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Severity of Illness in Patients with Systemic
Lupus Erythematosus Hospitalized at Academic Medical Centers
MICHAEL M. WARD
ABSTRACT. Methods. In this population based cross-sectional survey, data on all hospitalizations of patients with SLE in California, New York, and Pennsylvania in 2000 were obtained from discharge abstracts submitted by acute care hospitals to state health planning agencies. Patients hospitalized at one of 36 academic medical centers in these states (N = 2072) were compared to patients hospitalized at community hospitals (N = 9373). The primary measures of severity of illness were the SLE Comorbidity Index, a weighted index of SLE manifestations and comorbid medical conditions based on discharge diagnoses, and long lengths of stay, defined as stays that exceeded the 90th percentile of hospital stays in the same diagnosis-related group in the United States. Results. Compared to patients at community hospitals, patients at academic medical centers had substantially higher scores on the SLE Comorbidity Index (odds ratio for each 1-point increase 1.27, 95% confidence interval 1.15–1.40, p < 0.0001) and were more likely to have long lengths of stay (OR 1.65, 95% CI 1.42–1.91, p < 0.0001). Patients at academic medical centers also had higher scores on the SLE Comorbidity Index (OR for each 1-point increase 1.16, 95% CI 1.07–1.27, p = 0.0002) and were more likely to have long lengths of stay (OR 1.27, 95% CI 1.08–1.49, p = 0.004) compared to patients at large (≥ 300 beds) community hospitals in the same metropolitan areas. Results for the SLE Comorbidity Index were similar in the subset of patients with SLE as the primary discharge diagnosis. Conclusion. Patients with SLE hospitalized at academic medical centers are generally more severely ill than those hospitalized at community hospitals, including large community hospitals in the same area. (J Rheumatol 2005;32:27-33) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS From the Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA. M.M. Ward, MD, MPH. Address reprint requests to Dr. M.M. Ward, NIH/NIAMS/IRP, Building 10, Room 9S205, 10 Center Drive, MSC 1828, Bethesda, MD 20892-1828. E-mail: wardm1@mail.nih.gov Submitted February 9, 2004; revision accepted August 11, 2004. |