National trends in pediatric systemic lupus erythematosus hospitalization in the United States: 2000-2009

Abstract

Objective: In the setting of recent healthcare advances and emphasis on reduced spending, we aimed to characterize US trends in inpatient healthcare use and mortality for pediatric systemic lupus erythematosus (SLE).

Methods: We performed a retrospective, serial, cross-sectional analysis of the national Kids' Inpatient Database (for 2000, 2003, 2006, and 2009). We identified patients with SLE aged 2 to 21 years using an International Classification of Diseases, 9th revision (ICD-9) code of 710.0 listed as a discharge diagnosis. Using sampling weights, we estimated trends in hospitalization, inpatient mortality, procedure rates, and length of stay (LOS). We analyzed patient and hospital-specific risk factors for mortality and LOS, and compared those outcomes to those without SLE.

Results: We identified 26,903 estimated pediatric SLE hospitalizations. The hospitalization rate of 8.6 (95% CI 7.6-9.6) per 100,000 population and mean LOS of 5.9 days (95% CI 5.6-6.2) were stable over time. We found a significant downward trend in mortality, decreasing from 1% to 0.6% (p = 0.04), which paralleled a less pronounced trend for those without SLE. The rate of dialysis, blood transfusions, and vascular catheterization procedures increased. Patients with SLE nephritis and non-white race were at risk for increased healthcare use and death.

Conclusion: Pediatric SLE hospitalization rate and LOS remained stable, but inpatient mortality decreased as the rate of common therapeutic procedures increased. More research is needed to understand the drivers of these relationships.

Keywords: HOSPITALIZATION; LENGTH OF STAY; MORTALITY; PEDIATRIC; SYSTEMIC LUPUS ERYTHEMATOSUS.

Figure 1

Inpatient mortality for children and adolescents with a diagnosis of SLE showed a statistically significant decrease over the years of study (OR=0.95, 95% CI 0.900-0.998, p=0.04). Mortality for those with SLE nephritis also showed a statistically significant decrease (OR=0.93, 95%CI 0.88-0.99, p=0.01). Mortality for all other KID hospitalizations showed a statistically significant but very minor decrease (OR=0.97, 95%CI 0.96-0.97, p<0.001). The difference in rate of mortality decrease for hospitalizations with SLE diagnosis versus those without a SLE diagnosis was not statistically significant. Error bars indicate standard error; the error bars for the group of hospitalizations without a SLE diagnosis are so small that they are barely visible on the graph.

Figure 2A

Billed procedures comprising the most common 75% are shown (the remaining 25% are not shown).

Figure 2B

Temporal trends for the 5 most commonly billed procedures (comprising over 40% of all procedures) are shown. The associated p-values for trend are as follows: medication infusion (p=0.20), dialysis (p=0.01), blood transfusion (p<0.001), vascular catheterization (p=0.002), renal biopsy (p=0.74).