Association of Clinical Severity With Family Affluence–Based Socioeconomic Status Among Hospitalized Pediatric Hand, Foot, and Mouth Disease Patients in Henan, China: A Single Hospital-Based Case Series Study

Abstract

Background The association between the clinical severity of HFMD inpatients and socioeconomic status (SES) is important for quantifying SES inequality in HFMD disease burden and informing decision-makers regarding medical subsidy and reimbursement policies. Here, this association was investigated using a quantitative SES measurement. Methods Laboratory-confirmed HFMD cases hospitalized at Henan Children’s Hospital from February 15, 2017 to February 15, 2018 were invited. We utilized the revised Family Affluence Scale for family-affluence-based SES measurement. Clinical severity was diagnosed based on central nervous system (CNS) complications, treatments and length of stay. We applied logistic regression for association analyses and multiple imputation for missing data. Results A total of 1229 laboratory-confirmed HFMD inpatients responded. Adjusted by age, sex, rural residence, EV-A71 infection and health-seeking behavior, CNS complications (OR=2.72, 95%CI: 1.41-5.31), ICU admission (OR=7.30, 95%CI: 2.21-25.97) and prolonged hospitalization (OR=4.28, 95%CI: 2.44-7.58) were significantly associated with lower family-affluence-based SES. These associations increased as SES category descended. For EV-A71-infected inpatients, severe HFMD was significantly associated with low and intermediate SES. For non-EV-A71-infected inpatients, only the association of prolonged hospitalization with low SES increased significantly. Also, severe HFMD inpatients, especially those admitted to ICU, incurred high hospitalization costs. Conclusions The clinical severity of HMFD inpatients was significantly associated with family-affluence-based SES. Severe HFMD inpatients were more likely to have lower SES than non-severe inpatients and suffered heavy economic burden. Therefore, medical subsidy and reimbursement policies should offer sufficient monetary support to severe HFMD inpatients, to alleviate economic burden of low-SES populations and reduce potential SES inequality.

Disease burden in patients with severe hand, foot, and mouth disease in Jiangsu Province: a cross-sectional study

“…A previous study revealed that the socioeconomic status of the families of patients with severe HFMD may be lower, and that they may suffer a heavy economic burden. 15 Poor families are therefore more likely to suffer a heavier burden of disease. In addition, the results also indicated that reimbursement costs accounted for 61.96% of hospitalization costs.…”

“…14 Meanwhile, one study has pointed out that patients with severe HFMD are more likely to have a lower socioeconomic status and suffer a heavy economic burden. 15 Living with severe HFMD can carry a huge financial burden on individuals and families. In addition, severe HFMD can adversely affect the physical and mental health, as well as the quality of life among children.…”