J. Morel Symons, an Epidemiology doctoral student at the Johns Hopkins Bloomberg School of Public Health, has co-authored a paper concluding that the use of home therapy for persons with hemophilia, and the receipt of care in hemophilia treatment centers, are each associated with a substantially lower risk for hemorrhagic bleeding complications (HBC) among males with haemophilia. The report appeared in the March 2001 issue of Haemophilia.
Symons and colleagues at the Centers for Disease Control and Prevention (CDC) and elsewhere found as well that patients who had government-sponsored health insurance or who had no insurance, those of minority race or ethnicity, those with higher levels of factor use, and those with inhibitors were all at increased HBC risk.
The researchers analyzed the medical records of 2,650 U.S. males with hemophilia living in six states in order to examine, among other variables, the influence of administering factor infusion therapy at home on rates of hospitalization for a HBC over a four-year period. Other risk determinants considered in the analyses included age, race, employment status, health insurance type, care received in federally funded hemophilia treatment centers, factor deficiency type and severity, and amount of factor prescribed.
During 8,708 person years (PYs) of follow-up, 808 subjects (30.5 percent) had a total of 1,847 bleeding-related hospitalizations; that is, an overall rate of 21.2 admissions per 100 PYs.
The researchers found that home therapy use (among residents of four of the states) and care in HTCs were each independently associated with a decreased risk for a first HBC. In contrast, patients who had government-sponsored health insurance or who had no insurance, those of minority race or ethnicity, those with higher levels of factor use, and those with inhibitors were at increased HBC risk.
The authors conclude that the use of home therapy and receipt of care in specialized HTCs are each associated with a substantially lower risk for HBC among males with hemophilia.
Authors: Soucie JM, Symons J 4th, Evatt B, Brettler D, Huszti H, Linden J; The Hemophilia Surveillance System Project Investigators.
Hematologic Diseases Branch, Division of AIDS, STD, and TB Laboratory Research, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
