Sakai-Bizmark Rie, Webber Eliza J, Marr Emily H, Mena Laurie A, Chang Ruey-Kang R
1Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center,Torrance,CA,USA.
Cardiol Young. 2019 Mar;29(3):344-354. doi: 10.1017/S1047951118002421.
This study investigated patient characteristics in paediatric hospitalisations for hypertrophic cardiomyopathy. We used Nationwide Inpatient Sample, which is the largest all-payer inpatient database in the United States, yielding nationally representative estimates, from 2001 to 2014. ICD-9-CM diagnostic codes identified hospitalisations for patients with hypertrophic cardiomyopathy and <18 years. Outcomes included yearly rate of hospitalisation, death, admission via emergency department, and need for surgery. Predictors of interest were age groups (<1, 1-9, and ⩾10 y/o), sex, and race/ethnicity. Logistic regression modelled associations, adjusted by patient- and hospital-level variables. With 2302 weighted hospitalisations, hospitalisation rates were 0.22 per 100,000 children/year, with higher rates for <1 y/o (0.42) and ⩾10 y/o (0.31). Male-to-female ratios were more prominent in the oldest age group; 2.7:1 in ⩾10 y/o versus less than 1.7:1 for <10 y/o. In-hospital mortality was 1.5%, with highest mortality rates among the <1 y/o (6.3%). Children ⩾10 y/o had 5.59 times higher risk of admission from the emergency department than 1-9 y/o age group. Both ⩾10 and <1 y/o age groups had lower risk of surgical intervention compared to the 1-9 y/o group with odds ratio 0.56 and 0.26, respectively. Black children had higher risk of admission from the emergency department than White children with odds ratio 2.78. A relation between age group and sex was observed, with sex-based differences in prevalence and treatment of hypertrophic cardiomyopathy becoming more pronounced with age. Further studies are needed to clarify mechanisms behind age and racial disparity in hospitalisation, especially admission source.
本研究调查了肥厚型心肌病患儿住院的患者特征。我们使用了全国住院患者样本,它是美国最大的全付费者住院数据库,可得出2001年至2014年具有全国代表性的估计数据。国际疾病分类第九版临床修订本(ICD - 9 - CM)诊断代码确定了年龄小于18岁的肥厚型心肌病患者的住院情况。结局指标包括年住院率、死亡率、通过急诊科入院情况以及手术需求。感兴趣的预测因素为年龄组(小于1岁、1 - 9岁和≥10岁)、性别以及种族/民族。逻辑回归模型分析了关联,并根据患者和医院层面的变量进行了调整。在2302例加权住院病例中,住院率为每100,000名儿童/年0.22例,其中小于1岁(0.42)和≥10岁(0.31)的儿童住院率更高。男女比例在年龄最大的组中更为显著;≥10岁组为2.7:1,而小于10岁组小于1.7:1。住院死亡率为1.5%,其中小于1岁组的死亡率最高(6.3%)。≥10岁的儿童通过急诊科入院的风险比1 - 9岁年龄组高5.59倍。与1 - 9岁组相比,≥10岁和小于1岁年龄组的手术干预风险较低,优势比分别为0.56和0.26。黑人儿童通过急诊科入院的风险比白人儿童高,优势比为2.78。观察到年龄组与性别之间存在关联,肥厚型心肌病的患病率和治疗方面基于性别的差异随年龄增长而更加明显。需要进一步研究以阐明住院方面年龄和种族差异背后的机制,尤其是入院来源。