risk Behavior Survey, a school-based paper-and-pencil survey that assesses risky health behaviors among a nationally representative sample of 9th- to 12th-grade students. Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) to examine the association between methamphetamine use and being recently sexually active, having 2 or more recent sex partners, and ever being pregnant or getting someone pregnant. RESULTS: Lifetime methamphetamine use was reported by 7.6% of students. After adjustment for demographic covariates and lifetime use of cigarettes, alcohol, marijuana, and other illicit drugs, lifetime methamphetamine use was associated with recent sexual intercourse (AOR = 1.8, 95% confidence interval [CI] = 1.5-2.3), having 2 or more recent sex partners (AOR = 3.0, 95% CI = 2.2-4.2), and ever being pregnant or getting someone pregnant (AOR = 2.9, 95% CI = 2.1-3.9). CONCLUSIONS: Adolescent methamphetamine use is common and is associated with recent risky sexual behaviors and adolescent pregnancy. Prevention strategies for high school students should integrate education on substance abuse, pregnancy, sexually transmitted infections, and human immunodeficiency virus.