Background/Purpose: Studies indicate that of 11% of adult hospitalizations are related to systemic lupus erythematosus (SLE), with an average charge of $10,000 US per hospitalization and a 1 in 30 chance of death (1). There are few studies describing the hospitalization experience in pediatric SLE, and no national estimates for inpatient healthcare utilization. We aimed to characterize national US trends in inpatient healthcare utilization and mortality associated with pediatric SLE.

Methods: We performed a retrospective, serial, cross-sectional analysis of a nationally representative sample of pediatric SLE patients.  Using the Kids’ Inpatient Database (KID) for years 2000, 2003, 2006 and 2009, we identified patients with SLE by an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code of 710.0 listed as a primary or secondary diagnosis. The main outcome measures were: SLE hospitalization rate, length of stay (LOS), total hospitalization charges and mortality. Patient-specific demographic variables included: age, race, sex and insurance status. Hospital-specific variables included: type (general or children’s), teaching status, location (urban or rural) and region (Northeast, Midwest, South or West). We used KID reported sampling weights to calculate national estimates of the main outcome measures and multivariate regression to evaluate for trends over time.

Results: An estimated 27,076 (SE 1509) pediatric SLE discharges were identified in the KID for the years of study, with a hospitalization rate of 7.9 per 100,000 children (SE 0.5). The median LOS was constant across years at 2 days (IQR 2,3) . The mean total charges per hospitalization (inflated to 2009 USD) were $29,304 for 2000, $36,987 for 2003, $41,664 for 2006 and $42269 for 2009. (p value for trend <0.001). Factors associated with increased total charges were: male sex (p=0.03); age>=18 years (p=0.03); Black race (p=0.02) and Hispanic ethnicity (p=0.003); urban location (p<0.001); and West region (p<0.001). The death rate during hospitalization was 1% for 2000, 1.1% for 2003, 1.2% for 2006 and 0.6% for 2009, which was statistically different across years (p=0.03). Risk factors associated with death were: male sex OR=1.6 (p=0.03), age>=18 years OR=3 (p=0.01); Black race OR=2.6 (p=0.002); other race OR=2.5 (p=0.01); South region OR=2.1 (p=0.006) and West region OR=1.8 (p=0.03).

Conclusion: The length of stay for pediatric SLE has remained stable from 2000 to 2009. Total hospital charges have significantly increased, and mortality has decreased over time, with estimates differing by age, race, sex, hospital location and region. Further studies are needed to investigate the drivers of these differences in healthcare utilization and outcomes.

1.     Krishnan E: Hospitalization and mortality of patients with systemic lupus erythematosus. J Rheumatol 2006, 33(9):1770-1774.