Pardhan Salma, Mandalenakis Zacharias, Giang Kok Wai, Fedchenko Maria, Eriksson Peter, Dellborg Mikael
Institute of Health and Care Sciences, University of Gothenburg, Sweden.
Department of Biomedical Sciences, KU Leuven, Belgium.
Int J Cardiol Congenit Heart Dis. 2023 Jan 11;11:100440. doi: 10.1016/j.ijcchd.2023.100440. eCollection 2023 Mar.
Improvements in diagnosis, intervention, and care of congenital heart disease (CHD) have led to increased survivability and lifelong dependence on healthcare. This study aims to determine the extensiveness of inpatient care episodes across different life-stages and CHD severity compared to matched controls, and to explore how healthcare utilization among pediatric CHD cases have changed over time.
National registry data was used to conduct a 1:9 matching analysis with age and sex matched controls. Then, Poisson timeseries analysis was used to conduct trend analysis for inpatient healthcare utilization among pediatric cases <18 years of age.
Most CHD cases were non-complex (87.3%), with highest hospitalization rates occurring in infancy. Mean number of hospitalizations among complex cases were over twice that of non-complex cases. Also, as age progressed, mean hospitalization for non-complex cases began converging to the control population. In terms of trend analysis within this study period, healthcare utilization increased by 34% among the infant categories, but decreased by 12% and 32% among children between 1-9 years and 10-17 years, respectively. Also, utilization was not trending in one direction substantiating the claim that multiple time periods are required to assess temporal changes within this population.
Inpatient healthcare utilization among the CHD population appears to be decreasing over time in most cases, where non-complex cases transitioning to adult care are increasingly converging to the general population. Additionally, this study validates the need to use multiple time-periods when conducting longitudinal studies across the CHD population.
先天性心脏病（CHD）在诊断、干预和护理方面的改善提高了患者的生存率，且患者一生都依赖医疗保健。本研究旨在确定与匹配的对照组相比，不同生命阶段和CHD严重程度的住院护理事件的范围，并探讨小儿CHD病例的医疗保健利用率随时间的变化情况。
使用国家登记数据对年龄和性别匹配的对照组进行1:9匹配分析。然后，采用泊松时间序列分析对18岁以下小儿病例的住院医疗保健利用率进行趋势分析。
大多数CHD病例为非复杂性病例（87.3%），婴儿期的住院率最高。复杂性病例的平均住院次数是非复杂性病例的两倍多。此外，随着年龄的增长，非复杂性病例的平均住院次数开始接近对照组人群。在本研究期间的趋势分析方面，婴儿组的医疗保健利用率增加了34%，但1-9岁儿童和10-17岁儿童的利用率分别下降了12%和32%。而且，利用率并非呈单一趋势，这证实了需要多个时间段来评估该人群的时间变化这一说法。
大多数情况下，CHD人群的住院医疗保健利用率似乎在下降，其中向成人护理过渡的非复杂性病例越来越接近普通人群。此外，本研究验证了在对CHD人群进行纵向研究时使用多个时间段的必要性。
