title: The Geographic Impact on Hospitalization in Patients with Cystic Fibrosis.
abstract: OBJECTIVE
  To assess whether geographic location influences hospitalizations for pulmonary exacerbations for patients with cystic fibrosis (CF) in the US, as there is no existing literature regarding this subject.
  
  
  METHODS
  The CF Foundation Patient Registry was analyzed during the years 2007-2012 via geographic grouping of states. The impact of geographic region on recovery from hospitalization, hospitalization length, and time to next hospitalization were analyzed using multivariate models.
  
  
  RESULTS
  Posthospitalization lung function and nutritional measures were similar among regions for 1 year following hospitalization. The West region was associated with risk of longer hospital stays (OR 1.60, CI 1.45-1.77), however, dornase alfa use (OR 3.85, CI 1.15-12.92) was the only specific factor. History of allergic bronchopulmonary aspergillosis (OR 1.58, CI 1.11-2.25) and adult age (OR 2.48, CI 1.17-5.25) in the Northeast, chronic macrolide use in the South (OR 1.36, CI 1.03-1.79), and infection with Candida albicans (OR 1.47, CI 1.18-1.82) and Pseudomonas aeruginosa (OR 1.44, CI 1.02-2.04) in the Midwest were associated with increased hospitalization length. There was a significantly decreased risk for subsequent hospitalizations in the Northeast compared with other regions (P = .038). Sociodemographic analysis identified Caucasians in the South having a significantly lower risk of future hospitalization compared with African Americans (hazard ratio 0.79, CI 0.69-0.91, P = .0009).
  
  
  CONCLUSIONS
  There is significant regional variability in hospitalization length and risks for subsequent hospitalizations for patients with CF in the US. Regional variation should be subject to further study to determine if benchmarking standards can be achieved nationally.
authors.affiliation: Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH; Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, OH. Electronic address: Benjamin.Kopp@NationwideChildrens.org.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Kopp
authors.affiliation: Institute for Population Research, The Ohio State University, Columbus, OH.
authors.forename: Lisa
authors.initials: L
authors.lastname: Nicholson
authors.affiliation: Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Grace
authors.initials: G
authors.lastname: Paul
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tobias
authors.affiliation: Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Chandar
authors.initials: C
authors.lastname: Ramanathan
authors.affiliation: Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000503:physiopathology / Q000628:therapy*; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D014481:United States; D055815:Young Adult