Hospitalizations longer, costlier for children with juvenile dermatomyositis
Juvenile dermatomyositis increases patients’ hospital stays and inpatient cost of care, particularly among Hispanic and other non-white populations, according to data published in Pediatric Rheumatology.
“This study is important because it evaluates which children are admitted for hospitalization due to juvenile dermatomyositis and its complications, as well as assessing the associated costs of caring for these complex patients,” Kaveh Ardalan, MD, MS, of the Northwestern University Feinberg School of Medicine, told Healio Rheumatology. “We found multiple predictors of hospitalization for juvenile dermatomyositis, including higher odds of hospitalization in summertime likely due to greater ultraviolet light exposure as well as higher odds of hospitalization in more medically complex children with juvenile dermatomyositis.”
To calculate the prevalence and risk factors for hospitalization and evaluate inpatient burdens in juvenile dermatomyositis, Ardalan and colleagues reviewed data on 14,401,668 pediatric hospitalizations from the 2002 to 2012 Nationwide Inpatient Sample (NIS). Of those, the researchers analyzed 4,879,511 discharges, after eliminating live births and other connective tissue diseases.
The researchers searched the databases for primary and secondary diagnoses of juvenile dermatomyositis using the ICD-9-CM code 710.3. A control group included all hospitalizations without any diagnosis of juvenile dermatomyositis.
According to Ardalan and colleagues, there were 909 weighted admissions with a primary diagnosis and 495 with a secondary diagnosis of juvenile dermatomyositis. After multivariable logistic regression models with stepwise selection, the researchers determined that female sex (aOR = 2.22; 95% CI, 2.05-2.42), non-winter season (aOR = 1.18 [95% CI, 1.06-1.33] for autumn; aOR = 1.13 [95% CI, 1.01-1.27] for spring; and aOR = 1.53 [95% CI, 1.37-1.71] for summer), non-Medicaid administered government insurance coverage (aOR = 2.59; 95% CI, 2.26-2.97) and multiple chronic conditions were associated with higher rates of hospitalization for juvenile dermatomyositis.
In addition, the weighted total length of stay and cost of care — adjusted for inflation — for patients with a primary inpatient diagnosis of juvenile dermatomyositis was 19,159 days (geometric means = 2.5; 95% CI, 2.27-2.76) and $49,339,995 (geometric means = $7,350; 95% CI, 6228-8674). Hospitalization costs in primary juvenile dermatomyositis, as well as length of stay and cost in secondary diagnoses, were significantly higher compared with those without the disease. Non-white race or ethnicity was associated with increased length of stay and cost of care, particularly among Hispanic patients.
“Our findings are significant because they demonstrate that children with juvenile dermatomyositis who are admitted to the hospital may often have longer and costlier stays and that there may be some differences in rates of hospitalization, length of stay and cost among different children with juvenile dermatomyositis,” Ardalan said. “Even though juvenile dermatomyositis is rare, it may have an outsized impact on our health care system.” – by Jason Laday
Disclosure: Ardalan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.