Predominantly antibody deficiency (PAD) is associated with increased susceptibility to infections and chronic complications, yet we lack population-level data on its impact on hospitalization outcomes in the United States. We conducted a nationwide analysis to evaluate healthcare utilization, mortality, and discharge patterns among PAD patients compared with other hospitalized patients.
We performed a cross-sectional analysis from 2017 to 2020 using the National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project (HCUP) by the Agency for Healthcare Research and Quality. ICD-10 codes were used to identify PAD-associated admissions and assess hospitalization outcomes, including total hospital costs, length of stay, discharge disposition, and in-hospital mortality, as well as temporal trends in these outcomes.
We identified 36,276 PAD-associated admissions and 27,783,886 non-PAD–associated admissions from 2017 to 2020. Patients with PAD-associated admissions were older (mean age 54.9 vs. 49.9 years), predominantly female (57.2% vs. 55.9%), and predominantly white (81.1% vs. 62.2%). Patients with PAD had hospitalizations that were associated with higher total costs ($33,305 vs. $13,193, p < 0.0001) and longer length of stay (8.8 vs. 4.7 days, p < 0.0001) compared with non-PAD hospitalizations. PAD-associated admissions were less frequently discharged home routinely (59.9% vs. 67.7%, p < 0.0001) and more likely to require home health care (20.6% vs. 13.0%, p < 0.0001) or transfer to other facilities (13.1% vs. 13.7%, p < 0.0001). PAD-associated admissions had significantly higher in-hospital mortality rates (3.8% vs. 2.2%, p < 0.0001). Temporal analysis revealed worsening trends for PAD-associated hospitalizations over time. Total hospital costs increased significantly from $30,224 in 2017 to $40,458 in 2020 (p < 0.0001). The length of stay increased from 8.7 days in 2017 to 9.5 days in 2020 (p = 0.0001). Discharge to home health care became more frequent over time (19.2% in 2017 to 23.3% in 2020), while in-hospital mortality rose from 3.8% in 2017 to 4.5% in 2020 (p = 0.0025).
Patients with PAD had increased healthcare utilization and worse outcomes, including longer and more costly hospitalizations, and increased in-hospital mortality. These outcomes worsened in 2020, potentially reflecting the impact of COVID-19. Further investigation is warranted to identify underlying drivers and develop targeted strategies to improve outcomes in patients with PAD.
