Background: It is known that anemia is associated with increased morbidity and mortality in patients with chronic comorbidities. Here, we establish an association between mild and moderate anemia with increased healthcare utilization (HU).
Methods: We conducted a retrospective study analyzing HU comprising Emergency Room (ER) visits and Inpatient (IP) admissions over 12 months in patients discharged from Lincoln Medical Center between Jan 1 – May 15 of 2022, with mild and moderate anemia compared to no anemia patients at discharge. We defined Mild anemia as a hemoglobin level between 10 and 11.9 g/dL, and moderate anemia was between 7 and 9.9 g/dL. We analyzed HU using an ANOVA test across the three cohorts. Additionally, we categorized patients based on their Charleson Comorbidity Index (CCI) less than three and three or more to compare the association of chronic diseases with HU in each cohort using a t-test.
Results: We performed a Retrospective chart review of 2410 patients, where 758 with severe anemia, active cancer, and < 24-hour stays were excluded. We categorized the remaining 1,652 patients into control, mild, and moderate anemia groups based on the hemoglobin level at discharge, comprising 870, 437, and 345 patients, respectively. Based on our analysis, we have 940 males and 712 females, with 849 patients identified as Hispanics, 618 as African American, 103 as Caucasian, 11 as Asian, and 71 as belonging to other ethnicities. The average LOS for all admissions is 4.59 days, and there was no statistically significant difference based on sex, race or the CCI.Comparing HU based on IP visits at 1(p< 0.001), 3(p< 0.001), 6(p=0.011), and 12(p< 0.001) months showed a significant increase in HU with a mean of 1.325, 1.124, &0.771 at 12 month period in moderate, mild and control cohorts respectively.In comparison concerning CCI scores using the combined ED and IP visits at 12 months in the mild anemia group, patients with high CCI scores showed more frequent visits(p< 0.001) with a mean of 5.141 compared to 3.167 in the low CCI group. Patients with low CCI scores showed more frequent visits in the moderate anemia group, with a mean of 4.182 compared to 3.613 in the high CCI score group(p< 0.001). The Pearson Chi-square analysis was run on the groups to see which comorbidities have a significant association with health care utilization in 12 months comprising combined ER and IP visits, chronic diseases like Hypertension, Coronary artery Disease, Congestive heart failure, Peripheral vascular disease, chronic kidney disease (CKD), End Stage Renal Disease (ESRD), Cirrhosis, Peptic ulcer disease, cancer, and HIV had P< 0.05, with ESRD and CKD having the strongest association.
Conclusions: In this retrospective study, the rates of HU in patients with mild and moderate anemia were increased when compared to controls. Based on this analysis, we establish that moderate anemia patients require more follow-up visits as severe anemia patients due to increased acute HR.