Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Dermatol. 2016 Jun 1;152(6):645-54. doi: 10.1001/jamadermatol.2015.5240.
Pemphigus is an autoimmune blistering disorder associated with significant morbidity and mortality. However, little is known about the inpatient burden of pemphigus.
To determine the incidence of and risk factors for hospitalization with pemphigus and cost of care.
DESIGN, SETTING, AND PARTICIPANTS: The 2002-2012 Nationwide Inpatient Sample provided by the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality was analyzed. A total of 87 039 711 children and adults (mean [SD] age, 57.7 [0.98] years for those with a primary diagnosis of pemphigus; 70.6 [0.32] years for those with a secondary diagnosis of pemphigus; and 47.9 [0.19] years for those without a diagnosis of pemphigus) were studied. Data analysis was performed from June 1 to August 30, 2015.
Hospitalization rates, length of stay, and cost of care.
There were 1185 and 5221 patients admitted with a primary or secondary diagnosis of pemphigus, respectively; when factoring in weights that generalize the sample to the entire hospitalized US cohort, these admissions represented weighted frequencies of 5647 and 24 880, respectively. In multivariable logistic regression models with stepwise selection, increasing age (adjusted odds ratios [95% CIs]: 18-39 years: 5.53 [4.28-7.14], P < .001; 40-59 years: 10.98 [8.46-14.24], P < .001; 60-79 years: 7.54 [5.75-9.89], P < .001; ≥80 years: 7.57 [5.71-10.04], P < .001), female sex (1.10 [1.01-1.20], P = .047), nonwhite race/ethnicity (black: 1.94 [1.75-2.14], P < .001; Hispanic: 4.10 [3.74-4.48], P < .001; Asian: 3.16 [2.68-3.73], P < .001; Native American: 2.11 [1.45-3.08], P < .001), lower household income (quartile 2: 1.19 [1.07-1.32], P < .001), being insured with Medicare (1.56 [1.41-1.74], P < .001) or Medicaid (1.55 [1.39-1.73], P < .001), number of chronic conditions (2-5: 2.36 [2.10-2.65], P < .001; ≥6: 1.47 [1.29-1.69], P < .001), hospital location in a metropolitan area (not metropolitan or micropolitan: 0.60 [0.49-0.72], P < .001), and summer season (1.12 [1.02-1.23], P = .02) were all associated with hospitalization for pemphigus. The total inflation-adjusted cost of care for patients with a primary inpatient diagnosis of pemphigus was $74 466 305, with a mean (SD) annual cost of $14 520.93 ($913.22). The inflation-adjusted cost of care for patients with a primary diagnosis of pemphigus increased significantly from 2002 to 2012 (analysis of variance, P < .001). In particular, length of stay was higher in racial/ethnic minorities compared with whites (survey linear regression, log β [95% CI]: black: 0.076 [0.075-0.076]; Hispanic: 0.021 [0.021-0.022]; Asian: 0.037 [0.036-0.039]; Native American: 0.010 [0.0076-0.013]), lower quartile household income (quartile 1: 0.024 [0.023-0.024]; quartile 2: 0.0029 [0.0022-0.0035]), and those without private insurance (Medicare: 0.12 [0.12-0.12]; Medicaid: 0.082 [0.081-0.083]; no charge: 0.051 [0.047-0.055]).
There is a significant inpatient burden for pemphigus in the United States. Moreover, there appear to be racial/ethnic and health care disparities with respect to pemphigus, such that poor, nonwhite, and/or uninsured or underinsured patients have higher odds of hospitalization.
天疱疮是一种自身免疫性水疱性疾病，与显著的发病率和死亡率相关。然而，关于天疱疮的住院负担知之甚少。
确定天疱疮住院的发生率和相关风险因素以及治疗费用。
设计、地点和参与者：利用医疗保健成本和利用项目（Agency for Healthcare Research and Quality）提供的 2002-2012 年全国住院患者样本（Nationwide Inpatient Sample）进行分析。共纳入 87 039 711 名儿童和成人（天疱疮原发性诊断患者的平均[标准差]年龄为 57.7[0.98]岁；天疱疮次发性诊断患者为 70.6[0.32]岁；无天疱疮诊断的患者为 47.9[0.19]岁）。数据分析于 2015 年 6 月 1 日至 8 月 30 日进行。
住院率、住院时间和治疗费用。
原发性或次发性天疱疮患者分别有 1185 例和 5221 例住院，经权重（将样本推广到整个住院美国队列）后，这些住院人数分别为 5647 例和 24 880 例。在逐步选择的多变量逻辑回归模型中，年龄增长（校正优势比[95%CI]：18-39 岁：5.53[4.28-7.14]，P<0.001；40-59 岁：10.98[8.46-14.24]，P<0.001；60-79 岁：7.54[5.75-9.89]，P<0.001；≥80 岁：7.57[5.71-10.04]，P<0.001）、女性性别（1.10[1.01-1.20]，P=0.047）、非白人种族/民族（黑人：1.94[1.75-2.14]，P<0.001；西班牙裔：4.10[3.74-4.48]，P<0.001；亚裔：3.16[2.68-3.73]，P<0.001；美洲原住民：2.11[1.45-3.08]，P<0.001）、较低的家庭收入（四分位数 2：1.19[1.07-1.32]，P<0.001）、医疗保险（Medicare：1.56[1.41-1.74]，P<0.001）或医疗补助（Medicaid：1.55[1.39-1.73]，P<0.001）、合并慢性疾病数量（2-5 种：2.36[2.10-2.65]，P<0.001；≥6 种：1.47[1.29-1.69]，P<0.001）、医院位于大都市地区（非大都市或微都市：0.60[0.49-0.72]，P<0.001）和夏季（1.12[1.02-1.23]，P=0.02）与天疱疮住院相关。原发性天疱疮住院患者的总通胀调整治疗费用为 74 466 305 美元，平均每年治疗费用为 14 520.93 美元（913.22 美元）。2002 年至 2012 年，原发性天疱疮患者的通胀调整治疗费用显著增加（方差分析，P<0.001）。特别是，与白人相比，少数族裔（黑人：0.076[0.075-0.076]；西班牙裔：0.021[0.021-0.022]；亚裔：0.037[0.036-0.039]；美洲原住民：0.010[0.0076-0.013]）、收入较低的家庭（四分位数 1：0.024[0.023-0.024]；四分位数 2：0.0029[0.0022-0.0035]）和没有私人保险（医疗保险：1.2[1.2-1.2]；医疗补助：0.082[0.081-0.083]；免费：0.051[0.047-0.055]）的患者住院时间更长。
美国的天疱疮住院负担很大。此外，天疱疮似乎存在种族/民族和医疗保健差异，即贫困、非白人、以及/或者没有保险或保险不足的患者住院的可能性更高。
