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Inpatient Health Care Use Among Adult Survivors of Chronic Childhood Illnesses in the United States
Megumi J. Okumura, MD;
Andrew D. Campbell, MD;
Samya Z. Nasr, MD;
Matthew M. Davis, MD, MAPP
Arch Pediatr Adolesc Med. 2006;160:1054-1060.
Objectives To describe the inpatient length of stay and related charges for adults in the United States with childhood-onset chronic disease and to examine patterns with respect to different hospital settings.
Design We analyzed data from the 2002 Nationwide Inpatient Sample, a nationally representative data set of hospital discharges. We performed a case-mix–adjusted, sample-weighted regression analysis as well as descriptive statistics of hospital use among adults with childhood-onset chronic disease.
Setting United States.
Participants We identified hospitalizations for persons aged 18 years or older with a diagnosis of complex congenital heart disease, cystic fibrosis, sickle cell disease, or spina bifida.
Main Exposure Childhood chronic illness.
Main Outcome Measures Length of stay and total charges among pediatric, adult, and mixed hospitals.
Results In multivariate adjusted analyses, patients with complex congenital heart disease and cystic fibrosis had a significantly longer length of stay in pediatric hospitals than in adult or mixed hospitals (P<.001); no similar difference was found for sickle cell disease and spina bifida. For all of the 4 conditions, hospital charges were significantly greater in pediatric hospitals than in adult or mixed hospitals (P<.001 for cystic fibrosis, complex congenital heart disease, and sickle cell disease, and P<.01 for spina bifida).
Conclusions The vast majority of persons who have survived to adulthood with complex congenital heart disease, cystic fibrosis, spina bifida, or sickle cell disease are hospitalized in hospitals that predominantly care for adults, where charges for care appear to be lower than in pediatric hospitals.
Author Affiliations: Division of General Internal Medicine (Drs Okumura and Davis), Child Health Evaluation and Research Unit, Division of General Pediatrics (Drs Okumura and Davis), Sections of Pediatric Hematology (Dr Campbell) and Pediatric Pulmonology (Dr Nasr), Department of Pediatrics, and Gerald R. Ford School of Public Policy (Dr Davis), University of Michigan, Ann Arbor. Dr Okumura is now with the Division of General Pediatrics, University of California, San Francisco.
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