141st APHA Annual Meeting and Exposition

In This section

291890
Injury hospitalizations and associated costs between individuals with pre-existing quadriplegia versus paraplegia

Wednesday, November 6, 2013

Erin O. Heiden, MPH , Department of Community & Behavioral Health, University of Iowa, Iowa City, IA
Jingzhen Yang, PhD, MPH , Department of Social and Behavioral Sciences, Kent State University, Kent, OH
Corinne Peek-Asa, PhD, MPH , Occupational and Environmental Health, University of Iowa, Iowa City, IA
Richard K. Shields, PT, PhD , Department of Physical Therapy and Rehabilitation Science, University of Iowa Carver College of Medicine, Iowa City, IA
Marizen Ramirez, MPH, PhD , Occupational and Environmental Health, University of Iowa, Iowa City, IA
Shelly Campo, PhD , Community and Behavioral Health, University of Iowa, College of Public Health, Iowa City, IA
Purpose: To compare the differences in injury hospitalizations, including length of stay (LOS) and hospital costs, between individuals with pre-existing quadriplegia versus paraplegia, and determine factors associated with increased hospital costs. Methods: A retrospective cohort of injury hospitalizations among individuals with pre-existing quadriplegia or paraplegia in the Nationwide Inpatient Sample (2003-2009) was analyzed. Differences between patients with quadriplegia versus paraplegia in cause of subsequent injury, LOS, and hospital costs were compared using chi-square tests or independent t-test. Multivariable linear regression was conducted to estimate mean difference in hospital costs for injury hospitalizations among individuals with quadriplegia compared to paraplegia. Results: Over the seven-year period, national injury hospitalizations were 12,565 and 15,551 for individuals with pre-existing quadriplegia and paraplegia, respectively (an average of 1,795 and 2,222 per year). Over one-third of injury hospitalizations were due to falls. Patients who died were significantly more likely to be individuals with quadriplegia versus paraplegia. Despite fewer injury hospitalizations overall, individuals with quadriplegia have longer LOS, and higher average and total costs for injury hospitalizations due to falls and motor vehicle traffic, but similar outcomes for poisonings compared to individuals with paraplegia. Hospital costs also increased significantly for uninsured individuals or those with 2 or more comorbidities, compared to those covered by Medicare/Medicaid or without other comorbidities. Conclusions: Fewer injury hospitalizations, but longer hospital stays and higher hospital costs per discharge, were found for individuals with quadriplegia compared to individuals with paraplegia. Interventions to prevent subsequent injuries in this special population are urgently needed.

Learning Areas:
Epidemiology
Public health or related research

Learning Objectives:
Discuss the differences in patient and injury characteristics of subsequent injury hospitalizations among individuals with pre-existing paraplegia versus quadriplegia, respectively. Differentiate hospital costs from hospital charges in describing the economic burden of subsequent injury hospitalizations. Describe predictors of increased hospital costs per discharge for subsequent injury hospitalizations among individuals with preexisting quadriplegia and paraplegia, respectively.

Keywords: Injuries, Special Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: For the past 5 years, I have worked with the Nationwide Inpatient Sample database to investigate subsequent injury hospitalizations among individuals with spinal cord injury. My scientific interests during my doctoral program include injury prevention, health and safety for individuals with disabilities, and workplace wellness.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.