Ghimire Laxmi V, Khanal Sagya, Torabyan Zareh, El-Rahi Hiba, Cong Catherine, Chou Fu-Sheng, Aljohani Othman A, Moon-Grady Anita J
Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco, Fresno Regional Campus, 215 N Fresno St, Fresno, CA, USA.
Nepal Medical College, Kathmandu, Nepal.
Pediatr Cardiol. 2024 Dec 26. doi: 10.1007/s00246-024-03755-8.
Unplanned admissions are associated with worse clinical outcomes and increased hospital resource utilization. We hypothesized that children with congenital heart disease (CHD) from lower-income neighborhoods have higher rates of unplanned hospital admissions and greater resource utilization. Utilizing the Kids' Inpatient Database (2016 and 2019), we included children under 21 years of age with CHD, excluding newborn hospitalizations. CHD cases were categorized into simple lesions, complex biventricular lesions, and single ventricle lesions. Admissions were classified as surgical or non-surgical. A logistic regression model assessed the risk of unplanned hospital admission, mortality, and resource utilization across different neighborhood income levels. Out of 4,722,684 admitted children (excluding newborn hospitalizations), 199,757 had CHD and met the study criteria: 121,626 with mild CHD, 61,639 with complex biventricular lesions, and 16,462 with single ventricle lesions. Surgical admissions comprised 20% (n = 39,694). In the CHD cohort, 27% had planned admissions, while 73% were unplanned. Mortality was higher in unplanned admissions compared to planned admissions (3.0 vs. 0.93%, P < 0.001). Unplanned admissions were more common in the lowest-income neighborhoods compared to the highest-income neighborhoods (adjusted odds ratio [aOR] = 1.4; 95% confidence interval [CI]: 1.3-1.5; P < 0.001), consistent across different age groups. Higher rates of unplanned admissions in the lowest-income neighborhoods were observed for each CHD category and for both medical and surgical admissions. Median hospitalization length was longer in the poorest neighborhoods compared to the wealthiest (7 days [IQR 3-21] vs. 6 days [IQR 3-17], P < 0.001). In conclusion, children with CHD residing in the lowest-income neighborhoods have increased odds of unplanned hospitalization for both surgical and non-surgical admissions, along with higher mortality and resource utilization.
非计划入院与更差的临床结局及更高的医院资源利用率相关。我们推测，来自低收入社区的先天性心脏病（CHD）患儿非计划住院率更高，资源利用率也更高。利用儿童住院数据库（2016年和2019年），我们纳入了21岁以下患有CHD的儿童，不包括新生儿住院病例。CHD病例分为简单病变、复杂双心室病变和单心室病变。入院分为手术或非手术。逻辑回归模型评估了不同社区收入水平下非计划住院、死亡率和资源利用率的风险。在4722684名入院儿童（不包括新生儿住院病例）中，199757名患有CHD并符合研究标准：121626名患有轻度CHD，61639名患有复杂双心室病变，16462名患有单心室病变。手术入院占20%（n = 39694）。在CHD队列中，27%为计划入院，73%为非计划入院。与计划入院相比，非计划入院的死亡率更高（3.0%对0.93%，P < 0.001）。与最高收入社区相比，非计划入院在最低收入社区更常见（调整优势比[aOR] = 1.4；95%置信区间[CI]：1.3 - 1.5；P < 0.001），在不同年龄组中均一致。在每个CHD类别以及医疗和手术入院中，最低收入社区的非计划入院率都更高。最贫困社区的住院中位数长度比最富裕社区更长（7天[四分位间距3 - 21]对6天[四分位间距3 - 17]，P < 0.001）。总之，居住在最低收入社区的CHD患儿手术和非手术入院的非计划住院几率增加，同时死亡率和资源利用率更高。
