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

Jonathan Day, MD

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

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

There remains a need to better understand the in-hospital burden and healthcare utilization patterns for patients with hemophilia A and B. This is particularly true for pediatric patients.

Adult and Pediatric Patients

In the contemporary nationally representative cohort, the investigators examined patients hospitalized with hemophilia either as the primary reason for admission or 1 of all the listed diagnoses. They did so using ICD-10 codes from the 2017 Nationwide Inpatient Sample, which is the largest publicly available all-payer inpatient discharge database in the US.

The sampling weights were applied to generate nationally representative estimates.

Overall, there were 10,555 hospitalized patients identified, 18.3% were pediatric patients and 81.7% were adult patients with hemophilia listed as a one-of-all diagnosis. There were also 1465 patients with hemophilia as the principal 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 included in the study with hemophilia A and 1975 patients with hemophilia B.

Comorbidities

For adult patients, the most common comorbities were hypertension (33.4%), hyperlipidemia (23.6%), and diabetes (21.1%). For the pediatric patients, the most common comorbidities were hemarthrosis (11.4%). Contusions (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 younger than the age for inpatient mortality of 73 years for all hospitalizations (P <.05).

Costs

The investigators also found financial information for the patients.

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

The investigators also found the number of pediatric hospitalizations with inpatient mortality was below the HCUP reportable limit, with the most common diagnoses linked to in-hospital mortality being respiratory failure (67.3 ± 5.2%), acute renal failure (65.3 ± 4.9%), and sepsis (49.0 ± 5.1%).

“Bleeding and catheter-related infections are the significant reasons for pediatric hemophilia admissions,” the authors wrote. “Adult hemophilia admissions tend to be associated with age-related comorbidities. Costs for hemophilia-related hospitalizations are higher than the national average for all-cause hospitalizations.”

Currently, hemophilia A affects 1 in 5000 males, while hemophilia B affects 1 in 30,000 males in the US. There are approximately 33,000 patients with hemophilia A and B currently living in the US, according to the US Centers for Disease Control & Prevention (CDC).

The study, “Associated comorbidities, healthcare utilization & mortality in hospitalized patients with hemophilia in the United States: Contemporary nationally representative estimates,” was published online in Hemophilia.