Association of Diabetes Mellitus with Hospitalization Among Adult Congenital Heart Defect Patients, 2008-2010 Öffentlichkeit

Abstract

Context: Due to advances in medical technology and treatment, patients born with congenital heart defects (CHDs) are living longer, and their longer life expectancy puts them at risk for developing other acquired diseases like Diabetes Mellitus (DM). DM patients and Adult Congenital Heart Defect (ACHD) patients are both high utilizers of hospital resources, specifically through their use of hospitalization. However, there has been no research assessing the risk of increased hospitalization among diabetic ACHD patients.

Purpose: The objective of this study is to examine the relationship between hospitalization and DM among the ACHD population.

Methods: A cross-sectional study of ACHD patients was conducted using 2008-2010 data from Emory University Hospital (EUH), The Emory Clinic (TEC), and Emory University Hospital-Midtown (EUH-M) in Atlanta, Georgia. Using logistic regression, odds ratios were calculated to assess the association between DM and hospitalization.

Results: An association between DM and hospitalization among ACHD patients was found (OR=7.8; 95%CI: 5.41, 11.3). After controlling for CHD severity, hypertension, and hyperlipidemia, the adjusted odds of being hospitalized among diabetic ACHD patients was four times greater compared to non-DM ACHD patients (aOR=4.2, 95%CI: 2.9, 6.2).

Conclusion: DM may play a role in an increased risk of hospitalization among the ACHD population. Further exploration of the main reasons for hospitalization among diabetic ACHD patients is needed to develop strategic care management to prevent such hospitalizations.

Table of Contents

CHAPTER I: BACKGROUND. 1

Congenital Heart Defects (CHD). 1

Prevalence of Congenital Heart Defects (CHDs). 2

Diabetes Mellitus (DM). 4

Associations: Diabetes Mellitus (DM) Risk Factors. 5

Age. 6

Gender. 6

Race/Ethnicity and Socio-Economic Status. 7

BMI. 9

Hypertension. 9

Hyperlipidemia. 10

Physical Activity. 10

The Association of Diabetes and Congenital Heart Defects. 11

Hospitalization among Diabetic Patients. 13

Associations: Hospitalization Risk Factors. 14

Economic Status/Income. 15

Race/Ethnicity. 15

Body Mass Index. 15

Gender. 16

Hospitalization among CHD patients. 16

Hospitalization among Diabetic ACHD Patients. 17

CHAPTER II: METHODS. 19

Hypothesis. 19

Study Design and Population. 19

Data Management and IRB. 19

Inclusion/Exclusion Criteria. 20

Outcome Variable. 20

Exposure Variable. 20

Control Variables. 21

CHD Severity. 21

Age. 21

Race. 21

Gender. 22

Income. 22

BMI 22

Hypertension. 22

Hyperlipidemia. 23

Directed Acyclic Graph (DAG). 23

Statistical Analysis. 23

CHAPTER III: MANUSCRIPT.. 26

HOSPITALIZATION AMONG ADULT CONGENITAL HEART DEFECT PATIENTS WITH DIABETES MELLITUS. 26

Introduction. 27

Methods. 28

Study Design and Population. 28

Case Definition and Exclusion Criteria. 28

Control Variables. 29

Statistical Analysis. 29

Results. 31

Discussion. 32

Strengths and Study Limitations. 33

Conclusion. 34

REFERENCES. 36

TABLES. 44

FIGURES. 48

CHAPTER IV: EXTENDED ANALYSIS. 49

Univariate and Bivariate Analysis. 49

Multivariable Logistic Regression Modeling. 50

Crude Model and possible confounders. 50

Gold Standard Odds Ratio. 51

Adjusted Odds Ratio. 52

Full Sample. 52

Reduced Sample - Final Model 52

Assessment of Ascertainment Bias. 53

CHAPTER V: PUBLIC HEALTH IMPLICATIONS AND FUTURE TRENDS. 56

APPENDICES. 58

APPENDIX A. Marelli's Congenital Heart Defect Severity Classification. 58

APPENDIX B. Sixty-nine ICD9CM Codes to Determine DM Comorbidity. 60

APPENDIX C. Forty-six ICD9CM Codes to Determine HYPERTENSION Comorbidity. 62

APPENDIX D. Five ICD9CM Codes to Determine HYPERLIPIDEMIA Comorbidity. 64

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Stichwort	Congenital Heart Defect Adult Congenital Heart Defect Diabetes Mellitus Health Care Utilization Hospitalization
Committee Chair / Thesis Advisor	Hogue, Carol J, Emory University
Committee Members	Georgiopoulou, Vasiliki (Vicki), Emory University Raskind-Hood, Cheryl, Emory University
Partnering Agencies	Hospital or other health care provider CDC

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