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

Abstract

Background Although infectious diseases (IDs) remain a major public health problem in U.S. 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 U.S. 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 (OR for comparison of 2012 with 2000, 0.63; 95%CI, 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 $3,452 in 2003 to $3,784 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 U.S. children from 2000 to 2012, whereas skin infections statistically significantly increased. Additionally, the median direct cost per ID hospitalization increased by 10% during the study period.

Early nasal microbiota and acute respiratory infections during the first years of life

“…Clinical manifestations of ARI range from the self-limited common cold to severe (and even fatal) infections. Lower respiratory tract infections (LRTIs), including pneumonia and bronchiolitis, are the most frequent cause of hospitalisation in children, accounting for 50%–60% of hospitalisations before age 5 years 4. Some children are more susceptible to ARIs but known risk factors (such as age, household siblings, daycare and prematurity) do not completely explain the variability in the incidence and severity of ARIs.…”

Gestation at birth, mode of birth, infant feeding and childhood hospitalization with infection

“…Among children under five years of age infections, and repeat infections, are a leading reason for primary care and acute-care service use, and hospitalization (1,3,20,21). Planned birth or CS, GA <39 weeks and formula-only feeding were each independently associated with increased risk of hospitalization with infection.…”

“…infection by age five years, and one in ten have multiple hospitalizations (2,3). Reducing early planned birth and supporting breastfeeding may assist to reduce the risk of hospitalization.…”

Genomic Circuitry Underlying Immunological Response to Pediatric Acute Respiratory Infection

“…Lower respiratory tract infections (LRTIs, including bronchiolitis and viral and bacterial pneumonia) are the leading cause of pediatric hospital admission for infectious disease (Goto et al, 2016). Viral infections are the primary etiology of most ARTIs (Gooskens et al, 2014; Huijskens et al, 2012).…”