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Congenital Heart Disease Hospitalizations in Canada: A 10-Year Experience
Sunjidatul Islam1, Yutaka Yasui1, Padma Kaul2
1School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Insights
Hospitalizations for congenital heart disease (CHD) increased overall in Canada. However, the rate per person with CHD decreased for adults, suggesting better outpatient care, while remaining stable for children.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Growing population of children and adults with congenital heart disease (CHD) in Canada.
- Uncertain impact of this growing population on inpatient services.
Purpose of the Study:
- To assess temporal changes in hospitalizations among patients with CHD in Canada.
- To understand the trends in inpatient care utilization for CHD patients over time.
Main Methods:
- Utilized the Canadian Institute for Health Information's Discharge Abstract Database (2003-2012).
- Identified all patients with CHD receiving inpatient care.
- Employed Poisson regression to analyze annual hospitalization rates, indexed to both the general and CHD populations.
Main Results:
- Total of 103,034 hospitalizations in 61,051 patients from fiscal years 2003 to 2012.
- Annual hospitalizations increased by 4.0% in adults and 1.3% in children.
- Adult hospitalization rates decreased by 4% annually relative to the CHD population, while pediatric rates remained stable.
Conclusions:
- Absolute number of CHD hospitalizations rose in both pediatric and adult populations.
- Decreasing adult hospitalization rates may indicate improved outpatient management.
- The increasing absolute burden of CHD hospitalizations presents a significant financial challenge for Canadian healthcare systems.
Background:
The effect of the growing population of children and adults with congenital heart disease (CHD) on inpatient services in Canada is not known. We sought to assess temporal changes in hospitalizations of CHD patients.
Methods:
We identified all patients with a CHD diagnosis who received inpatient care in Canada between fiscal years 2003 and 2012 according to the Discharge Abstract Database of the Canadian Institute for Health Information. Poisson regression was performed to assess temporal changes in the annual hospitalization rate. Hospitalization rates were indexed to the general population and the estimated CHD population.
Results:
A total of 103,034 hospitalizations occurred in 61,051 patients from fiscal years 2003 to 2012. The absolute number of hospitalizations increased by 4.0% per year in adults and 1.3% per year in children. The greatest increase was in patients aged ≥ 65 years followed by those 40-64 years. However, the hospitalization rate in adults varied between 39 and 55 per 1000 CHD population with a reduction of 4% per year (95% confidence interval, 0.95-0.96; P < 0.001). The hospitalization rate in children ranged from 79 to 87 per 1000 CHD population and did not change significantly over time (rate ratio, 1.00; 95% confidence interval, 1.00-1.01; P = 0.035). Men accounted for 53.5% of hospitalizations.
Conclusions:
The absolute number of hospitalizations of patients with CHD increased over time in children and adults. However, the hospitalization rate relative to the CHD population decreased among adults, possibly reflecting improved outpatient management. The absolute increase in CHD hospitalizations will pose a financial burden on health care systems.
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