Associated comorbidities, healthcare utilization & mortality in hospitalized patients with haemophilia in the United States: Contemporary nationally representative estimates

Abstract

Introduction Current in‐hospital burden and healthcare utilization patterns for persons with haemophilia (PWH) A and B, including both children (ages < 18 years) and adults (ages ≥ 18 years), in the United States (US) are lacking. Aim To evaluate healthcare utilization, the prevalence of comorbidities, and mortality in hospitalized paediatric and adult PWH using a contemporary nationally representative cohort. Methods Hospitalizations of PWH either as the primary reason for admission (principal diagnosis) or one of all listed diagnoses were identified using ICD‐10 codes from the 2017 Nationwide Inpatient Sample (NIS), the largest publicly available all‐payer inpatient discharge database in the US. Sampling weights were applied to generate nationally representative estimates. Results The contemporary cohort included 10,555 hospitalizations (paediatrics, 18.3%; adults, 81.7%) among PWH as one‐of‐all listed diagnoses (n = 1465 as principal diagnosis). Median age (interquartile range) was 46 (24–66) years overall; adults, 54 (35–70) years and paediatric, 4 (1–11). The most common comorbidities in adults were hypertension (33.4%), hyperlipidaemia (23.6%), and diabetes (21.1%). In children, hemarthrosis (11.4%), contusions (9.6%), and central line infections (9.3%) were the most common. The overall mortality rate was 2.3%. Median hospital charges per haemophilia admission were $52,616 ($24,303–$135,814) compared to $26,841 ($12,969–$54,568) for all‐cause admissions in NIS. Conclusion Bleeding and catheter‐related infections are the significant reasons for paediatric haemophilia admissions. Adult haemophilia admissions tend to be associated with age‐related comorbidities. Costs for haemophilia‐related hospitalizations are higher than the national average for all‐cause hospitalizations.

Prevalence of selected bleeding and thrombotic events in persons with hemophilia versus the general population: A scoping review

“…One study by Day et al. [ 34 ] not included in Table 3 reported in-hospital mortality for admissions with hemophilia from 2017 and compared against all admissions. Although no numerical data are provided in that study, visual data show that mortality appears to be reduced in persons with hemophilia codiagnosed with nontraumatic ICH, acute myocardial infarction, and stroke when compared to all hospital admissions.…”

Cardiovascular Risk Factors in Patients with Congenital Hemophilia: A Focus on Hypertension

“…The life expectancy of hemophiliacs has increased due to the wide availability of replacement therapies, and the comorbidities related to aging have become present. By analyzing more than 10,000 hospitalizations of hemophiliacs, it was found that HTN ranked first among the comorbidities, with it being identified in 33.4% of the admitted patients [ 72 ]. One study showed that among the cardiovascular diseases, HTN was the most common cause of an emergency department presentation [ 75 ].…”