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February 04, 2014; 82 (5) Article

Burden of encephalitis-associated hospitalizations in the United States, 1998–2010

Neil M. Vora, Robert C. Holman, Jason M. Mehal, Claudia A. Steiner, Jesse Blanton, James Sejvar
First published January 2, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000086
Neil M. Vora
From the Epidemic Intelligence Service (N.M.V.) and Division of High-Consequence Pathogens and Pathology (N.M.V., R.C.H., J.M.M., J.B., J.S.), Centers for Disease Control and Prevention, Atlanta, GA; and Healthcare Cost and Utilization Project (C.A.S.), Center for Delivery, Organizations, and Markets, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD.
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Robert C. Holman
From the Epidemic Intelligence Service (N.M.V.) and Division of High-Consequence Pathogens and Pathology (N.M.V., R.C.H., J.M.M., J.B., J.S.), Centers for Disease Control and Prevention, Atlanta, GA; and Healthcare Cost and Utilization Project (C.A.S.), Center for Delivery, Organizations, and Markets, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD.
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Jason M. Mehal
From the Epidemic Intelligence Service (N.M.V.) and Division of High-Consequence Pathogens and Pathology (N.M.V., R.C.H., J.M.M., J.B., J.S.), Centers for Disease Control and Prevention, Atlanta, GA; and Healthcare Cost and Utilization Project (C.A.S.), Center for Delivery, Organizations, and Markets, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD.
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Claudia A. Steiner
From the Epidemic Intelligence Service (N.M.V.) and Division of High-Consequence Pathogens and Pathology (N.M.V., R.C.H., J.M.M., J.B., J.S.), Centers for Disease Control and Prevention, Atlanta, GA; and Healthcare Cost and Utilization Project (C.A.S.), Center for Delivery, Organizations, and Markets, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD.
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Jesse Blanton
From the Epidemic Intelligence Service (N.M.V.) and Division of High-Consequence Pathogens and Pathology (N.M.V., R.C.H., J.M.M., J.B., J.S.), Centers for Disease Control and Prevention, Atlanta, GA; and Healthcare Cost and Utilization Project (C.A.S.), Center for Delivery, Organizations, and Markets, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD.
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James Sejvar
From the Epidemic Intelligence Service (N.M.V.) and Division of High-Consequence Pathogens and Pathology (N.M.V., R.C.H., J.M.M., J.B., J.S.), Centers for Disease Control and Prevention, Atlanta, GA; and Healthcare Cost and Utilization Project (C.A.S.), Center for Delivery, Organizations, and Markets, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD.
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Citation
Burden of encephalitis-associated hospitalizations in the United States, 1998–2010
Neil M. Vora, Robert C. Holman, Jason M. Mehal, Claudia A. Steiner, Jesse Blanton, James Sejvar
Neurology Feb 2014, 82 (5) 443-451; DOI: 10.1212/WNL.0000000000000086

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Abstract

Objective: To estimate the burden of encephalitis-associated hospitalizations in the United States for 1998–2010.

Methods: Using the Nationwide Inpatient Sample, a nationally representative database of hospitalizations, estimated numbers and rates of encephalitis-associated hospitalizations for 1998–2010 were calculated. Etiology and outcome of encephalitis-associated hospitalizations were examined, as well as accompanying diagnoses listed along with encephalitis on the discharge records. Total hospital charges (in 2010 US dollars) were assessed.

Results: An estimated 263,352 (standard error: 3,017) encephalitis-associated hospitalizations occurred in the United States during 1998–2010, which corresponds to an average of 20,258 (standard error: 232) encephalitis-associated hospitalizations per year. A fatal outcome occurred in 5.8% (95% confidence interval [CI]: 5.6%–6.0%) of all encephalitis-associated hospitalizations and in 10.1% (95% CI: 9.2%–11.2%) and 17.1% (95% CI: 14.6%–20.0%) of encephalitis-associated hospitalizations in which a code for HIV or a tissue or organ transplant was listed, respectively. The proportion of encephalitis-associated hospitalizations in which an etiology for encephalitis was specified was 50.3% (95% CI: 49.6%–51.0%) and that for which the etiology was unspecified was 49.7% (95% CI: 49.0%–50.4%). Total charges for encephalitis-associated hospitalizations in 2010 were an estimated $2.0 billion.

Conclusions: Encephalitis remains a major public health concern in the United States. Among the large number of encephalitis-associated hospitalizations for which an etiology is not reported may be novel infectious and noninfectious forms of encephalitis. Associated conditions such as HIV or transplantation increase the risk of a fatal outcome from an encephalitis-associated hospitalization and should be monitored.

GLOSSARY

CI=
confidence interval;
ICD-9-CM=
International Classification of Diseases, ninth revision, Clinical Modification;
IQR=
interquartile range;
NIS=
Nationwide Inpatient Sample;
RR=
rate ratio;
SE=
standard error;
WNV=
West Nile virus

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received July 8, 2013.
  • Accepted in final form October 23, 2013.
  • © 2014 American Academy of Neurology
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