Changes in hospitalization patterns among patients with congenital heart disease during the transition from adolescence to adulthood.
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.
Gurvitz
Michelle Z
MZ
Department of Pediatrics, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA. Michelle.Gurvitz@seattlechildrens.org
Inkelas
Moira
M
Lee
Maggie
M
Stout
Karen
K
Escarce
Jose
J
Chang
Ruey-Kang
RK
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