Tadahiro Goto1, Yusuke Tsugawa, Jonathan M Mansbach, Carlos A Camargo, Kohei Hasegawa. 1. From the *Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; †Harvard Interfaculty Initiative in Health Policy, Harvard University, Boston, MA; and ‡Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: Although infectious diseases (IDs) remain a major public health problem in US children, there have been no recent efforts to examine comprehensively the change in epidemiology of ID hospitalizations. METHODS: A serial cross-sectional analysis using the Kids' Inpatient Database 2000, 2003, 2006, 2009, and 2012. We identified children ≤19 years of age with a primary diagnosis of IDs. Outcomes were national rate of ID hospitalizations, in-hospital mortality, length-of-stay and hospitalization-related direct costs. Negative binomial and multivariable logistic models were constructed to test the change in hospitalization rate and in-hospital mortality, respectively. RESULTS: We identified 3,691,672 weighted hospitalizations for IDs, accounting for 24.5% of all pediatric hospitalizations. From 2000 to 2012, the rate of overall ID hospitalizations decreased from 91.0 to 75.8 per 10,000 US children (P < 0.001). The most frequently listed ID subgroup was lower respiratory infections (42.8% of all ID hospitalizations in 2012). Although the hospitalization rate for most ID subgroups decreased, the hospitalization rate for skin infections significantly increased (67.6% increase; P < 0.001). The multivariable model demonstrated a significant decline in in-hospital mortality (odds ratio for comparison of 2012 with 2000, 0.63; 95% confidence interval, 0.51-0.79). From 2000 to 2012, there was no significant change in the median length-of-stay (2 days in 2000 to 2 days in 2012; Ptrend = 0.33). The median direct cost for ID hospitalization increased from $3452 in 2003 to $3784 in 2012 (P = 0.007), with the nationwide direct cost of $4.4 billion in 2012. CONCLUSIONS: We found a statistically significant decline in overall ID hospitalization rate among US children from 2000 to 2012, whereas skin infections statistically significantly increased. In addition, the median direct cost per ID hospitalization increased by 10% during the study period.
BACKGROUND: Although infectious diseases (IDs) remain a major public health problem in US children, there have been no recent efforts to examine comprehensively the change in epidemiology of ID hospitalizations. METHODS: A serial cross-sectional analysis using the Kids' Inpatient Database 2000, 2003, 2006, 2009, and 2012. We identified children ≤19 years of age with a primary diagnosis of IDs. Outcomes were national rate of ID hospitalizations, in-hospital mortality, length-of-stay and hospitalization-related direct costs. Negative binomial and multivariable logistic models were constructed to test the change in hospitalization rate and in-hospital mortality, respectively. RESULTS: We identified 3,691,672 weighted hospitalizations for IDs, accounting for 24.5% of all pediatric hospitalizations. From 2000 to 2012, the rate of overall ID hospitalizations decreased from 91.0 to 75.8 per 10,000 US children (P < 0.001). The most frequently listed ID subgroup was lower respiratory infections (42.8% of all ID hospitalizations in 2012). Although the hospitalization rate for most ID subgroups decreased, the hospitalization rate for skin infections significantly increased (67.6% increase; P < 0.001). The multivariable model demonstrated a significant decline in in-hospital mortality (odds ratio for comparison of 2012 with 2000, 0.63; 95% confidence interval, 0.51-0.79). From 2000 to 2012, there was no significant change in the median length-of-stay (2 days in 2000 to 2 days in 2012; Ptrend = 0.33). The median direct cost for ID hospitalization increased from $3452 in 2003 to $3784 in 2012 (P = 0.007), with the nationwide direct cost of $4.4 billion in 2012. CONCLUSIONS: We found a statistically significant decline in overall ID hospitalization rate among US children from 2000 to 2012, whereas skin infections statistically significantly increased. In addition, the median direct cost per ID hospitalization increased by 10% during the study period.
Authors: Eyal Leshem; Jacqueline E Tate; Claudia A Steiner; Aaron T Curns; Ben A Lopman; Umesh D Parashar Journal: JAMA Date: 2015-06-09 Impact factor: 56.272
Authors: Jacqueline E Tate; Amber Haynes; Daniel C Payne; Margaret M Cortese; Benjamin A Lopman; Manish M Patel; Umesh D Parashar Journal: Pediatr Infect Dis J Date: 2013-07 Impact factor: 2.129
Authors: Niranjan Bhat; Jennifer G Wright; Karen R Broder; Erin L Murray; Michael E Greenberg; Maleeka J Glover; Anna M Likos; Drew L Posey; Alexander Klimov; Stephen E Lindstrom; Amanda Balish; Marie-jo Medina; Teresa R Wallis; Jeannette Guarner; Christopher D Paddock; Wun-Ju Shieh; Sherif R Zaki; James J Sejvar; David K Shay; Scott A Harper; Nancy J Cox; Keiji Fukuda; Timothy M Uyeki Journal: N Engl J Med Date: 2005-12-15 Impact factor: 91.245
Authors: Sheldon L Kaplan; William J Barson; Philana Ling Lin; José R Romero; John S Bradley; Tina Q Tan; Jill A Hoffman; Laurence B Givner; Edward O Mason Journal: Pediatr Infect Dis J Date: 2013-03 Impact factor: 2.129
Authors: Kohei Hasegawa; Yusuke Tsugawa; David F M Brown; Jonathan M Mansbach; Carlos A Camargo Journal: Pediatrics Date: 2013-06-03 Impact factor: 7.124
Authors: Daniel J Pallin; Daniel J Egan; Andrea J Pelletier; Janice A Espinola; David C Hooper; Carlos A Camargo Journal: Ann Emerg Med Date: 2008-01-28 Impact factor: 5.721
Authors: Jordan L Kennedy; Dana L Haberling; Chaorui C Huang; Fernanda C Lessa; David E Lucero; Demetre C Daskalakis; Neil M Vora Journal: Chest Date: 2019-04-29 Impact factor: 9.410
Authors: Sarah E Henrickson; Sasikanth Manne; Douglas V Dolfi; Kathleen D Mansfield; Kaela Parkhouse; Rakesh D Mistry; Elizabeth R Alpern; Scott E Hensley; Kathleen E Sullivan; Susan E Coffin; E John Wherry Journal: Cell Rep Date: 2018-01-09 Impact factor: 9.423
Authors: Kohei Hasegawa; Christopher J Stewart; Jonathan M Mansbach; Rachel W Linnemann; Nadim J Ajami; Joseph F Petrosino; Carlos A Camargo Journal: BMC Res Notes Date: 2017-07-26
Authors: Leah Cuthbertson; Stephen W C Oo; Michael J Cox; Siew-Kim Khoo; Des W Cox; Glenys Chidlow; Kimberley Franks; Franciska Prastanti; Meredith L Borland; James E Gern; David W Smith; Joelene A Bizzintino; Ingrid A Laing; Peter N Le Souëf; Miriam F Moffatt; William O C Cookson Journal: PLoS One Date: 2019-10-17 Impact factor: 3.240