Socioeconomic Status Associated With Length of Hospital Stay in Pediatric Lupus

Low household income was found to be a predictor for prolonged hospital stay in children with systemic lupus erythematosus (SLE), according to study findings published in Arthritis Care & Research.

Hospitalization records data were collected from the Kids’ Inpatient Database. Patients aged from 2 to 20 years who were hospitalized for SLE in 2016 were included in the cross-sectional analysis. Demographic and clinical information were also collected from discharge records.

The primary study outcome was hospital length of stay, measured in days. The primary predictor was income, which was divided into 4 strata, including $1 to $42,999 for quartile 1; $43,000 to $53,999 for quartile 2; $54,000 to $70,999 for quartile 3; and $71,000 and higher for quartile 4.

Multivariate negative binomial regression was used to assess the impact of household income on hospital length of stay. Logistic regression was used to identify predictors of severe lupus features in hospitalized patients.

Data from 3136 hospitalizations were used in the analysis. Median age at hospitalization was 18 years, and the majority of hospitalized patients were girls (82%-87% across income quartiles).

Income level was found to be a statistically significant predictor of hospital length of stay; patients in the lowest vs highest income quartile had a 12% increased length of stay. In addition, patients in the 2 lowest income quartiles vs the highest quartile were more likely to have a prolonged (≥4 day) hospital stay.

Compared with White patients, Black patients (odds ratio [OR], 1.51; 95% CI, 1.11-2.06) and patients of other races (OR, 1.61; 95% CI, 1.01-2.55) were more likely to present with severe lupus features, such as lupus nephritis. Patients with public vs private insurance were also more likely to experience severe lupus features (OR, 1.51; 95% CI, 1.17-2.55).

Results from the analysis highlighted low household income as a significant predictor of hospital length of stay in patients with SLE. Race and insurance status were also associated with disease severity in hospitalized patients.

One of the study limitations was that income data were derived using the median income estimates for patients’ zip codes of residence rather than by self-report.

“Future work is required to better understand the role of economic deprivation and poverty and possible intersection with identified racial disparities in the outcomes of pediatric rheumatic diseases,” the study authors wrote.