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Clinical characteristics and healthcare utilization of orthostatic dysregulation in Japan: a nationwide descriptive
Kazuma Shinno1,2,3, Hiroyuki Iijima4, Kazue Ishitsuka5
1Clinical Research Center, National Hospital Organization (NHO) Saitama Hospital, Saitama, Japan. shinno-k@ncchd.go.jp.
Insights
Orthostatic dysregulation (OD) in children is linked to mental health and sleep issues. This study reveals diverse patient profiles and treatment patterns, emphasizing the need for personalized care strategies.
Area of Science:
- Pediatrics
- Autonomic Nervous System Disorders
- Clinical Practice Research
Background:
- Orthostatic dysregulation (OD) affects children, causing circulatory issues due to autonomic nervous system imbalance.
- OD is common in Japan, associated with school non-attendance and managed from a psychosomatic viewpoint.
- Limited large-scale data exists on real-world clinical practices for pediatric OD.
Purpose of the Study:
- To describe comorbidities, prescribed medications, and medical practices for pediatric orthostatic dysregulation in Japan.
- To analyze nationwide data on the clinical characteristics and healthcare utilization of OD patients.
- To identify patterns in OD management and patient profiles.
Main Methods:
- A descriptive study using the Medical Information Analysis databank (Japan).
- Inclusion of 7,213 patients aged 6-18 years diagnosed with OD between 2016-2023.
- Analysis of demographics, comorbidities, medications, and medical practices, with subgroup analyses by prescription patterns.
Main Results:
- The median age of diagnosis was 13 years, with 55.6% females. Mental health/behavioral disorders were the most common comorbidities (23.6%).
- Sleep disorders (10.2%), school non-attendance (9.3%), and neurodevelopmental disorders (7.1%) were prevalent. Midodrine was the most prescribed medication (78.3%).
- Blood tests (48.6%), diagnostic imaging (35.9%), and ECGs (24.2%) were common practices. Patients on sleep medication showed higher rates of neurodevelopmental disorders, school non-attendance, and depression.
Conclusions:
- This nationwide study provides real-world evidence on pediatric OD in Japan.
- Diverse comorbidity profiles and prescription patterns highlight patient heterogeneity.
- Tailored therapeutic strategies are needed for more effective OD care.
Background:
Orthostatic dysregulation (OD) is a physical disorder characterized by circulatory disturbances due to autonomic nervous system imbalance that predominantly affects children. In Japan, OD is common and closely associated with school non-attendance, and its clinical management has developed from a psychosomatic perspective. However, large-scale data on real-world clinical practices are lacking. This study uses nationwide data to describe the comorbidities, prescribed medications, and medical practices for OD.
Methods:
This descriptive study utilized the Medical Information Analysis databank, a nationwide administrative database operated by the National Hospital Organization in Japan. We identified 7,213 patients aged 6 to 18 years who were first diagnosed with OD between 2016 and 2023. Descriptive statistics were used to analyze patient demographics, comorbidities, prescribed medications, and medical practices. Subgroup analyses stratified by prescription patterns were conducted.
Results:
The median age at diagnosis was 13 years, and 55.6% of the patients were female. The most common comorbidity category was mental health/behavioral disorders (23.6%). The most prevalent specific conditions were sleep disorders (10.2%), school non-attendance (9.3%), and autism spectrum disorder/attention-deficit hyperactivity (7.1%). Pharmacotherapy was provided to 44.0% of the patients, with a mean of 1.3 medications per patient. Midodrine was the most prescribed medication (78.3%), followed by amezinium metilsulfate (6.7%), and propranolol (2.8%). Sleep medications were prescribed to 9.4% of treated patients. The most frequent medical practices were blood tests (48.6%), diagnostic imaging (35.9%), and electrocardiograms (24.2%). The subgroup prescribed sleep medications had a higher prevalence of neurodevelopmental disorders, school non-attendance, and depression.
Conclusions:
This first nationwide descriptive study of OD in Japan provides real-world evidence on clinical characteristics and healthcare utilization. Heterogeneous comorbidity profiles and prescription patterns reveal the clinical diversity of the patient population. Our findings highlight the need for tailored therapeutic strategies to support more effective care.
