Hypertension-related hospitalizations up in U.S. children

This article originally appeared here.
Children increasingly at risk of high blood pressure.
Children increasingly at risk of high blood pressure.

Hypertension-related hospitalizations are increasing significantly among children in the United States along with inpatient expenses related to the condition, study results suggest.

From 1997 to 2006 the proportion of hypertension-related hospitalizations doubled, increased from 2.2% to 4.4% (P<0.0001) and cost the U.S. health-care system an estimated $3.1 billion in charges, Cheryl L. Tran, MD, from the University of Michigan in Ann Arbor, and colleagues reported in Hypertension.

"Given the apparent cost of hypertension even in the pediatric age range, not to mention its whopping cost in adults, now is the time to invest in early detection, prevention, and treatment of elevated blood pressure in children," Joshua Samuels, MD, MPH, of the department of pediatrics at the University of Texas Medical School in Houston, wrote in an accompanying editorial. "If the current study tells us anything, it is that we cannot afford to wait."

Although previous epidemiological studies have examined the national economic burden of hypertension in adults, little is known about the cost of the condition in children. Currently 1% to 3% of U.S. children are known to have hypertension and prevalence is increasing.

To better understand healthcare utilization among these children, Tran and colleagues examined cohorts from the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) -- the only comprehensive all-payer health-care database for children in the United States -- for the years 1997, 2000, 2003 and 2006.

During the study period 71,282  children were hospitalized with a primary or secondary diagnosis of hypertension, the researchers found.

Over time, the frequency of hypertension discharges increased significantly for children aged 2 to 18 years (P=0.02) and among those aged 10 to 18 years (P=0.03). The proportion of inpatient charges attributable to hypertension also increased significantly (P<0.0001).

End-stage renal disease or renal transplant was diagnosed in 6% of children with hypertension. There were significant correlations between the length of stay (P<0.0001) and end-stage renal disease (P=0.03) and increases in hospitalization-associated charges.

When a hypertension diagnosis was coded as the primary diagnosis, the most common secondary diagnoses were convulsive disorder not otherwise specified (4.7%), headache (2.6%), obesity (2.4%) and systemic lupus
erythematosus (2.4%), the researchers found.

Overall, 9.3% of hypertension claims also had a code for obesity. Among patients who had joint codes for obesity and hypertension, 9% were aged 2 to 9 years old, whereas 91% were aged 10 to 18 years.

The researchers hypothesized that increases in childhood obesity may be partially to blame for the rise in hypertension-related hospitalizations particularly among older children. However, the ability to identify obesity in this study was limited by coding accuracy. Because obesity is not typically reimbursable, the likelihood of obesity being coded as a discharge diagnosis is particularly low, they noted.

Other study limitations include the potential for confounding in trend analyses due to sampling restrictions in the HCUP-KID, the availability of only inpatient data and changes in the way pediatric hypertension is managed.

The researchers called for more detailed studies to examine the effects of hypertension on resource use in outpatient settings to gain a more complete understanding of hypertension-related healthcare utilization and charges.

Tran CL et al. Hypertension. 2012; doi: 10.1161/​HYPERTENSIONAHA.111.188813

Samuels J. Hypertension. 2012; doi: 10.1161/​HYPERTENSIONAHA.112.197624.

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