Van Doren Bryce A, Roy Debosree, Noone Joshua M, Blanchette Christopher M, Arthur Susan T
University of North Carolina at Charlotte, NC, USA.
Drugs Context. 2015 Feb 27;4. doi: 10.7573/dic.212277. eCollection 2015.
To characterize the frequency, cost, and hospital-reported outcomes of cachexia and debility in children and adolescents with complex chronic conditions (CCCs).
We identified children and adolescents (aged ≤20 years) with CCCs, cachexia, and debility in the Kids' Inpatient Database [Healthcare Cost and Utilization Project, Agency for Healthcare Research & Quality]. We then compared the characteristics of patients and hospitalizations, including cost and duration of stay, for CCCs with and without cachexia and/or debility. We examined factors that predict risk of inpatient mortality in children and adolescents with CCCs using a logistic regression model. We examined factors that impact duration of stay and cost in children and adolescents with CCCs using negative binomial regression models. All costs are reported in US dollars in 2014 using Consumer Price Index inflation adjustment.
We estimated the incidence of hospitalization of cachexia in children and adolescents with CCCs at 1,395 discharges during the sample period, which ranged from 277 discharges in 2003 to 473 discharges in 2012. We estimated the incidence of hospitalization due to debility in children and adolescents with CCCs at 421 discharges during the sample period, which ranged from 39 discharges in 2003 to 217 discharges in 2012. Cachexia was associated with a 60% increase in the risk of inpatient mortality, whereas debility was associated with a 40% decrease in the risk of mortality. Cachexia and debility increased duration of stay in hospital (17% and 39% longer stays, respectively). Median cost of hospitalization was $15,441.59 and $23,796.16 for children and adolescents with cachexia and debility, respectively.
Incidence of hospitalization for cachexia in children and adolescents with CCCs is less than that for adults but the frequency of cachexia diagnoses increased over time. Estimates of the incidence of hospitalization with debility in children and adolescents with CCCs have not been reported, but our study demonstrates that the frequency of these discharges is also increasing.
描述患有复杂慢性病（CCC）的儿童和青少年恶病质和虚弱的发生率、成本及医院报告的结局。
我们在儿童住院数据库[医疗成本与利用项目，医疗保健研究与质量局]中识别出患有CCC、恶病质和虚弱的儿童和青少年（年龄≤20岁）。然后，我们比较了患有和未患有恶病质和/或虚弱的CCC患者的特征及住院情况，包括成本和住院时间。我们使用逻辑回归模型研究预测患有CCC的儿童和青少年住院死亡风险的因素。我们使用负二项回归模型研究影响患有CCC的儿童和青少年住院时间和成本的因素。所有成本均使用消费者价格指数通胀调整后以2014年美元报告。
我们估计在样本期间，患有CCC的儿童和青少年因恶病质住院的发生率为1395例出院，范围从2003年的277例出院到2012年的473例出院。我们估计在样本期间，患有CCC的儿童和青少年因虚弱住院的发生率为421例出院，范围从2003年的39例出院到2012年的217例出院。恶病质与住院死亡风险增加60%相关，而虚弱与死亡风险降低40%相关。恶病质和虚弱增加了住院时间（分别延长17%和39%）。患有恶病质和虚弱的儿童和青少年住院的中位数成本分别为15441.59美元和23796.16美元。
患有CCC的儿童和青少年因恶病质住院的发生率低于成人，但恶病质诊断的频率随时间增加。尚未报告患有CCC的儿童和青少年因虚弱住院发生率的估计值，但我们的研究表明这些出院的频率也在增加。
