Lower family income predicts longer hospital stays in children with lupus
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Key takeaways:
- Income level predicted longer hospital stays for pediatric lupus in the lowest income group.
- Black patients and those with public insurance were more likely to exhibit severe disease.
Family income level is a significant predictor of longer hospital stays among children with lupus in the lowest income quartile, according to data published in Arthritis Care & Research.
The researchers additionally concluded that Black patients and those on public insurance were more likely to demonstrate severe disease features.
“Health disparities are prevalent across the spectrum of chronic disease, including lupus,” William Daniel Soulsby, MD, of the department of pediatrics at the University of California, San Fransisco, and colleagues wrote. “Similar trends have been identified in pediatric lupus, including increased mortality and length of stay (LOS) among underrepresented populations, particularly Latinx individuals.”
To investigate the relationship between income level, race and ethnicity, and lupus severity and hospitalizations, Soulsby and colleagues conducted a cross-sectional analysis of children who were hospitalized for lupus in 2016. The researchers collected data from the Kids’ Inpatient Database, the Healthcare Cost and Utilization Project and the Agency for Healthcare Research and Quality, including patients aged 2 through 20 years who were hospitalized with a primary or secondary diagnosis of lupus.
The researchers defined income levels as the median annual income for each patient ZIP code, divided into quartiles for each data source. The resulting brackets were $1 to $42,999 for the first quartile, $43,000 to $53,999 for the second quartile, $54,000 to $70,999 for the third quartile and $71,000 or higher for the fourth. The primary outcome was the hospital length of stay.
The analysis included 3,367 unweighted hospitalizations. For patients in the lowest income bracket, income was a statistically significant predictor of a longer length of stay (IRR = 1.12; 95% CI, 1.02-1.23), according to the researchers. In addition, Black race (OR = 1.51; 95% CI, 1.11-2.06), “other” race (OR = 1.61; 95% CI, 1.01-2.55) and public health insurance coverage (OR = 1.51; 95% 1.17-2.55) were associated with more severe disease features. For the purposes of this analysis, the researchers defined “other” race as identities outside of white, Black, Hispanic and Asian or Pacific Islander.
“Using a nationally representative dataset of pediatric discharges from across the United States, this analysis highlights racial and socioeconomic health disparities impacting pediatric lupus hospitalizations,” Soulsby and colleagues wrote. “Among pediatric hospitalizations including a diagnosis code for lupus, those with the lowest levels of income experienced prolonged hospital length of stay as compared to the highest income level. Additionally, Black and ‘other’ race and public insurance were identified as statistically significant predictors of severe lupus features.”
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