Rationale: Asthma is one of the most common chronic disorders of childhood and is associated with significant healthcare utilization and costs. Comorbid psychiatric illnesses, specifically depression and anxiety, are more prevalent in patients with asthma and associated with worse asthma control, more emergency department visits, and increased hospitalization rates. Objectives: We aimed to compare hospital outcomes and charges for children with severe asthma with and without comorbid depression and anxiety, hypothesizing that those with depression and anxiety would have longer hospitalizations and higher charges. Methods: Retrospective review of the 2000-2012 Healthcare Cost and Utilization Project's Kids' Inpatient Databases for admissions of patients aged 10-21 years with an ICD-9 code severe asthma (status asthmaticus or any asthma diagnosis with a procedure code for endotracheal intubation). Depression and Anxiety subgroups were created based on ICD-9 codes. Data collected included demographics, hospital outcomes and charges and comparisons made between groups. Results: There were 52,485 admissions for severe asthma: 45,094 (86%) with No Comorbid Psychiatric Illnesses, 1284 (2.4%) with depression, and 1297 (2.5%) with anxiety. Patients with depression or anxiety were older, had longer hospitalizations, and higher hospital charges (p < .001 for all). Conclusions: Comorbid depression or anxiety is associated with significantly longer hospitalizations and higher charges for children with severe asthma. These findings add to prior reports of worse outcomes for children with asthma and comorbid depression or anxiety and suggest that improved screening for and management of these conditions in children with asthma could improve hospital outcomes and reduce costs.
No abstract
Rationale: Asthma is one of the most common chronic disorders of childhood and is associated with significant healthcare utilization and costs. Comorbid psychiatric disorders, specifically depression and anxiety, are more prevalent in patients with asthma and are associated with worse asthma control, more emergency room visits, and increased hospitalization rates. The aim of our study was to compare hospital outcomes and charges for children with status asthmaticus with and without comorbid depression and anxiety. Methods: Retrospective review of the 2000-2012 Healthcare Cost and Utilization Project's (HCUP) Kids' Inpatient Databases (KID). The databases were queried for admissions of patients aged 10-21 years old with an ICD-9 code for status asthmaticus (493.01, 493.11, 493.21, 493.91) or any asthma (493 and non-status asthmaticus subcodes) with a procedure code for endotracheal intubation (96.02 or 96.04), to capture all admissions for severe asthma. Two subgroups were created for admissions with ICD-9 codes for depression (296 and subcodes) or anxiety (300 and subcodes). Data collected included demographics, hospital outcomes and charges. The depression and anxiety groups were compared to admissions with no ICD-9 code for any neuropsychiatric disorders using independent samples Kruskal-Wallis test with Bonferroni correction and χ 2 , as appropriate. Results: There were 52,485 admissions with status asthmaticus, 45,094 (86%) with no neuropsychiatric disorders, 1,284 (2.4%) with depression, and 1,297 (2.5%) with anxiety. Demographics, hospital outcomes and charges are in Table 1. Admissions with either depression or anxiety were older, had a longer length of stay and had higher hospital charges (p<0.001 for all). There was a higher in-hospital mortality rate for the depression group. Conclusions: A comorbid diagnosis of depression or anxiety is associated with a longer length of stay and higher hospital charges for status asthmaticus in children. These findings suggest that screening for and management of comorbid psychiatric disorders in this population could improve hospital outcomes.
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