Background: Anemia increases morbidity & mortality in all patients but mild and moderate anemia’s association with health care utilization over medium to short term is not well studied. Further research is needed to investigate how changes in hemoglobin levels, whether increasing or decreasing, may influence healthcare utilization as well.
Methods: We investigate 30-day, 6-month, and 12-month total hospital visits (encompassing ER visits and admissions), separately analyzing inpatient stays, and all-cause mortality in patients discharged from Lincoln Medical Center (Jan 1, 2022 – May 15, 2022). The comparison involves patients with mild, moderate anemia, and those without anemia.A retrospective chart review compared 2410 Lincoln Medical Center discharges, excluding 796 with severe anemia, active cancer, blood diathesis, or < 24-hour stays. Our study includes 1,614 patients categorized into control, mild anemia, and moderate anemia groups, comprising 851, 418, and 345 patients, respectively. Mild anemia was defined as a hemoglobin concentration between 10 and 11.9 g/dL, and moderate anemia between 7 and 9.9 g/dL.
Results: To assess the influence of Anemia on Hospital visits (ED and IP visits) between 1, 3, 6, and 12 months, A (one-way) ANOVA was performed. There was no statistically significant difference in total hospital visits between the study groups in the 3,6,12 months ( p = 0.730,p=0.084,p = 0.392). At 30 days, there were significant differences in total hospital visits (p = 0.005), with mean visits for Control, Mild Anemia, and Moderate Anemia at 0.4, 0.51, and 0.64, respectively. There were statistically significant differences in inpatient stays between the groups, at all time intervals, with a predominance of moderate anemia groups. The mean number of visits at 12 months were 1.325, 1.124, & 0.771 for Moderate, Mild and Control group (p< 0.001). Similar findings at 6 months, 3 months and 30 day mark with respective p values being 0.011,< 0.001, & < 0.001..Additionally, patients were categorized into four groups based on change in hemoglobin levels for more precise analysis: Mild increase 0-25%, significant increase >25% / mild decrease (0-(-25%), and significant decrease> (-25%). There were no significant statistical differences between the groups in total hospital visit numbers (ER+IP) in 1, 6, and 12 months (p=0.161 p=0691;p = 0.188). However, there were statistically significant differences for inpatient visit numbers in groups with significant changes compared to the groups with mild changes of Hg 1, 6, and 12-month periods. (p< 0.001). Patients who had a 25% or more drop in their hemoglobin had significantly more IP hospital stays versus other cohorts.We also found that there was some increase in Hemoglobin in patients with moderate anemia vs almost no change in those with mild anemia (calculated as mean value). Finally, all cause mortality was higher in Moderate Anemia as compared to control (p value: 0.025) but the difference between all cause mortality of mild and moderate anemia was not statistically different.
Conclusions: Conclusion – Patients with mild and moderate anemia as well as those with significant hemoglobin decrease have more hospitalizations compared to non-anemic patients and those without a significant hemoglobin change.
