Abstract Number: PB0496
Meeting: ISTH 2021 Congress
Theme: Hemophilia and Rare Bleeding Disorders » Hemophilia - Clinical
Background: Improvements in treatment strategies over time have led to increased life expectancy of patients with hemophilia (PWH). Consequently, age-related comorbidities become increasingly relevant and pose challenges in management.
Aims: We aimed to evaluate the prevalence of age-related comorbidities and health service utilization among adult men with hemophilia compared to the general population.
Methods: We conducted a retrospective cohort study using linked administrative data. Cases of hemophilia were identified in Alberta, Canada from 2012 to 2019 with a validated case definition and were age and sex-matched (1:3) with population controls. Comorbidities were identified by presence of at least 2 international classification of diseases (ICD) codes. Research ethics approval was obtained.
Results: We identified 206 and 36 male adult patients with hemophilia A (HA) and hemophilia B (HB), respectively. Thirty (12.6%) were over age 65. There was a significantly higher prevalence of hypertension (HA: 14.1% vs 6.6%), hyperlipidemia (HA: 2.4.% vs 0.3%), liver diseases (HA: 13.1% vs 0.8%, HB: 22.2% vs 0.0%) and malignancy (HA: 5.8% vs 2.3%, HB: 16.7% vs 2.8%) in hemophilia cases than controls (Table 1). However, prevalence of cardiovascular and other major organ diseases was not significantly different from the general population for both types of hemophilia. Hemophilia was associated with significantly higher rates of hospitalization (HA: 53.4% vs 18.8%, HB: 50.0% vs 17.6%), intensive care unit admission (HA: 5.8% vs 1.1%), emergency department visit (HA: 83.5% vs 68.4%, HB: 83.3% vs 63.3%), and longer surgical admission length of stay (HA: 15.7 vs 7.4 days) (Table 2).
| Hemophilia A | Hemophilia B | |||||
| Case N= 206 (%) |
Control N= 618 (%) |
P a value | Cases N= 36 (%) |
Control N= 108 (%) |
P a value | |
| Cardiovascular risk factors
Hypertension |
29 (14.1) 5 (2.4) 24 (11.7) 4 (1.9) 3 (1.5) |
41 (6.6) 2 (0.3) 48 (7.8) 3 (0.5) 6 (1.0) |
0.001 0.01 0.09 0.07 0.69 |
2 (5.6) 0 (0.0) 1 (2.8) 0 (0.0) 0 (0.0) |
6 (5.6) 1 (0.9) 5 (4.6) 0 (0.0) 1 (0.9) |
0.99 0.99 0.99 N/A 0.99 |
| Cardiovascular or coronary artery diseases
Coronary artery diseases |
9 (4.4) |
18 (2.9) |
0.21 |
1 (2.8) |
3 (2.8) |
0.99 |
| Venous thromboembolism | 0 (0.0) | 10 (1.6) | 0.07 | 0 (0.0) | 2 (1.9) | 0.99 |
| Malignancy | 12 (5.8) | 14 (2.3) | 0.02 | 6 (16.7) | 3 (2.8) | 0.008 |
| Chronic pulmonary disease | 9 (4.4) | 13 (2.1) | 0.08 | 0 (0.0) | 2 (1.9) | 0.99 |
| Liver disease | 27 (13.1) | 5 (0.8) | <0.001 | 8 (22.2) | 0 (0.0) | <0.001 |
| Neurological disease | 3 (1.5) | 12 (1.9) | 0.77 | 1 (2.8) | 3 (2.8) | 0.99 |
| a: Based on chi square or fisher’s exact test (as appropriate) |
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Prevalence of comorbidities among adult men with hemophilia compared with age- and sex-matched control population
| Hemophilia A | Hemophilia B | |||||
| Case N= 206 (%) |
Control N= 618 (%) |
P a value | Case N= 36 (%) |
Control N= 108 (%) |
P a value | |
| Hospital admission | 110 (53.4) | 116 (18.8) | <0.001 | 18 (50.0) | 19 (17.6) | <0.001 |
| Intensive care admission | 12 (5.8) | 11 (1.8) | 0.002 | 1 (2.8) | 3 (2.8) | 0.99 |
| Emergency department visit | 172 (83.5) | 423 (68.4) | <0.001 | 30 (83.3) | 68 (63.0) | 0.02 |
| Ambulatory orthopedic surgery visits | 56 (27.2) | 62 (10.0) | <0.001 | 7 (19.4) | 9 (8.3) | 0.12 |
| Orthopedic surgery inpatient admission | 22 (10.7) | 10 (1.6) | <0.001 | 1 (2.8) | 2 (1.9) | 0.99 |
| Hematology inpatient admissions | 11 (5.3) | 0 (0.0) | <0.001 | 1 (2.8) | 0 (0.0) | 0.25 |
| Mean LoS b (±SD c) in Surgery departments | 15.7 (±31.6) | 7.4 (±10.5) | 0.04 | 5.09 (±4.6) | 11.73 (±14.9) | 0.17 |
| a: Based on chi square or fisher’s exact test (as appropriate) for categorical variable and t-test for continuous variable; b: length of stay; c: standard deviation |
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Comparison of health service utilization of adult men with hemophilia and age and sex-matched control population
Conclusions: Despite advanced care, hemophilia is associated with higher acute care utilization than the general population. PWH have higher prevalence of malignancies and cardiovascular risk factors without increased risk of vascular diseases. Future studies are needed to examine the reasons for increased health service utilization.
To cite this abstract in AMA style:
Alam AU, Wu C, Sun H. Increased Prevalence of Age-related Comorbidities and Health Service Utilization among Adult Men with Hemophilia in Alberta, Canada [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/increased-prevalence-of-age-related-comorbidities-and-health-service-utilization-among-adult-men-with-hemophilia-in-alberta-canada/. Accessed September 29, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/increased-prevalence-of-age-related-comorbidities-and-health-service-utilization-among-adult-men-with-hemophilia-in-alberta-canada/