Abstract
Objectives: The status of children with comorbid congenital anomalies (CAs) and their effects on related hospital resource utilization have been minimally investigated. We aimed to describe the congenital anomalies comorbidity status and their effects on hospital resource utilization (length of stay, cost) by pediatric patients.Setting: This study was conducted in five tertiary care children's hospitals in Shanghai, China.Participants: Data were obtained from the inpatients' electronic health records; diagnoses were recorded using International Classification of Disease, Ninth Revision codes. In total, 7,890 children were diagnosed with congenital anomalies (13.13%), which were either primary or secondary.Primary and secondary outcome measures: The dependent variables were length of stay and cost. The independent variables were demographic and clinical characteristics and CA status.Results: In total, 50.98% of the hospitalized patients had comorbid CA conditions. Medical+CA patients were associated with a longer LOS (β = 2.656, P < 0.001), and CA+medical patients were associated with higher costs (β = 7.222, P < 0.001). Cardiovascular, musculoskeletal, and genitourinary diseases were the top three comorbid diseases. The average LOS for the top three comorbid diseases was longest in the medical+CA group, followed by CA+medical group. Cardiovascular disease was the most frequent comorbidity (ranking 1 in the medical+CA group and 2 in the CA+medical group), and the cost of cardiovascular disease was highest in all groups.Conclusions: A high prevalence of comorbid CA conditions was observed among pediatric inpatients in the sampled tertiary hospitals in China. Strategic planning should be improved to guide resource utilization for complex comorbid CA care.
Highlights
Due to the tremendous progress in prenatal diagnosis and improvements in health care services brought about by increased focus on primary health care, there has been a significant reduction in infant and childhood mortality rates in most countries over the past two decades [1,2,3,4]
542 (6.87%) were categorized into the medical+congenital anomalies (CAs) group, 3,480 (44.11%) were in the CA+medical group, and 3,868 (49.02%) were in the CA-only group; 50.98% of the hospitalized patients presented with a comorbid CA condition
Studies have revealed that in developing countries, including China, exposure of women to air pollutants such as sulfur dioxide, nitrogen dioxide, ozone, and particulate matter (PM) during pregnancy increases the risk of congenital heart disease (CHD) and other birth defects in infants [22, 23]
Summary
Due to the tremendous progress in prenatal diagnosis and improvements in health care services brought about by increased focus on primary health care, there has been a significant reduction in infant and childhood mortality rates in most countries over the past two decades [1,2,3,4]. Empirical studies in developed countries have begun to focus on the very large hospital resource utilization of patients with CAs. For instance, in the U.S, based on a 20% stratified sample of discharges from nonfederal community hospitals in 2013, Arth et al [11] estimated the annual cost of birth defect-associated hospitalizations in the U.S and found that these conditions had disproportionately high costs, accounting for 3.0% of all hospitalizations and 5.2% of total hospital costs. In China, by using the CHD inpatient database (2007–2012) from all secondary and tertiary hospitals in Beijing, China, Cui [13] found that inpatients with severe CHD had a longer LOS and higher average cost than those with mild conditions
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