Increased Hospital Encounters in Individuals With Spina Bifida Compared to the General Population: Statewide Health Care Utilization in California From 1995 to 2017.

Abstract

Our goal was to understand health care utilization by comparing hospital encounters among individuals with spina bifida and the general population and to identify the factors associated with utilization. Using the Department of Health Care Access and Information database (1995-2017), individuals with spina bifida were identified and matched to controls by birth year. The primary outcome measures were the number of hospital encounters (stratified as ≤2 vs ≥3 encounters) and the time between the first and second encounters. Univariate, multivariate, and subgroup analyses were performed to identify factors associated with ≥ 3 encounters. When compared to controls, individuals with spina bifida had more ≥ 3 hospital encounters (69% vs 29%), spent more days in the hospital (58 days vs 13 days), and had a higher average charge per hospital stay ($433,537 vs $99,975) (P < .001 for all). After adjusting for covariates, we found that having spina bifida was associated with increased hospital encounters compared to controls (odds ratio 3.95, 95% CI 3.77-4.14, P < .001). Individuals with spina bifida were found to have less time between their first and second encounters (2.5 vs 3.3 years, P < .001). Within the spina bifida population, sex, race, ethnicity, comorbidities, and nonprivate insurance were associated with ≥ 3 encounters. Spina bifida is associated with more hospital encounters and fewer days between first and second encounters compared to the general population. These findings highlight factors driving increased utilization of resources, thereby empowering providers to better support this vulnerable population.