Skip to main content

Advertisement

Log in

Socioeconomic predictors of cost and length of stay for erythroderma: a cross-sectional analysis of the national inpatient sample

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Erythroderma is an uncommon but serious dermatologic disorder that often requires hospitalization for diagnosis and treatment. However, little is known about predictors influencing cost and patient outcomes. The present study sought to characterize the sociodemographic factors that predict patient outcomes and hospital cost. Data were obtained from the 2016–2018 National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality for patients of any age with a primary or secondary diagnosis of exfoliative dermatitis. Regression analyses were performed to find predictors for hospital costs and patient outcomes, represented by the length of stay (LOS). Univariate analysis of LOS revealed urban teaching hospitals were associated with prolonged LOS (p = 0.023). Univariate analysis of hospital cost yielded the following factors associated with increased hospital cost: Black and Asian patients (p = .045), urban teaching hospitals (p = .035), and northeast or south geographic location (p = .004). Multivariable regression analysis revealed prolonged LOS was associated with female sex (p = .043) and large bed capacity (p = .044) while shorter LOS was associated with increased age (p = .025); lower hospital costs were associated with private-owned hospitals −  (p = .025). In patients diagnosed with erythroderma, there appear to be racial, economic, and geographic disparities for patients that lead to greater hospital costs and longer LOS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Data availability

The authors verify that the data is accurate and data can be made available upon request with IRB and institution approval.

References

  1. Applebaum E (2022) Private equity is a driving force behind devious surprise billing. Available at: https://thehill.com/opinion/healthcare/444011-private-equity-a-driving-force-behinddevious-surprise-billing. Accessed 30 June 2022

  2. Ashbaugh AG, Ekelem C, Landaverde Y, Mesinkovska NA (2020) Psoriatic disease in the US Latino population: a comprehensive review. Am J Clin Dermatol 21(2):265–274. https://doi.org/10.1007/s40257-019-00498-8

    Article  PubMed  Google Scholar 

  3. Ayyala HS, Weisberger JS, Malhotra R, Lee ES (2020) The cost of the “july effect” in microsurgery. Ann Plast Surg 85(4):392–396. https://doi.org/10.1097/SAP.0000000000002294

    Article  CAS  PubMed  Google Scholar 

  4. Barry WA, Rosenthal GE (2003) Is there a July phenomenon? The effect of July admission on intensive care mortality and length of stay in teaching hospitals. J Gen Intern Med 18(8):639–645. https://doi.org/10.1046/j.1525-1497.2003.20605.x

    Article  PubMed  PubMed Central  Google Scholar 

  5. Benlagha I, Nguyen BM (2021) Changes in dermatology practice characteristics in the United States from 2012 to 2017. JAAD Int 3:92–101. https://doi.org/10.1016/j.jdin.2021.03.005

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bruch JD, Gondi S, Song Z (2020) Changes in hospital income, use, and quality associated with private equity acquisition. JAMA Intern Med 180(11):1428–1435. https://doi.org/10.1001/jamainternmed.2020.3552

    Article  PubMed  Google Scholar 

  7. César A, Cruz M, Mota A, Azevedo F (2016) Erythroderma. A clinical and etiological study of 103 patients. J Dermatol Case Rep 10(1):1–9. https://doi.org/10.3315/jdcr.2016.1222

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cooper Z, Nguyen H, Shekita N, Morton FS (2019) Out-of-network billing and negotiated payments for hospital-based physicians: the cost impact of specialists who bill patients at out-of-network rates even though the patients do not choose and cannot avoid these specialists, such as anesthesiologists. Health Aff. https://doi.org/10.1377/hlthaff.2019

    Article  Google Scholar 

  9. Elson LE, Luke AA, Barker AR, McBride TD, Joynt Maddox KE (2021) Trends in hospital mortality for uninsured rural and urban populations, 2012–2016. J Rural Health 37(2):318–327. https://doi.org/10.1111/jrh.12425

    Article  PubMed  Google Scholar 

  10. Feng H, Berk-Krauss J, Feng PW, Stein JA (2018) Comparison of dermatologist density between urban and rural counties in the United States. JAMA Dermatol 154(11):1265–1271. https://doi.org/10.1001/jamadermatol.2018.3022

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fleishon HB, Vijayasarathi A, Pyatt R, Schoppe K, Rosenthal SA, Silva E 3rd (2019) White paper: corporatization in radiology. J Am Coll Radiol 16(10):1364–1374. https://doi.org/10.1016/j.jacr.2019.07.003

    Article  PubMed  Google Scholar 

  12. Gasparini A (2018) comorbidity: An R package for computing comorbidity scores. J Open Source Softw 3(23):648. https://doi.org/10.21105/joss.00648

    Article  Google Scholar 

  13. HCUP Nationwide Inpatient Sample (NIS) (2021) Cost-to-charge ratio for inpatient files. Agency for Healthcare Research and Quality, Rockville, MD. Available at: https://www.hcup-us.ahrq.gov/db/ccr/ip-ccr/ip-ccr.jsp. Accessed 9 Oct 2021

  14. Hsu D, Brieva J, Silverberg JI (2016) Costs of care for hospitalization for pemphigus. JAMA Dermatol 152(6):645–654. https://doi.org/10.1001/jamadermatol.2015.5240

    Article  PubMed  Google Scholar 

  15. Inamadar AC, Ragunatha S (2019) The rash that becomes an erythroderma. Clin Dermatol 37(2):88–98. https://doi.org/10.1016/j.clindermatol.2018.12.002

    Article  PubMed  Google Scholar 

  16. Konda S, Francis J (2020) The evolution of private equity in dermatology. Clin Dermatol 38(3):275–283. https://doi.org/10.1016/j.clindermatol.2020.02.007

    Article  PubMed  Google Scholar 

  17. Miyashiro D, Sanches JA (2020) Erythroderma: a prospective study of 309 patients followed for 12 years in a tertiary center. Sci Rep 10(1):9774. https://doi.org/10.1038/s41598-020-66040-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Olanipekun T, Chris-Olaiya A, Esperti S, Nambudiri V, Duff R, Westney G (2021) July effect on mortality and complications in patients with ARDS in US teaching hospitals. Am J Crit Care 30(4):e64–e70. https://doi.org/10.4037/ajcc2021608

    Article  PubMed  Google Scholar 

  19. Pagan M, Mercier AM, Whitcombe D, Ounpraseuth ST, Magann EF, Phillips A (2022) July effect in obstetric outcomes. Int J Womens Health 14:149–154. https://doi.org/10.2147/IJWH.S341044

    Article  PubMed  PubMed Central  Google Scholar 

  20. Patel AA, Fernandez C, Mazmudar A (2021) Private equity and its emergence in orthopaedics. J Am Acad Orthop Surg 29(20):e1005–e1012. https://doi.org/10.5435/JAAOS-D-21-00058

    Article  PubMed  Google Scholar 

  21. Ravi M, Trinidad J, Spaccarelli N, Kaffenberger BH (2021) A cross-sectional hospital study of erythroderma. Int J Dermatol 60(5):e203–e205. https://doi.org/10.1111/ijd.15342

    Article  PubMed  Google Scholar 

  22. Shwe S, Kassira S, Kim DJ, Elsensohn A, Lee P (2019) How to navigate dermatology care for the uninsured. J Am Acad Dermatol 80(6):1809–1813. https://doi.org/10.1016/j.jaad.2018.06.072

    Article  PubMed  Google Scholar 

  23. Silverberg J (2015) Racial and ethnic disparities in atopic dermatitis. Curr Derm Rep 4:44–48

    Article  Google Scholar 

  24. Tsai S, Ezaldein HH, Conic RRZ, Merati M, Scott JF (2019) Inpatient dermatology consultations and the July effect: a retrospective cohort study. J Am Acad Dermatol 81(1):267–269. https://doi.org/10.1016/j.jaad.2019.02.030

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tso S, Moiz H, Satchwell F, Hari T, Dhariwal S, Barlow R, Forbat E, Blee IC, Tan YT, Thind C, Ilchyshyn A, Randeva H, Kwok MM, Tso A, Barber TM (2021) Erythroderma (exfoliative dermatitis). Part 2: energy homeostasis and dietetic management strategies. Clin Exp Dermatol 46(6):1011–1015. https://doi.org/10.1111/ced.14667

    Article  CAS  PubMed  Google Scholar 

  26. Tso S, Satchwell F, Moiz H, Hari T, Dhariwal S, Barlow R, Forbat E, Randeva H, Tan YT, Ilchyshyn A, Kwok MM, Barber TM, Thind C, Tso A (2021) Erythroderma (exfoliative dermatitis). Part 1: underlying causes, clinical presentation and pathogenesis. Clin Exp Dermatol 46(6):1001–1010. https://doi.org/10.1111/ced.14625

    Article  CAS  PubMed  Google Scholar 

  27. van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ (2009) A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care 47(6):626–633. https://doi.org/10.1097/MLR.0b013e31819432e5

    Article  PubMed  Google Scholar 

  28. Zogg CK, Metcalfe D, Sokas CM, Dalton MK, Hirji SA, Davis KA, Haider AH, Cooper Z, Lichtman JH (2021) Reassessing the July effect: 30 years of evidence show no difference in outcomes. Ann Surg. https://doi.org/10.1097/SLA.0000000000004805

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nahid Y. Vidal.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, Yh., Bhandarkar, A.R., Adeleye, O. et al. Socioeconomic predictors of cost and length of stay for erythroderma: a cross-sectional analysis of the national inpatient sample. Arch Dermatol Res 315, 869–877 (2023). https://doi.org/10.1007/s00403-022-02463-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-022-02463-8

Keywords

Navigation