Trends in Bronchiolitis Hospitalizations in the United States: 2000-2016

Abstract

Objectives: To investigate the temporal trend in the national incidence of bronchiolitis hospitalizations, their characteristics, inpatient resource use, and hospital cost from 2000 through 2016.

Methods: We performed a serial, cross-sectional analysis of nationally representative samples (the 2000, 2003, 2006, 2009, 2012, and 2016 Kids' Inpatient Databases) of children (age <2 years) hospitalized for bronchiolitis. We identified all children hospitalized with bronchiolitis by using International Classification of Diseases, Ninth Revision, Clinical Modification 466.1 and International Classification of Diseases, 10th Revision, Clinical Modification J21. Complex chronic conditions were defined by the pediatric complex chronic conditions classification by using inpatient data. The primary outcomes were the incidence of bronchiolitis hospitalizations, mechanical ventilation use, and hospital direct cost. We examined the trends accounting for sampling weights.

Results: From 2000 to 2016, the incidence of bronchiolitis hospitalization decreased from 17.9 to 13.5 per 1000 person-years in US children (25% decrease; P _trend < .001). In contrast, the proportion of bronchiolitis hospitalizations among overall hospitalizations increased from 16% to 18% (P _trend < .001). There was an increase in the proportion of children with a complex chronic condition (6%-13%; 117% increase), hospitalization to children's hospital (15%-29%; 93% increase), and mechanical ventilation use (2%-5%; 184% increase; all P _trend < .001). Likewise, the hospital cost increased from $449 million to $734 million (63% increase) nationally (with an increase in geometric mean of cost per hospitalization [from $3267 to $4086; 25% increase; P _trend < .001] adjusted for inflation) from 2003 to 2016.

Conclusions: From 2000 through 2016, the incidence of bronchiolitis hospitalizations among US children declined. In contrast, mechanical ventilation use and nationwide hospital direct cost substantially increased.

FIGURE 1

Incidence of bronchiolitis hospitalizations and all hospitalizations per 1000 children in the United States, 2000–2016. Overall, there was a significant decrease in the incidence of bronchiolitis hospitalization (25% decrease; P_trend < .001) and all hospitalizations (31% decrease; P_trend < .001) from 2000 through 2016. Likewise, there was a significant decrease in the incidence in infants (32% decrease; P_trend < .001). By contrast, there was a significant increase in children with complex chronic conditions (70% increase; P_trend < .001).

FIGURE 2

In-hospital mechanical ventilation use for US children with bronchiolitis according to different subpopulations, 2000–2016. Overall, the proportion of mechanical ventilation use in bronchiolitis hospitalizations increased from 2000 to 2016 (184% increase; P_trend < .001). Similarly, there was a significant increase in mechanical ventilation use across all different subpopulations (all P_trend < .001).

FIGURE 3

In-hospital invasive and noninvasive mechanical ventilation use for US children with bronchiolitis, 2000–2016. From 2000 to 2016, whereas the use of invasive mechanical ventilation modestly increased (34% increase; P_trend < .001), that of noninvasive mechanical ventilation substantially increased (1450% increase; P_trend < .001).