Trends in pediatric pulmonary hypertension-related hospitalizations in the United States from 2000-2009

Abstract

There are few data on the epidemiology of pulmonary hypertension (PH)-related hospitalizations in children in the United States. Our aim was to determine hospital mortality, length of hospitalization, and hospital charges pertaining to PH-related hospitalizations and also the effects of codiagnoses and comorbidities. A retrospective review of the Kids' Inpatient Database during the years 2000, 2003, 2006, and 2009 was analyzed for patients ≤20 years of age with a diagnosis of PH by ICD-9 (International Classification of Diseases, Ninth Revision) codes, along with associated diagnoses and comorbidities. Descriptive statistics, including Rao-Scott χ(2), ANOVA, and logistic regression models, were utilized on weighted values with survey analysis procedures. The number of PH-related hospital admissions is rising, from an estimated 7,331 (95% confidence interval [CI]: 5,556-9,106) in 2000 to 10,792 (95% CI: 8,568-13,016) in 2009. While infant age and congenital heart disease were most commonly associated with PH-related hospitalizations, they were not associated with mortality. Overall mortality for PH-related hospitalizations was greater than that for hospitalizations not associated with PH, 5.7% versus 0.4% (odds ratio: 16.22 [95% CI: 14.78%-17.8%], P < 0.001), but mortality is decreasing over time. Sepsis, respiratory failure, acute renal failure, hepatic insufficiency, arrhythmias, and the use of extracorporeal membrane oxygenation are associated with mortality. The number of PH-related hospitalizations is increasing in the United States. The demographics of PH in this study are evolving. Despite the increasing prevalence, mortality is improving.

Keywords: epidemiology; pediatrics; pulmonary hypertension; survival.

Figure 1

A, Mean length of stay, in days, for pulmonary hypertension (PH)–related hospitalizations in children across the years studied; P < 0.001 from ANOVA across years. B, Associated diagnoses’ effect on mean length of stay, in days, for pulmonary hypertension–related hospitalizations. An asterisk indicates P < 0.05 for diagnoses associated with a change in length of stay compared to non–pulmonary hypertension–related hospitalizations. BPD: bronchopulmonary dysplasia; CDH: congenital diaphragmatic hernia; CHD: congenital heart disease; ECMO: extracorporeal membrane oxygenation; SLE/CTD: systemic lupus erythematosus/connective-tissue disorder.

Figure 2

A, Hospital mortality, in percent, for pulmonary hypertension–related hospitalization in children across the years studied; P < 0.001 from ANOVA across years. B, Association of codiagnoses and mortality. An asterisk indicates P < 0.05 for factors significantly associated with increased or decreased mortality. BPD: bronchopulmonary dysplasia; CDH: congenital diaphragmatic hernia; CHD: congenital heart disease; ECMO: extracorporeal membrane oxygenation; SLE/CTD: systemic lupus erythematosus/connective tissue disorder.

Figure 3

A, Hospital charges, in US dollars, for pulmonary hypertension–related hospitalizations in children across the years studied; P < 0.001 from ANOVA across years. B, Associated diagnoses effect on hospital charges for pulmonary hypertension–related hospitalizations. An asterisk indicates P < 0.05 for diagnoses associated with a change in hospital charges compared to non–pulmonary hypertension–related hospitalizations. BPD: bronchopulmonary dysplasia; CDH: congenital diaphragmatic hernia; CHD: congenital heart disease; ECMO: extracorporeal membrane oxygenation; SLE/CTD: systemic lupus erythematosus/connective tissue disorder.