Comorbid Urolithiasis Significantly Increases Utilization Across Healthcare Settings for Individuals With Spina Bifida

Abstract

Objective: To capture the impact of comorbid urolithiasis on healthcare utilization in spina bifida (SB) patients.

Methods: We performed a secondary analysis of California's Department of Health Care Access and Information database from 2005 to 2017, comparing individuals with SB with urolithiasis (SB-Stone) to individuals with SB without urolithiasis (SB-Control). The primary outcome was the mean number of healthcare encounters per patient in inpatient, emergency department, and ambulatory surgery settings. We assessed charges and length of stay for inpatient encounters. Adjusted, multivariable logistic regression identified factors associated with 9+ encounters per patient-representing the median value of encounters for the SB-Control group. An alpha P-value of .01 determined statistical significance.

Results: The mean number of encounters per patient was 35.4 for SB-Stone patients vs 15.6 for SB-Control (P <.001) and was significantly increased across all settings. SB-Stone patients had increased mean cumulative charges and mean cumulative length of stay for inpatient encounters (both P <.001). On multivariate analysis, urolithiasis was independently associated with increased odds of 9+ encounters (Odds Ratio: 2.47; 95% Confidence Interval: 2.17-2.81). In the SB-Stone group, increased Charlson Comorbidity Index (1.49; 1.39-1.59) was associated with greater odds of 9+ encounters.

Conclusion: Urolithiasis in individuals with SB disproportionately increases healthcare utilization. Increasing comorbidity is associated with increased risk of encounters for SB-Stone patients, further amplifying the vulnerability of this patient population in terms of healthcare utilization.