Background/Purpose: Childhood rheumatic diseases (cRD) have wide spectrum of complexity and disease course from mild disease to acute fulminate disease and even sudden death. Physicians and policy makers are increasingly interested in admission rates and resource utilization of chronic illnesses. We aimed to describe temporal trends in inpatient hospitalizations and service costs for patients with cRD.

Methods: Pediatric Health Information System database was used to query children with rheumatic conditions between 2004 and 2012. Clinical variables, including age, gender, ethnicity, diagnoses, length of stay (LOS), payer type, admission costs (adjusted for hospital location then rescaled to 2012 dollar), chronic condition indicator and co-morbidity were determined. We excluded patients with LOS ≤1 day as these patients may not represent unplanned admissions.

Results: This study comprised 24,291 discharges from pediatric hospital inpatient units. There were more female (53%) than male (47%) patients. Mean age (±SD) was 7 years (±5.76 years). There was an increase in the total number of admissions and inpatient adjusted service cost during the 9 year study period (Figure 1). Linear trend for admissions and adjusted costs were significant at p=0.01 and <0.001 respectively. Lupus, vasculitis and scleroderma admissions were associated with more chronic co-morbidities and chronic diagnoses than the rest of cRD groups.

Kawasaki disease accounted for nearly half of the admissions, lupus for 21.7%, Henoch-Schonlein Purpura for 10.2%, juvenile idiopathic arthritis (JIA) for 7%, vasculitis for 5%, inflammatory myositis for 5% and scleroderma for <1%. The increase in admission rate was seen in all groups except JIA which showed small decline by 5%. The median LOS (3 days) did not change over time for all disease groups. The LOS was longer for older patients (p <0.001) and increased with number of chronic co-morbidities (p <0.001).

During the 9-year study period, the total number of inpatient admissions increased by 24% from 2,194 in 2004 to 2,715 in 2012. After rescaling to 2012 dollar, the median adjusted inpatient services cost of cRD increased by 53% and the total costs increased by 61.5% from 78 million in 2004 to 127 million in 2012. Patients with government supported insurance had higher median adjusted admission cost $25,344 compared to patients with commercial insurance $24,284.  

Conclusion: Both, rate of hospitalization and cost of admission for cRD increased over the study period of 2004 to 2012. The observed trends highlight the burden of cRD on patients, families and payers. Further research and development of management strategies to support high-value pediatric care and resource targeting is warranted to ensure patients with cRD are cared for in the most efficient manner without compromising quality. This study also reinforces the need for pediatric rheumatologists in the United States. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inpatient-pediatric-rheumatic-diseases-characteristics-cost-and-trends/