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Cachexia & debility diagnoses in hospitalized children and adolescents with complex chronic conditions: evidence from
Bryce A Van Doren1, Debosree Roy1, Joshua M Noone1
1University of North Carolina at Charlotte, NC, USA.
Insights
Hospitalizations for cachexia and debility in children with complex chronic conditions (CCCs) are increasing. Cachexia raises mortality risk, while debility decreases it, both impacting hospital stay duration and cost.
Area of Science:
- Pediatric complex chronic conditions (CCCs)
- Inpatient healthcare utilization
- Disease-specific outcomes
Background:
- Cachexia and debility are significant concerns in pediatric complex chronic conditions (CCCs).
- Understanding their impact on hospital outcomes is crucial for patient management and resource allocation.
Purpose of the Study:
- To determine the frequency, cost, and hospital-reported outcomes of cachexia and debility in pediatric CCCs.
- To analyze trends in hospitalizations related to these conditions.
Main Methods:
- Utilized the Kids' Inpatient Database to identify pediatric patients (≤20 years) with CCCs, cachexia, and debility.
- Compared hospitalization characteristics, costs, and duration of stay between patients with and without cachexia/debility.
- Employed logistic and negative binomial regression models to identify predictors of mortality, duration of stay, and cost.
Main Results:
- Hospitalizations for cachexia and debility in pediatric CCCs increased from 2003 to 2012.
- Cachexia was linked to a 60% increased mortality risk; debility showed a 40% decreased mortality risk.
- Both conditions prolonged hospital stays (17% for cachexia, 39% for debility) and increased median hospitalization costs.
Conclusions:
- The incidence of cachexia hospitalizations in pediatric CCCs is rising, though less frequent than in adults.
- While not previously reported, hospitalizations for debility in pediatric CCCs are also increasing.
- These findings highlight the growing burden of cachexia and debility in pediatric CCCs, necessitating further research and clinical attention.
Objective:
To characterize the frequency, cost, and hospital-reported outcomes of cachexia and debility in children and adolescents with complex chronic conditions (CCCs).
Methods:
We identified children and adolescents (aged ≤20 years) with CCCs, cachexia, and debility in the Kids' Inpatient Database [Healthcare Cost and Utilization Project, Agency for Healthcare Research & Quality]. We then compared the characteristics of patients and hospitalizations, including cost and duration of stay, for CCCs with and without cachexia and/or debility. We examined factors that predict risk of inpatient mortality in children and adolescents with CCCs using a logistic regression model. We examined factors that impact duration of stay and cost in children and adolescents with CCCs using negative binomial regression models. All costs are reported in US dollars in 2014 using Consumer Price Index inflation adjustment.
Results:
We estimated the incidence of hospitalization of cachexia in children and adolescents with CCCs at 1,395 discharges during the sample period, which ranged from 277 discharges in 2003 to 473 discharges in 2012. We estimated the incidence of hospitalization due to debility in children and adolescents with CCCs at 421 discharges during the sample period, which ranged from 39 discharges in 2003 to 217 discharges in 2012. Cachexia was associated with a 60% increase in the risk of inpatient mortality, whereas debility was associated with a 40% decrease in the risk of mortality. Cachexia and debility increased duration of stay in hospital (17% and 39% longer stays, respectively). Median cost of hospitalization was $15,441.59 and $23,796.16 for children and adolescents with cachexia and debility, respectively.
Conclusions:
Incidence of hospitalization for cachexia in children and adolescents with CCCs is less than that for adults but the frequency of cachexia diagnoses increased over time. Estimates of the incidence of hospitalization with debility in children and adolescents with CCCs have not been reported, but our study demonstrates that the frequency of these discharges is also increasing.
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