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. 2016 Jun;35(6):e158-63.
doi: 10.1097/INF.0000000000001134.

Trends in Infectious Disease Hospitalizations in US Children, 2000 to 2012

Tadahiro Goto  1 , Yusuke Tsugawa, Jonathan M Mansbach, Carlos A Camargo Jr, Kohei Hasegawa
Affiliations

Trends in Infectious Disease Hospitalizations in US Children, 2000 to 2012

Tadahiro Goto et al. Pediatr Infect Dis J. 2016 Jun.

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.

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Figures

Figure 1
Figure 1. Change in infectious disease hospitalization rates per 10,000 U.S. children, 2000–2012
From 2000 to 2012, the rate of overall ID hospitalizations decreased from 91.0 to 75.8 per 10,000 U.S. children (16.5% decrease; Ptrend<0.001). A similar decreasing trend was observed in children aged <1 year and children aged 1–4 years (both Ptrend=0.002).
Figure 2
Figure 2. Adjusted odds ratio of in-hospital mortality in in U.S. children hospitalized for infectious disease, 2000–2012
Models were adjusted for patient and hospital characteristics. The reference year is 2000. Error bars represent the 95% confidence interval. From 2000 to 2012, the adjusted OR significantly decreased (OR for comparison of 2012 with 2000, 0.63; 95%CI, 0.51–0.79; P<0.001).
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