Healthcare resource utilisation and costs associated with hypertension in children and adolescents: a population-based cohort study

Background — The global prevalence of paediatric hypertension has increased, contributing to long-term cardiovascular and kidney morbidity. However, healthcare resource utilisation and costs attributable to paediatric hypertension remain uncertain. This study evaluates healthcare utilisation and costs among hypertensive children compared to controls.

Methods — In a population-based retrospective cohort study, we analysed youth (aged 3–18 years) diagnosed with hypertension in Ontario, Canada (1993–2021). Using propensity score matching, 25,605 hypertensive children were compared to 128,025 controls and followed until death, emigration, or 31 March 2022. Healthcare utilisation (hospitalisations, emergency visits, outpatient visits) was assessed via negative binomial regression. Secondary outcomes included healthcare costs and specialist follow-up.

Findings — Median age was 15 years [IQR 11–17], 49% were female, and comorbidities were uncommon (4% (6497/153,630) congenital heart disease, 2% (9359/153,630) malignancy, 2% (2892/153,630) diabetes, 1% (2004/153,630) chronic kidney disease). Over a median follow-up of 12.9 [IQR 6.8–19.9] years, hypertensive children had higher hospitalisations (rate ratio [RR] 2.13, 95% CI 2.03–2.22), emergency visits (RR 1.08, 95% CI 1.05–1.11), and outpatient visits (RR 1.33, 95% CI 1.31–1.34). Mean healthcare costs were substantially higher in children with hypertension, especially in the first year ($16,690 vs $2659 per person-year).

Interpretation — Healthcare resource utilisation was significantly higher in youth with hypertension. These findings provide a basis for future cost-effectiveness studies on preventing paediatric hypertension and its complications.