Respiratory tract infection-related healthcare utilisation in children with Down’s syndrome

Abstract

Purpose Children with Down's syndrome (DS) are prone to respiratory tract infections (RTIs) due to anatomical variation, immune system immaturity and comorbidities. However, evidence on RTI-related healthcare utilisation, especially in primary care, is incomplete. In this retrospective cohort study, we use routinely collected primary and secondary care data to quantify RTI-related healthcare utilisation in children with DS and matched controls without DS. Methods Retrospective cohort study of 992 children with DS and 4874 matched controls attending English general practices and hospitals as identified in Clinical disease research using LInked Bespoke studies and Electronic health Records (CALIBER) from 1997 to 2010. Poisson regression was used to calculate consultation, hospitalisation and prescription rates, and rate ratios. Wald test was used to compare risk of admission following consultation. The Wilcoxon rank-sum test was used to compare length of stay by RTI type and time-to-hospitalisation. Results RTI-related healthcare utilisation is significantly higher in children with DS than in controls in terms of GP consultations (adjusted RR 1.73; 95% CI 1.62-1.84), hospitalisations (adjusted RR 5.70; 95% CI 4.82-6.73), and antibiotic prescribing (adjusted RR 2.34; 95% CI 2.19-2.49). Two percent of children with DS presenting for an RTI-related GP consultation were subsequently admitted for an RTI-related hospitalisation, compared to 0.7% in controls. Conclusions Children with DS have higher rates of GP consultations, hospitalisations and antibiotic prescribing compared to controls. This poses a significant burden on families. Further research is recommended to characterise healthcare behaviours and clinical decision-making, to optimise care for this at risk group.

Effect of antibiotics in preventing hospitalizations from respiratory tract infections in children with Down syndrome

“…This finding has added significance because children with DS may be more at risk of antibiotic resistance given immune system immaturity and increased likelihood of receiving multiple antibiotic courses 27–30 . Despite this, children with DS are prescribed antibiotics for RTIs more frequently than healthy controls, at a rate of 42 per 100 person years for children with DS versus 19 per 100 person years for controls (adjusted RR, 2.26) 9 . The reasons for this are unclear and may be due to perceived benefits in other areas that have not been well‐studied.…”

“…[27][28][29][30] Despite this, children with DS are prescribed antibiotics for RTIs more frequently than healthy controls, at a rate of 42 per 100 person years for children with DS versus 19 per 100 person years for controls (adjusted RR, 2.26). 9 The reasons for this are unclear and may be due to perceived benefits in other areas that have not been well-studied. Previous studies have suggested that prescribing decisions are also related to parental expectation, uncertainty, and pressure from employers.…”

“…This methodology is also reported in our paper investigating RTI-related healthcare utilization in children with DS. 9…”

“…7 These respiratory infections account for a large proportion of healthcare utilization in children with DS, especially at younger ages. 9 In an Australian study of 3786 hospitalizations in 405 children with DS, 26.7% of all admissions were due to RTIs, with 52.6% of all children with DS experiencing any hospital admission due to an RTI. 8 When compared to published admission rates for the pediatric population in Western Australia, significant differences were noted-the rate ratio for hospitalizations with respiratory system-related diagnoses in children with DS was 17.9.…”

“…A study of 22 children with DS age‐matched to 22 healthy siblings found children with DS had a significantly higher frequency of lower RTIs (LRTIs) compared to their siblings alongside observed immune parameter differences 7 . These respiratory infections account for a large proportion of healthcare utilization in children with DS, especially at younger ages 9 . In an Australian study of 3786 hospitalizations in 405 children with DS, 26.7% of all admissions were due to RTIs, with 52.6% of all children with DS experiencing any hospital admission due to an RTI 8 .…”