Text

theses

BACKGROUND: Down’s syndrome is one of the most common genetic diseases that causes a disability to their hosts. The prevalence of this disability is reported in approximately one per seven hundred births and is influenced by several factors such as the age of the mother and environment of the pregnancy. Approximately ninety five percent of the cases are related to an abnormal addition of chromosome 21. There is a relationship to the translocation of certain genetic chromosomes. One example is the Robertsonian chromosomal abnormality. It is associated with the fusion of up to four percent of the chromosomes in Down’s syndrome patients. The main defects and abnormalities found in patients with Down’s syndrome are congenital deformity, heart disease and abnormal functions of the respiratory tract. These deformities negatively influence the life span and survival rates of the patients. The abnormal physiological functions of their body organs increase the need for healthcare professionals to manage the complications and mortality of the disease.

METHOD: The study implemented a cross sectional design to achieve the objectives of the present study. The data was downloaded and extracted, with permission, from the Nationwide Inpatient Sample (NIS). A total of 58,438 patients with Down’s syndrome were admitted to hospitals in the United States between the years of 2007-2012. The main variables of the NIS dataset involved non-clinical and clinical information. The non-clinical information included the patients’ demographic information, financial statuses, hospital information, length of stay and total charges. The clinical information involved the patients’ health status, comorbidities, number of procedures, healthcare services and mortality. The Statistical Package for the Social Sciences (SPSS) version 22 was used to analyze the data for the present study. All outcomes with a p-value of less than 0.05 were found to be significant. Multinomial logistic regression and multiple linear regressions (dummy method) were the appropriate statistical tests utilized to determine the predictors of the study outcomes.

RESULTS: The descriptive analysis of the present study revealed the highest incidences of the patient socio-demographic information were those who were younger than thirty years of age (55.2%), White (53.8%), Male (53.9%), on Medicare (36.7%) and had a household income in the 0-25th percentile (27.5%). The patients’ medical information showed the highest comorbidity with hypothyroidism (23.5%), fluid-electrolyte disorders (20.9%) and neurological disorders (14.2%). The incidence of mortality for Down’s syndrome patients was 2.9%. The mean (± SD) for the length of hospital stay and total charges are 7.34 (±12.605) days and $ 53678.26 (±120800.0) respectively. The admission of Down’s syndrome patients with Alzheimer’s disease was higher than those with Parkinson’s disease. The overall mortality showed a higher incidence with Alzheimer’s than with Parkinson’s disease (9.1% vs. 0.7%). The incidence of mortality increased with dementia and cardiac malformation by 13.49% and 7.78%, respectively. A significant association was found between Down’s syndrome complications and Parkinson’s disease in terms of atlantoaxial instability by 12.77%. The risk factors for the length of stay for Down’s syndrome only were congestive heart failure, fluid and electrolyte disorders and weight loss. The Down’s syndrome patients with Parkinson’s and Alzheimer’s diseases presented drug abuse and weight loss as the main risk factors for the length of hospital stay. The number of procedures is the predictor with the highest effect on total charges for Down’s syndrome patients. It is followed by coagulopathy and congestive heart failure. The predictors of total charges for Down’s syndrome patients with Parkinson’s and Alzheimer’s diseases presented drug abuse and the number of procedures as the main risk factors. The number of procedures showed the highest incidence of mortality for Down’s syndrome patients, followed by fluid and electrolyte disorders and age categories. In Down’s syndrome patients the risk factor with the highest incidence of mortality was pulmonary circulation disorder. The risk factor with the highest incidence of mortality was neurological disorders for Parkinson’s and Alzheimer’s diseases respectively.

CONCLUSION: Several factors were observed to increase the high risk of mortality, total charges and length of stay for Down’s syndrome patients included in the present study. The comorbidities can increase the costs and mortality. These are considered as serious risks for the patients’ outcome. The patients with Down’s syndrome showed little difference in the type and severity of risk factors between those with and without aging diseases. Although the mortality is higher with numerous risk factors in Down’s syndrome patients with Alzheimer’s disease, the severity of risk factors is higher with Parkinson’s disease. This is because of the complications that result from the Down’s syndrome related diseases. It will require more attention from the government, clinicians and researchers to manage the preventable risk factors to minimize the incidence of mortality and control the costs of therapy and health services administered to Down’s syndrome patients with and without aging diseases.

ETD_10430

Ph.D.

Includes bibliographical references

doi:10.7282/t3-4s24-4106

ETD doctoral

The author owns the copyright to this work.