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Age, insurance status related to hospitalization for children with congenital adrenal hyperplasia
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Among children with congenital adrenal hyperplasia, those who are younger and those with government insurance may be at increased risk for hospitalization, recent data indicate.
Perrin C. White, MD, professor of pediatrics, and Ming Yang, PhD, a fellow in pediatric endocrinology, both in the department of pediatrics at UT Southwestern Medical Center, evaluated medical records from Children’s Medical Center Dallas from 1999 to 2013 and identified 522 children with congenital adrenal hyperplasia (CAH) to determine risk factors for postdiagnosis hospitalization. Overall, 155 participants had salt-wasting disease, and 55 participants were hospitalized 105 times.
Hospitalization was more common among participants younger than 2 years (RR = 3.3; 95% CI, 2.2-4.8) and those with noncommercial insurance (RR = 1.8; 95% CI, 1.1-2.8). Five participants with government insurance were hospitalized 37 times. Compared with white participants, nonwhite participants were more likely to be hospitalized (RR = 1.5; 95% CI, 1-2.3); however, this was not significant after adjustment for insurance status.
Hospitalized participants had significantly higher average fludrocortisone daily doses compared with participants who were not hospitalized. The most common admitting diagnosis was infection: gastrointestinal infection in 48 patients, respiratory infection in 10 patients, urinary tract infection in eight patients and other infections in nine patients.
“Around a third of patients with the severe, salt-wasting form of CAH are hospitalized during childhood at some point after diagnosis, most often during the first 2 years of life,” White told Endocrine Today. “Gastroenteritis is the most frequent admitting diagnosis. No outpatient laboratory test predicts hospitalization risk, but patients who require higher fludrocortisone disease and thus have more severe salt-wasting are more likely to be hospitalized. A small number of patients of lower socioeconomic status accounted for a disproportionate number of admissions. Such patients might benefit from case management strategies.” – by Amber Cox
For more information:
Perrin C. White, MD, can be reached at perrin.white@utsouthwestern.edu.
Disclosure: White reports receiving support from Janssen Scientific Affairs. Yang reports no relevant financial disclosures.
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