Kidney Week

Abstract: FR-PO386

Health Care Resource Utilization and Costs Associated with Childhood Hypertension: A Population-Based Cohort Study

Session Information

• Hypertension, CVD, and the Kidneys: Epidemiology
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Robinson, Cal, The Hospital for Sick Children Division of Nephrology, Toronto, Ontario, Canada

Cal Robinson, MBChB

• Hussain, Junayd, McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada

Junayd Hussain, MSc

• Brady, Tammy McLoughlin, Johns Hopkins Children's Center, Baltimore, Maryland, United States

Tammy McLoughlin Brady, MD, PhD

• Dionne, Janis M., BC Children's Hospital, Vancouver, British Columbia, Canada

Janis M. Dionne, MD

• Karam, Sabine, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States

Sabine Karam, MD

• McKay, Ashlene Maree, The Hospital for Sick Children Division of Nephrology, Toronto, Ontario, Canada

Ashlene Maree McKay, MD

• Parekh, Rulan S., Women's College Hospital, Toronto, Ontario, Canada

Rulan S. Parekh, MD, MS, FASN

• Shroff, Rukshana, University College London, London, United Kingdom

Rukshana Shroff, MD, PhD

• Vincent, Carol, Brenner Children's Hospital and Health Services, Winston-Salem, North Carolina, United States

Carol Vincent, MD

• Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada

Rahul Chanchlani, MD, MBBS, MS, FASN

Background

Pediatric hypertension has risen significantly in recent decades and has been linked to long-term cardiovascular and kidney-related morbidity. However, healthcare resource utilization and costs associated with pediatric hypertension are unclear. This study aims to compare healthcare resource use and costs between children with and without hypertension.

Methods

Population-based retrospective cohort study of children aged 3-18 years diagnosed with hypertension from 1996 to 2021 in Ontario, Canada, using validated case definitions in health administrative databases. Each case was propensity score-matched with five controls without hypertension. Children were followed until death, provincial emigration, or March 31, 2022. Our primary outcome was rates of healthcare system utilization, including hospitalizations, emergency department(ED), and outpatient physician visits, analyzed by negative binomial regression. Secondary outcomes were total healthcare system costs and specialist physician follow-up.

Results

We matched 25,605 children diagnosed with hypertension to 128,025 non-hypertensive controls. Baseline covariates were balanced after propensity score matching. Median age was 15 years[IQR 11-17], 49% were female, and prior comorbidities were uncommon(1% congenital heart disease, 1.7% malignancy, 0.4% diabetes). During median 12.9-year[IQR 6.8-19.9] follow-up, hypertensive children were more likely to be hospitalized(rate ratio [RR] 2.13, 95%CI 2.03-2.22, incidence rate [IR] 105.5 vs 62.8 events per 1000 person-years). Hypertensive children were also more likely to have an ED visit(RR 1.08, 95%CI 1.05-1.11) and outpatient visit(RR 1.33, 95%CI 1.31-1.34). Within 1 year of hypertension diagnosis, 40% of children saw a pediatrician, 24% saw a cardiologist, and 5% saw a nephrologist. Hypertension was associated with substantially higher total healthcare costs throughout follow-up(median $1375 vs. $384 per person-year).

Conclusion

Healthcare utilization and costs were significantly higher among children and adolescents diagnosed with hypertension than matched non-hypertensive children. These results provide a basis for future cost-effectiveness studies of strategies to prevent childhood hypertension occurrence and late complications.