Association Between Anatomic Group and 30-day Outpatient Healthcare Utilization Among Children and Adolescents with Both Congenital Heart Defects and an Influenza Diagnosis, 2008-2013 Pubblico
Zhang, Yining (Summer 2021)
Published
Abstract
Background: The population with congenital heart defects (CHD) continues to grow due to improved survival, and so does the burden on the healthcare system as CHD cases require continuous and specialized care across the lifespan. CHD anatomic complexity is a risk factor for healthcare utilization of patients with CHD. Evidence of excess healthcare utilization attributable to influenza among pediatric patients with chronic conditions requires assessment of the association between CHD anatomic group and healthcare utilization after patients contract influenza.
Methods: This retrospective secondary analysis assessed the association between CHD anatomic group and 30-day outpatient healthcare utilization among a pediatric and adolescent cohort with CHD and influenza. Clinical and administrative electronic healthcare records (eHR) between 2008-2013 were examined for 2,184 children and adolescents aged 1-19 years with CHD and an influenza diagnosis. CHD Anatomic complexity was categorized as complex, shunt, valve or shunt+valve, and outpatient utilization was determined from encounters that occurred within 30 days of an influenza diagnosis. Poisson regression models with robust variance estimates were applied to estimate crude and adjusted relative risks (cRR and aRR) and 95% confidence intervals (CIs).
Results: Occurrence of any or none outpatient encounters within 30-days of an influenza diagnosis differed across CHD anatomic groups (shunt: 31.6% vs 32.1%; valve: 20.0% vs 26.7%; shunt+valve: 22.0% vs 17.4%; complex: 26.4% vs 23.8%). There was no association between CHD anatomic group and outpatient utilization after adjusting for age, race, ethnicity, hypertension, and heart failure, aside from comparison of the shunt+valve group with the shunt group. Patients with shunt+valve lesions were at a slightly increased risk of having outpatient visits within 30-days of an influenza diagnosis compared to patients with shunt lesions (aRR: 1.09; 95% CI:1.00-1.19), whereas no difference in risk existed between the valve group and shunt group (aRR: 0.92; 95% CI: 0.84-1.02) or the complex group and the shunt group (aRR: 0.98; 95% CI: 0.90-1.08).
Conclusions: Findings suggest an association between CHD anatomic group and one-month outpatient healthcare utilization after an influenza diagnosis among children and adolescents with CHD. Future studies should further examine this association in other populations, and using prospective data.
Table of Contents
Abstract iv
Acknowledgements vi
List of Abbreviations ix
CHAPTER I. BACKGROUND 1
Prevalence of CHD in the U.S. 1
Diagnosis of CHD 2
Types of CHD and Clinical Classification 3
Etiology of CHD 4
Cardiac Health Outcomes of CHD 5
Incidence of Influenza and Healthcare Utilization in Children and Adolescents 7
Pre-existing Conditions in Children and Adolescents Who Contract Influenza 8
Healthcare Utilization in Children and Adolescents with CHD 9
Factors Associated with Healthcare Utilization in Children with CHD 10
Co-Occurring Health Conditions and Healthcare Utilization in Children with CHD 12
Study Rationale and Objectives 12
CHAPTER II. METHODS 14
Data Source 14
Study Population 15
Variable Definitions 15
Outcome Variables 15
Exposure Variable 16
Covariables 16
Age 16
Sex 16
Race 17
Ethnicity 17
Geographic Distribution - Rurality 17
Socioeconomic Status (SES) 17
Health Insurance 18
Select Comorbid Conditions 18
Asthma 18
Atrial Arrhythmia 18
Diabetes Mellitus (DM) 18
Endocarditis 19
Heart Failure (HF) 19
Hyperlipidemia 19
Hypertension (HTN) 19
Statistical Analysis 19
CHAPTER III. RESULTS 21
CHAPTER IV. DISCUSSION 26
CHAPTER V. PUBLIC HEALTH IMPLICATIONS / FUTURE DIRECTIONS 32
REFERENCES 34
TABLES 44
Table 1. Descriptive Characteristics of Children and Adolescents with Congenital Heart Defects (CHD) and Influenza, 2008-2013 (N=2,184) 44
Table 2. Distribution of Congenital Heart Defect (CHD) Anatomic Group and Covariables by Whether Had Outpatient Visits within 30 Days of an Influenza Diagnosis among Children and Adolescents with Congenital Heart Defects (CHD) and Influenza (N=2,184) 46
Table 3. Distribution of Covariables by CHD Anatomic Group among Children and Adolescents with Congenital Heart Defects (CHD) and Influenza (N=2,184) 48
Table 4. Unadjusted and Adjusted Analyses for the Association between Congenital Heart Defect (CHD) Anatomic Group and Outpatient Visits within 30 Days of an Influenza Diagnosis Among Children and Adolescents with CHD and Influenza 50
FIGURES 51
Figure 1. Patient Selection Process 51
Appendices 52
Appendix A. ICD-9-CM Codes for Anatomic Complexity of Congenital Heart Defects 52
Appendix B: ICD-9-CM Codes for Influenza (9 codes) 54
Appendix C: ICD-9-CM Codes for Comorbidity Classification 55
Asthma Classification (14 codes) 55
Diabetes Mellitus (DM) Classification (64 codes) 55
Hyperlipidemia (5 codes) 57
Heart Failure (HF) (16 codes) 57
Endocarditis (19 codes) 58
Atrial Arrhythmia (4 codes) 58
Hypertension (HTN) (40 codes) 58
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