Hospitalizations in Infants and Young Children With Cystic Fibrosis Enrolled in Medicaid
Laurie P Murray1, Mark Zamani2, Jonathan D Cogen3
1Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, USA.
Insights
Infants and young children with cystic fibrosis (CF) face significant hospitalization burdens, with respiratory issues being common in the second and third years of life. This highlights the need for new CF and RSV therapies.
Area of Science:
- Pediatric Pulmonology
- Healthcare Informatics
- Epidemiology
Background:
- Limited data exist on hospitalization rates for children with cystic fibrosis (CF).
- National administrative claims databases offer a valuable resource for characterizing CF hospitalizations.
- Understanding these patterns can inform the impact of emerging CF therapies.
Purpose of the Study:
- To characterize hospitalization rates and reasons among children with CF (cwCF) during their first three years of life.
- To identify common diagnoses and pathogens associated with hospitalizations in young cwCF.
- To provide data that can inform future assessments of novel CF and RSV therapies.
Main Methods:
- Retrospective cohort study using the Merative Medicaid Marketscan database (2010-2019).
- Identified eligible cwCF using ICD-9/10 codes and pancreatic enzyme fills.
- Categorized hospitalizations into neonatal, respiratory, gastrointestinal, or other using Diagnosis Related Groups (DRGs).
Main Results:
- 62.7% of unique cwCF were hospitalized, with an overall rate of 70.9 per 100 child-years.
- Complicated neonatal DRGs were most frequent in the birth year; respiratory DRGs predominated in years two and three.
- Respiratory hospitalizations in year two included significant proportions of respiratory syncytial virus (RSV) and influenza (11.1% and 6.8%, respectively).
Conclusions:
- Children with CF experience a substantial hospitalization burden in early childhood.
- Respiratory conditions, including those linked to RSV and influenza, are major drivers of hospitalization in the second and third years of life.
- These findings are crucial for evaluating the effectiveness of new treatments for CF and RSV.
Background:
There are limited data describing hospitalization rates among infants and young children with CF (cwCF). National administrative claims databases can be used to characterize hospitalizations among cwCF which could inform the future impact of novel therapies increasingly being integrated into routine care for cwCF.
Methods:
We performed a retrospective cohort study of the Merative Medicaid Marketscan database from 2010 to 2019 to characterize hospitalizations among cwCF during their first 3 calendar-years of life. Eligible cwCF were identified using International Classification of Diseases 9/10 codes and had a pharmacy fill for pancreatic enzymes. Hospitalizations were categorized as complicated neonatal, respiratory, gastrointestinal, or other types using Diagnosis Related Groups (DRG).
Results:
During the study period, 518 (62.7%) of unique cwCF were hospitalized, amounting to an overall hospitalization rate of 70.9 (95% CI: 67.0-75.0) per 100 child-years. In the birth year complicated neonatal DRGs were most common while in the second and third calendar-years respiratory DRGs were most common. In the second calendar-year of life, respiratory syncytial virus (RSV) and influenza were identified in 11.1% and 6.8% of respiratory hospitalizations, respectively.
Conclusions:
CwCF experienced a large burden of hospitalizations during their first three calendar-years of life. Respiratory DRGs were most common in the second and third calendar-years and included a substantial proportion of RSV- and influenza-associated hospitalizations. Such data can inform future work assessing the impact of new therapies for CF and RSV.
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