美国皮肌炎成年患者住院、住院时长及护理费用的预测因素

Predictors of Hospitalization, Length of Stay, and Cost of Care Among Adults With Dermatomyositis in the United States.

作者信息

Kwa Michael C, Ardalan Kaveh, Laumann Anne E, Silverberg Jonathan I

机构信息

Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois.

出版信息

Arthritis Care Res (Hoboken). 2017 Sep;69(9):1391-1399. doi: 10.1002/acr.23190. Epub 2017 Aug 8.

DOI:10.1002/acr.23190

PMID:28556622

Abstract

OBJECTIVE

To determine the prevalence and risk factors for hospitalization with dermatomyositis and assess inpatient burden of dermatomyositis.

METHODS

Data on 72,651,487 hospitalizations from the 2002-2012 Nationwide Inpatient Sample, a 20% stratified sample of all acute-care hospitalizations in the US, were analyzed. International Classification of Diseases, Ninth Revision, Clinical Modification coding was used to identify hospitalizations with a diagnosis of dermatomyositis.

RESULTS

There were 9,687 and 43,188 weighted admissions with a primary or secondary diagnosis of dermatomyositis, respectively. In multivariable logistic regression models with stepwise selection, female sex (logistic regression: adjusted odds ratio 2.05 [95% confidence interval (95% CI) 1.80, 2.34]), nonwhite race (African American: 1.68 [1.57, 1.79]; Hispanic: 2.38 [2.22, 2.55]; Asian: 1.54 [1.32, 1.81]; and multiracial/other: 1.65 [1.45, 1.88]), and multiple chronic conditions (2-5: 2.39 [2.20, 2.60] and ≥6: 2.80 [2.56, 3.07]) were all associated with higher rates of hospitalization for dermatomyositis. The weighted total length of stay (LOS) and inflation-adjusted cost of care for patients with a primary inpatient diagnosis of dermatomyositis was 80,686 days and $168,076,970, with geometric means of 5.38 (95% CI 5.08, 5.71) and $11,682 (95% CI $11,013, $12,392), respectively. LOS and costs of hospitalization were significantly higher in patients with dermatomyositis compared to those without. Notably, race/ethnicity was associated with increased LOS (log-linear regression: adjusted β [95% CI] for African American: 0.14 [0.04, 0.25] and Asian: 0.38 [0.22, 0.55]) and cost of care (Asian: 0.51 [0.36, 0.67]).

CONCLUSION

There is a significant and increasing inpatient burden for dermatomyositis in the US. There appear to be racial differences, as nonwhites have higher prevalence of admission, increased LOS, and cost of care.

摘要

目的

确定皮肌炎住院的患病率和危险因素，并评估皮肌炎患者的住院负担。

方法

分析了2002年至2012年全国住院患者样本中的72651487例住院数据，该样本是美国所有急性护理住院患者的20%分层样本。使用国际疾病分类第九版临床修订本编码来识别诊断为皮肌炎的住院病例。

结果

分别有9687例和43188例加权入院病例，其主要或次要诊断为皮肌炎。在采用逐步选择法的多变量逻辑回归模型中，女性（逻辑回归：调整后的优势比为2.05 [95%置信区间（95%CI）1.80，2.34]）、非白人种族（非裔美国人：1.68 [1.57，1.79]；西班牙裔：2.38 [2.22，2.55]；亚裔：1.54 [1.32，1.81]；多种族/其他：1.65 [1.45，1.88]）以及多种慢性病（2 - 5种：2.39 [2.20，2.60]，≥6种：2.80 [2.56，3.07]）均与皮肌炎住院率较高相关。主要住院诊断为皮肌炎的患者加权总住院时长（LOS）和通胀调整后的护理费用分别为80686天和168076970美元，几何平均数分别为5.38（95%CI 5.08，5.71）和11682美元（95%CI 11013美元，12392美元）。与未患皮肌炎的患者相比，皮肌炎患者的住院时长和住院费用显著更高。值得注意的是，种族/族裔与住院时长增加（对数线性回归：非裔美国人调整后的β[95%CI]为0.14 [0.04，0.25]，亚裔为0.38 [0.22，0.55]）和护理费用增加（亚裔：0.51 [0.36，0.67]）相关。