Several Reasons Identified for Hospital Admissions for Adult and Pediatric Patients With Hemophilia

New research shows that there are vastly different causes for hospitalization between adult and pediatric patients with haemophilia A or B.

A team, led by Jonathan R. Day, Department of Internal Medicine, University of Iowa Carver College of Medicine, evaluated health care utilization, prevalence of comorbidities, and mortality in hospitalized pediatric and adult patients with hemophilia.

There continues to be a need for a better understanding of the hospital burden and the patterns of care use for patients with haemophilia A and B. This is especially true for pediatric patients.

Adult and Pediatric Patients

In the contemporary nationally representative cohort, the researchers examined patients admitted to hospital with haemophilia as the primary reason for admission or 1 of all diagnoses listed. They did this using ICD-10 codes from the 2017 Nationwide Inpatient Sample, the largest publicly available hospital discharge database for all payers in the US.

The sample weights have been applied to generate nationally representative estimates.

A total of 10,555 hospitalized patients were identified, 18.3% were pediatric patients and 81.7% were adult patients with haemophilia listed as a general diagnosis. There were also 1465 patients with hemophilia as the primary diagnosis. The median age of the patient population was 46 years, but 54 years for adults and 4 years for pediatric patients.

In addition, there were 8690 patients enrolled in the study with haemophilia A and 1975 patients with haemophilia B.

Comorbidities

For adult patients, the most common comorbidities were hypertension (33.4%), hyperlipidemia (23.6%) and diabetes (21.1%). For the pediatric patients, the most common comorbidities were haemarthrosis (11.4%). Bruising (9.6%) and central line infections (9.3%).

The mortality rate of the entire patient population was 2.3% (95% CI, 1.7-3.1%) and the median age at death was 68 years, which was less than the clinical mortality age of 73 years for all hospitalizations (P <. 05).

Cost

The researchers also found financial information for the patients.

The median hospital costs for patients admitted for hemophilia were $52,616 ($24,303-$135,814), which was nearly double the median hospital costs for all-cause admissions ($26,841; $12,969-$54,568) in the NOS.

The researchers also found that the rate of pediatric hospitalizations with clinical mortality was below the HCUP reportable limit, with respiratory failure (67.3 ± 5.2%), acute renal failure (65.3 ± 4.9%), the most common diagnoses. associated with in-hospital mortality. and sepsis (49.0 ± 5.1%).

“Haemorrhage and catheter-related infections are the leading reasons for pediatric hemophilia admissions,” the authors wrote. “Adult haemophilia admissions are often associated with age-related comorbidities. The costs for haemophilia-related hospitalizations are higher than the national average for all-cause hospitalizations.”

Currently, hemophilia A affects 1 in 5,000 men, while hemophilia B affects 1 in 30,000 men in the US. According to the US Centers for Disease Control & Prevention (CDC), approximately 33,000 patients with hemophilia A and B currently live in the US.

The study, “Associated comorbidities, health care utilization, and mortality in hospitalized patients with hemophilia in the United States: Contemporary Nationally Representative Estimates,” was published online in Hemophilia.