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

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia 2023-01, Vol.29 (1), p.219-229
• Main Authors: Alam, Arafat Ul, Goodyear, M. Dawn, Wu, Cynthia, Sun, Haowei (Linda)
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cohort analysis; Cohort Studies; comorbidities; Comorbidity; Critical Care; Emergency medical care; haemophilia A; haemophilia B; health services research; Health services utilization; Hemophilia; Hemophilia A - complications; Hemophilia A - epidemiology; Hemophilia A - pathology; hospitalisations; Hospitalization; Humans; Life span; Liver diseases; Male; Malignancy; Mortality; Population studies; Population-based studies; Retrospective Studies; Risk Factors
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/hae.14680

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 utilisation and predictors of hospitalisation 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 utilisation including Emergency Department visits and hospitalisations. Logistic regression was applied to identify predictors of hospitalisation. Results We identified 198 and 329 persons with moderately severe haemophilia and mild/moderate, respectively. Moderately severe haemophilia had a higher risk of death (standardised 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 hospitalisations (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 hospitalisations among PWH. Conclusion Despite advanced care, haemophilia is associated with higher acute care utilisation than the general population, highlighting the substantial burden of illness on patients and the health care system.