Healthcare utilization in patients with spina bifida and bone fractures

OBJECTIVE: To compare bone fractures and fracture-related healthcare costs in individuals with and without spina bifida (SB). DESIGN: This is a retrospective observational trial. SUBJECTS/PATIENTS: California's Healthcare Access and Information database was utilized to identify all individuals with SB who sought care in California emergency departments, inpatient hospitals, or ambulatory surgery centres between 2005 and 2017. METHODS: Bone fracture encounters and associated healthcare utilization factors were compared among individuals with spina bifida vs individuals without spina bifida, matched 5:1 by birth year. RESULTS: Between 2005 and 2017, 20,290 individuals with spina bifida sought care in California emergency departments, inpatient hospitals, or ambulatory surgery centres. Compared with 101,450 individuals in the comparison group, those with spina bifida were more likely to seek care for a bone fracture (OR 1.64, p < 0.001) and more likely to sustain repeat fractures (36% vs 26%, p < 0.001). Individuals with spina bifida sustained more bone fractures per capita at each body location studied, with more than double the fractures per capita at the chest (2.0x), foot (2.1x), pelvis (2.4x), leg (2.5x), and vertebrae (2.5x). Individuals with spina bifida spent more cumulative days hospitalized for bone fractures (mean 9.4 vs 7.6, p < 0.001). CONCLUSION: Individuals with spina bifida were diagnosed with more bone fractures per capita than age-matched persons without spina bifida.