title: Changes in hospitalization patterns among patients with congenital heart disease during the transition from adolescence to adulthood.
abstract: OBJECTIVE
  This study was designed to evaluate hospitalization patterns of congenital heart disease (CHD) patients surrounding the transition from adolescence to adulthood.
  
  
  BACKGROUND
  Few population data exist on hospitalizations among adolescent and adult CHD patients.
  
  
  METHODS
  Patients ages 12 to 44 years with CHD were selected from the 2000 to 2003 California hospital discharge database. Patient demographics, hospitalization patterns, emergency department (ED) admissions, CHD complexity, and insurance patterns were described. Data were analyzed in 3-year age increments and compared between patients over and under age 21. Predictors of admission via the ED were determined using multivariate regression analysis.
  
  
  RESULTS
  There were 9,017 hospitalizations at 368 hospitals. For patients ages 12 to 20 years, 12 hospitals accounted for 70% of hospitalizations; for patients ages 21 to 44 years, 25 hospitals accounted for only 44.8% of cases. Regarding insurance, 53% of admissions were private, 44% public, and <4% were self-pay. Sixty-five percent of patients had complex CHD and 19% had a cardiac procedure during hospitalization. The proportion of patients admitted via the ED nearly doubled surrounding the transition to adulthood. The positive predictors of admission via the ED included public insurance, self-pay, and age >17 years, whereas having a procedure and being female decreased the likelihood.
  
  
  CONCLUSIONS
  Congenital heart disease hospitalizations occur at a wide variety of hospitals and disperse as patients enter adulthood. Those without private insurance and >17 years old are at higher risk of being admitted via the ED. These findings require further investigation to examine access to care and possible disparities, as they are important for future healthcare planning.
authors.affiliation: Department of Pediatrics, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA. Michelle.Gurvitz@seattlechildrens.org
authors.forename: Michelle Z
authors.initials: MZ
authors.lastname: Gurvitz
authors.forename: Moira
authors.initials: M
authors.lastname: Inkelas
authors.forename: Maggie
authors.initials: M
authors.lastname: Lee
authors.forename: Karen
authors.initials: K
authors.lastname: Stout
authors.forename: Jose
authors.initials: J
authors.lastname: Escarce
authors.forename: Ruey-Kang
authors.initials: RK
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D002140:California / Q000453:epidemiology; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000145:classification / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012720:Severity of Illness Index