Increased acute care utilization, comorbidities and mortality in adults with haemophilia: A population-based cohort study from 2012 to 2019

Authors: Alam, AU; Goodyear, MD; Wu, C; Sun, HL

Affiliations: Department of Medicine, University of Alberta, Edmonton, Canada. Division of Hematology, Department of Medicine, University of Calgary, Calgary, Canada.

Publication: Haemophilia ; 2022 October

Abstract: INTRODUCTION: Improvements in treatment strategies have led to increased life expectancy of persons with haemophilia (PWH). Consequently, age-related comorbidities become increasingly relevant. AIM: To evaluate the prevalence of age-related comorbidities, mortality, health service utilization and predictors of hospitalization in PWH compared to the general population. METHODS: We conducted a population-based retrospective cohort study using linked administrative data. Men with haemophilia were identified in Alberta, Canada (2012-2019) with a validated case definition and were age-matched with male population controls. We calculated the prevalence of major comorbidities, all-cause mortality, and examined health service utilization including Emergency Department visits and hospitalizations. Logistic regression was applied to identify predictors of hospitalization. RESULTS: We identified 198 and 329 persons with moderately severe haemophilia and mild/moderate, respectively. Moderately severe haemophilia had a higher risk of death (standardized mortality ratio 3.2, 95% confidence interval [CI] 1.4-6.3) compared to the general population. PWH had a significantly higher prevalence of hypertension, liver diseases and malignancies than controls. Moderately severe haemophilia was associated with significantly higher rates of hospitalizations (52.5% vs. 14.5%), Emergency Department visits (89.1% vs. 62.7%) and intensive care admissions (8.9% vs. 2.3%). Age > 65 years (adjusted odds ratio [aOR] 6.8) and presence of multiple comorbidities (aOR 3.9) were significant predictors of hospitalizations among PWH. CONCLUSION: Despite advanced care, haemophilia is associated with higher acute care utilization than the general population, highlighting the substantial burden of illness on patients and the health care system.