Matched Cohort Of Children Research Articles

Long-Term Health Care Utilization After Cardiac Surgery in Children Covered Under Medicaid

BackgroundUnderstanding the longitudinal burden of health care expenditures and utilization after pediatric cardiac surgery is needed to counsel families, improve care, and reduce outcome inequities. ObjectivesThe purpose of this study was to describe and identify predictors of health care expenditures and utilization for Medicaid-insured pediatric cardiac surgical patients. MethodsAll Medicaid enrolled children age <18 years undergoing cardiac surgery in the New York State CHS-COLOUR database, from 2006 to 2019, were followed in Medicaid claims data through 2019. A matched cohort of children without cardiac surgical disease was identified as comparators. Expenditures and inpatient, primary care, subspecialist, and emergency department utilization were modeled using log-linear and Poisson regression models to assess associations between patient characteristics and outcomes. ResultsIn 5,241 New York Medicaid-enrolled children, longitudinal health care expenditures and utilization for cardiac surgical patients exceeded noncardiac surgical comparators (cardiac surgical children: $15,500 ± $62,000 per month in year 1 and $1,600 ± $9,100 per month in year 5 vs noncardiac surgical children: $700 ± $6,600 per month in year 1 and $300 ± $2,200 per month in year 5). Children after cardiac surgery spent 52.9 days in hospitals and doctors’ offices in the first postoperative year and 90.5 days over 5 years. Being Hispanic, compared with non-Hispanic White, was associated with having more emergency department visits, inpatient admissions, and subspecialist visits in years 2 to 5, but fewer primary care visits and greater 5-year mortality. ConclusionsChildren after cardiac surgery have significant longitudinal health care needs, even among those with less severe cardiac disease. Health care utilization differed by race/ethnicity, although mechanisms driving disparities should be investigated further.

The Risk of Hospitalizations with Injury Diagnoses in a Matched Cohort of Children and Adolescents with and without Attention Deficit/Hyperactivity Disorder in Germany: A Database Study

Attention deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in children and adolescents worldwide, and children with ADHD have elevated risk of injuries. Our aim was to assess the risk of hospitalizations with injury diagnoses and their various subtypes in children and adolescents with newly diagnosed ADHD compared to those without ADHD, as well as to study sex effects on this risk in the setting of the German health care system. The German Pharmacoepidemiological Research Database, in which 20 million insured from four statutory health insurances in Germany are included, was used to set up a matched cohort study of 3- to 17-year-old children and adolescents with and without ADHD. We calculated age-specific incidence rates and used Cox regression to obtain hazard ratios (HRs) for hospitalizations with injury diagnoses. We used the injury mortality diagnosis matrix for classification of injuries. The matched cohort comprised a total of 75,300 children. The age-specific incidence rates for hospitalization with injury diagnosis for males with ADHD displayed a u-shaped form with highest incidences in the in the age groups 3-6 years [26.2 per 1,000 person-years; 95% confidence interval (CI) 20.5-33.0] and 18-21 years (28.6; 22.4-36.0). Girls with ADHD were less affected in younger age-groups, but the incidence rate for 18-21 year olds was similar to boys with ADHD (26.4; 17.4-38.4). The adjusted HR for children with ADHD was 1.40 (95% CI 1.30-1.49) compared to non-affected children. With respect to nature of injury, ADHD was associated with hospitalization with injury diagnoses of the internal organs, open wounds, and contusions but not with other injuries. With respect to body regions, children with ADHD were more prone to hospitalizations with injuries of the abdomen, traumatic brain injuries, other head injuries, and system-wide injuries such as poisoning and intoxication. No significant associations were seen for the other body regions. Differences between sexes were only seen for system-wide injuries. Children and adolescents with ADHD are at an increased risk for hospitalizations with diagnoses of injuries compared to non-affected children. Despite differences in health-care systems, the risk increase is at a similar level in Germany as in other countries.

Forearm Pronation Osteotomy for Supination Contracture Secondary to Obstetrical Brachial Plexus Palsy: A Retrospective Cohort Study.

Obstetrical brachial plexus palsy can lead to fixed forearm supination contracture. Fixed supination may lead to functional deficits as the affected hand cannot be positioned optimally for activities on a desk such as writing and typing, or for using tools including utensils, which require a neutral or pronated forearm. Forearm pronation osteotomy has been used to address this problem, although the functional benefit over nonoperative management has not been clearly defined. Potentially deleterious consequences on hand function that requires supination or fine motor skills are also uncertain. Patients with fixed forearm supination contracture were selected from our institutional brachial plexus database. Those who underwent both bone forearm rotational osteotomy were analyzed for age at time of surgery, preoperative forearm resting position, active and passive supination and pronation, and preoperative function assessed by the brachial plexus outcome measure (BPOM) and active movement scale (AMS). Preoperative results were compared with values obtained at follow-up at least 12 months postoperatively. A matched cohort of children with fixed forearm supination contracture that were treated nonoperatively and followed for at least 12 months, was also selected. For this group, forearm resting position, movement, AMS, and BPOM scores were analyzed at a baseline clinic visit and the most recent follow-up. Changes in forearm resting position, AMS, and BPOM activity scale scores were then compared between groups. Records were obtained for 14 cases and 10 controls. Study groups were similar with respect to resting forearm position, hand function, and time from initial to final evaluation. Groups differed with respect to age and active supination. We observed a statistically significant change in resting position among operative patients compared with their preoperative status and compared with controls. Hand-specific AMS score did not change significantly in the operative group as compared with controls. The BPOM score for drums, reflective of function in neutral rotation to mild pronation, improved in the operated patients as compared with controls. There was no loss of plate holding ability (reflective of supination function, putty (grasp), or bead placement (fine motor) among the operated patients as compared with controls. By pronating resting forearm position by about 90 degrees to near neutral, osteotomy resulted in improved neutral to mild pronation-dependent function without loss of supination-dependent function or hand motor skills. Level III-retrospective cohort study.

A123: HLA Associations in a Matched Cohort of Juvenile Idiopathic Arthritis Children With and Without Uveitis

Background/Purpose:Studies have shown that HLA‐DRB1*8, 11 and 13 are strong risk alleles for various juvenile idiopathic arthritis (JIA) subtypes. There are few studies investigating the role of HLADRB1 alleles in children with uveitis. Our objective is to determine the association of these alleles with uveitis in a matched cohort of children with JIA and JIAassociated uveitis (JIA‐U). We will also explore associations with uveitis complications and the need for antitumor necrosis factor (TNF) agents.Methods:We matched children with JIA and JIA‐U on race, ethnicity, sex, age at arthritis diagnosis, and JIA subtype. We included Non‐Hispanic White (NHW) controls. We performed high‐resolution HLADRB1 genotyping. Odds ratios and 95% confidence intervals are presented. In some instances, exact confidence intervals and p‐value are provided due to small sample sizes.Results:There were 373 controls, 43 children with JIA‐U and 48 with JIA of whom 37 were matched. Each matched group had 29 (78.4%) females and 28 children with oligoarticular (6 extended, 22 persistent) and 9 polyarticular rheumatoid factor (RF) negative JIA.In our matched analysis comparing children with JIA‐U and JIA, there was a difference in the frequency of carriage of DRB1*11 (35.1% vs. 18.9%) and both DRB1*11 and DRB1*13 alleles (16.2% vs. 2.7%) which approached significance, reflecting our modest sample size (OR 2.32, p = 0.116 and OR 6.97, p = 0.107, respectively).In comparison with controls, children with JIA and JIA‐U had increased odds of having DRB1*8 (OR 5.54, p &lt; 0.001 and OR 9.00, p &lt; 0.001, respectively) and DRB1*13 (OR 2.38, p = 0.005 and OR 2.40, p = 0.007). Additionally, compared to controls, children with JIA and JIA‐U had greater odds of having at least one of the following: DRB1*8, 11 or 13 (OR 4.27, p &lt; 0.001 and OR 5.37, p &lt; 0.001) and DRB1*11 or 13 (OR 2.30, p = 0.006 and OR 2.29, p = 0.010). Only children with JIA‐U had increased odds of having DRB1*11 (OR = 2.22, p = 0.024), and carriage of both DRB1*11 and 13 (OR 9.92, p &lt; 0.001).No increase in allele frequency was noted with regards to ocular complications or the use of anti‐TNF agents in children with JIA‐U. Comparison of HLA‐DRB1 in children with JIA and JIA‐U HLA Configuration % OR p value Matched JIA (N = 37) vs JIA‐U (N = 37) JIA (N = 48) vs controls JIA‐U (N = 43) vs controls DRB1*8 21.6% vs. 27.0% 22.9% vs. 5.1% 32.6% vs. 5.1% OR 1.34 OR 5.54 OR 9.00 P=NS P&lt;0.001 P &lt;0.001 DRB1*11 18.9% vs. 35.1% 18.9% vs. 16.4% 30.2% vs. 16.4% OR 2.32 OR 1.18 OR 2.22 P=0.116 P=NS P=0.024 DRB1*13 54.1% vs. 54.1% 41.7% vs. 23.1% 41.9% vs. 23.1% OR 1.000 OR 2.38 OR 2.40 P=NS P=0.005 P=0.007 DRB1*8, 11 or 13 78.4% vs. 81.1% 75.0% vs. 41.3% 79.1% vs. 41.3% OR 1.18 OR 4.27 OR 5.37 P=NS P &lt;0.001 P &lt;0.001 DRB1*11 or 13 64.9% vs. 62.2% 58.3% vs. 37.8% 58.1% vs. 37.8% OR 1.12 OR 2.30 OR 2.29 P=NS P=0.006 P=0.010 DRB1*11/8 2.7% vs. 5.4% 4.2% vs. 1.1% 4.7% vs. 1.1% OR 2.06 OR 3.95 OR 4.50 P=NS P=NS P=NS DRB1*11/13 2.7% vs. 16.2% 2.1% vs. 1.6% 14.0% vs. 1.6% OR 6.97 OR 1.30 OR 9.92 P=0.107 P=NS p&lt;0.001 DRB1*13/8 2.7% vs. 5.4% 2.1% vs. 0.5% 7.0% vs. 0.5% OR 2.06 OR 3.95 OR 13.91 P=NS P=NS P=0.009 NS = not significantConclusion:This is the first matched analysis of children with JIA and JIA‐U. Carriage of both DRB1*11 and 13 appear to increase the risk for developing uveitis. Further studies should be conducted in a larger matched cohort of children with JIA, and the role of HLA in the risk for ocular complications and severe disease should be considered.