title: Trends and Associations in Hospitalizations Due to Corneal Ulcers in the United States, 2002-2012.
abstract: To estimate incidence, temporal trends, and factors associated with inpatient hospitalization due to corneal ulcers in the United States.
  
  
  
  Data on inpatient hospitalizations due to corneal ulcers between 2002 and 2012 were reviewed using the National Inpatient Sample. A literature review was conducted to identify the most common causes of corneal ulcers, and use of contact lenses.
  
  
  
  An estimated 19,878 patients were seen in US emergency departments for evaluation of corneal ulcers in 2012. Rates of inpatient hospitalization due to corneal ulcers remained comparable over the decade (2003: 4.9, 95% confidence interval, CI, 3.0-6.7; 2012: 2.7, 95% CI 2.2-3.3 patients per million US population). Among those hospitalized for ophthalmic disease, patients holding public or no insurance (odds ratio, OR, 1.8 and 2.5, respectively, p<0.001), from low-income neighborhoods (OR 1.6, p < 0.001), and of older age (OR 3.4, p < 0.001) were more likely to be hospitalized for corneal ulceration. Medical conditions associated with hospitalization for corneal ulcer included history of keratitis (7.7%, p < 0.001), HIV infection (2.6%, p = 0.003), history of contact lens-related complications (2.5%, p < 0.001), and history of eye injury (2.5%, p = 0.001). Patients with a history of keratitis (p = 0.006) or rheumatoid arthritis (p = 0.001) were each twice as likely to receive a corneal transplant.
  
  
  
  Factors associated with hospitalization for corneal ulcer include insurance status in addition to history of contact lens-related disease and keratitis. Efforts should be made to address these factors prior to development of severe ulcers.
authors.affiliation: a Stanford University School of Medicine , Palo Alto , CA , USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lee
authors.affiliation: a Stanford University School of Medicine , Palo Alto , CA , USA.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Manche
mesh_terms: D003261:Contact Lenses / Q000009:adverse effects; D003320:Corneal Ulcer / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology
keywords: Contact lens; corneal transplant; corneal ulcer; epidemiology; keratitis