Patients with Spina Bifida have Increased Number of Hospital Encounters Compared to the General Population: Statewide Healthcare Utilization in California from 1995-2017. Siddeek MH, Castro C, Goldberg D, Hampson LA*, Copp HL*
Mohamed Hisham Siddeek, BSc., Coral Castro, BSc., Debbie Goldberg, PhD, Lindsay Hampson, MD, Hillary Copp, MD.
UCSF, San Francisco, CA, USA.
Background: While multiple studies have shown that SB patients have greater healthcare utilization compared to the general population, the specific factors influencing this pattern have yet to be elucidated. Existing studies are outdated and involve small sample sizes. The purpose of this population-based study is to evaluate healthcare utilization in the form of hospital encounters among patients with SB. We hope to understand if SB is associated with increased number of hospital encounters and to identify factors associated with increased encounters among SB patients. We hypothesize that patients with SB, given their increased burden of comorbidities, will have greater utilization of healthcare than the control group. Method: Using the Department of Health Care Access and Information (HCAI) database from 1995 to 2017, a total of 14,588 SB patients were identified and matched by age to 72,223 healthy controls. The primary outcome measure was the number of hospital encounters categorized by ≤2 vs. ≥3 encounters, based on the median number of encounters among controls. The time that elapsed between the 1st and 2nd encounters was also recorded among those with multiple encounters. Given the large sample size, p <0.01 was considered statistically significant. Univariate and multivariable logistic regression was performed between the predictor variables and the main outcome variable. A sub-analysis among SB patients was also performed to identify factors associated with ≥3 hospital encounters.Results: Univariate analysis demonstrated that 69% of patients with SB had ≥3 hospital encounters compared to 29% within the control population (p<0.001). After adjusting for sex, race, ethnicity, insurance status, neighborhood socio-economic status, and the Charlson Comorbidity Index (CCI) in multivariable analysis, we found that SB was associated with increased hospital encounters compared to controls (OR = 3.95, 95% CI = 3.77,4.13). Examining the subgroup of individuals who had more than one hospital encounter, we found that SB patients had less time between their 1st and 2nd hospital encounters (915 days, p<0.01) compared to controls (1207 days, p<0.01). Within the SB population, being female, multiracial, mixed ethnicity, increasing comorbidities, and non-private insurance, were associated with increased hospital encounters. Conclusions: SB patients were shown to have an increased number of hospital encounters and fewer days between encounters when compared to the general population. Comorbidities, ethnicity, and insurance status were strongly associated with a greater number of hospital encounters within the SB population. These findings highlight the need to better understand the specific factors driving increased utilization of hospital resources for SB patients to empower providers and healthcare systems to better support this vulnerable population.
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