Hospitalizations for mitochondrial disease across the lifespan in the U.S.

Abstract

Importance Mitochondrial disease is being diagnosed with increasing frequency. Although children with mitochondrial disease often have severe, life-limiting illnesses, many survive into adulthood. There is, however, limited information about the impact of mitochondrial disease on healthcare utilization in the U.S. across the lifespan. Objectives To describe the characteristics of inpatient hospitalizations related to mitochondrial disease in the U.S., to identify patient-level clinical factors associated with in-hospital mortality, and to estimate the burden of hospitalizations on individual patients. Design Cross-sectional and longitudinal observational studies. Setting U.S. hospitals. Participants Individuals with hospital discharges included in the triennial Healthcare Cost and Utilization Project (HCUP) Kids Inpatient Database (KID) and the National Inpatient Sample (NIS) in 2012 (cross-sectional analysis); individuals with hospital discharges included in the HCUP California State Inpatient Database from 2007 2011, inclusive (longitudinal analysis). Exposure Hospital discharge associated with a diagnosis of mitochondrial disease. Main outcome measures Total number and rate of hospitalizations for individuals with mitochondrial disease (International Classification of Diseases, 9th revision, Clinical Modification code 277.87, disorder of mitochondrial metabolism); in-hospital mortality. Results In the 2012, there were approximately 3,200 inpatient pediatric hospitalizations (1.9 per 100,000 population) and 2,000 inpatient adult hospitalizations (0.8 per 100,000 population) for mitochondrial disease in the U.S., with associated direct medical costs of $113 million. In-hospital mortality rates were 2.4% for children and 3.0% for adults, far exceeding population averages. Higher socioeconomic status was associated with both having a diagnosis of mitochondrial disease and with higher in-hospital mortality. From 2007–2011 in California, 495 individuals had at least one admission with a diagnosis of mitochondrial disease. Patients had a median of 1.1 hospitalizations (IQI, 0.6 2.2) per calendar year of follow-up; infants under 2y were hospitalized more frequently than other age groups. Over up to five years of follow up, 9.9% of participants with any hospitalization for mitochondrial disease were noted to have an in-hospital death. Conclusions and Relevance Hospitalizations for pediatric and adult mitochondrial diseases are associated with serious illnesses, substantial costs, and significant patient time. Identification of opportunities to prevent or shorten such hospitalizations should be the focus of future studies.

Costs for mitochondrial medicine will remain high as long as mitochondrial disorders are misdiagnosed

“…Accordingly, we do not agree with the figure 1:4300 for the prevalence of MIDs [1] . Nonspecific MIDs are regarded much more frequent occurring with a prevalence of 1:400 [4] .…”

“…We read with interest the article by McCormack et al about frequency and costs of hospitalisations of mitochondrial disorder (MID) patients in California [1] . There are several reasons why the figures provided are underestimations.…”

A retrospective analysis of health care utilization for patients with mitochondrial disease in the United States: 2008–2015

“…The severity of illness for MD is such that hospitalization and surgeries for some patients are unavoidable. A previous study using the Kids’ Inpatient Database and the National Inpatient Survey from the Healthcare Cost and Utilization Project (HCUP) showed that hospitalizations for mitochondrial disease is associated with substantial costs estimated at $113 million in 2012 [ 18 ]. In our analysis we found that total health care cost for pediatric MD was greater than that of adult MD ($4829 vs. $3100).…”

“…This is consistent with the multi-systemic nature of MD affecting any organ with any degree of severity and requiring chronic as well as acute care through high increase in emergency medicine resources. The HCUP study showed that in children, emergency room visits were associated with higher in-hospital mortality [ 18 ]. Although the lungs are typically not directly involved in the clinical manifestation of MD, neuromuscular and CNS involvement may affect ventilation, both the ventilator drive as well as motor control, and mistakenly get classified as a primary pulmonary problem.…”

Susceptibility to COVID‐19 in populations with health disparities: Posited involvement of mitochondrial disorder, socioeconomic stress, and pollutants

“…[ 8,9 ] A delay in clinical symptoms has suggested involvement of toxic events from environmental pollutants such as cigarette smoke, which may evoke or enhance MtD. [ 10,11 ] Children of white and non‐Hispanic ancestry with a higher median income have been reported to have a higher prevalence of MtD [ 12 ] ; however, the phenotypes and genetic abnormalities of MtD have been increasing since earlier investigations in 1988, [ 13 ] which has raised the question of environmental influences. [ 14 ]…”