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Pediatric infectious disease hospitalizations declined since 2000


 

FROM THE PEDIATRIC INFECTIOUS DISEASE JOURNAL

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The rate of pediatric hospitalizations for infectious diseases has decreased overall among U.S. children from 2000 to 2012, though skin infection hospitalizations have climbed, a recent study found.

“The observed reduction in infectious disease hospitalizations (vaccine-preventable diseases and others) supports a cautious optimism that the infectious disease-related morbidity can be further reduced,” Dr. Tadahiro Goto of the department of emergency medicine at Massachusetts General Hospital, Boston, and coauthors reported online. Yet approximately 625,000 children were still hospitalized for infectious diseases in 2012. “These findings should facilitate continued efforts, such as bridging the gaps in immunization coverage, to reduce the infectious disease–related morbidity and health care utilization nationally,” the authors wrote (Pediatr Infect Dis J. 2016 Mar 10. doi: 10.1097/INF.0000000000001134).

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The researchers analyzed all cases of youth under age 20 years with an infectious disease diagnosis who were included in the nationally representative Kids’ Inpatient Database for 2000, 2003, 2006, 2009 and 2012.

In their cross-sectional analysis, the authors identified more than 2.2 million pediatric infectious disease hospitalizations, which translated to a weighted estimate of nearly 3.7 million across the five datasets. These hospitalizations comprised almost a quarter (24.5%) of all pediatric hospitalizations over those 12 years, but their rate dropped 16.5%, from 91/10,000 children in 2000 to 75.8/10,000 children in 2012 (P less than .001). A 30.3% decrease in hospitalizations among infants less than 1 year old primarily drove the overall rate decline, alongside a slighter (13.4%) drop in children aged 1-4 years.

Lower respiratory infections, including pneumonia and bronchiolitis, were the most common infectious diseases leading to pediatric hospitalization. Although these accounted for 42.8% of all infectious disease hospitalizations in 2012, their hospitalization rate had dropped 19.1% since 2000, from 40.1 children to 32.5 children per 10,000, driven mostly by a 25.5% drop in pneumonia hospitalizations.

Abdominal and rectal infections comprised 13.8% of all infectious disease hospitalizations in 2012 but had declined 6.9% since 2000. Upper respiratory infections had been the third most common subgroup in 2000 but was replaced by skin infections in 2012.

Hospitalization rates decreased for all infectious disease subgroups except skin infections, perinatal infections, septicemia, and postoperative infections. Skin infections had the biggest jump, 67.6% over the period studied (P less than .001), followed by a 16.7% increase in perinatal infections and smaller increases in the other two subgroups.

The biggest subgroup declines were HIV/AIDS, with an 81.5% drop, and nonviral meningitis, with a 64.9% drop. Mortality in the hospital also declined among children admitted for infectious disease: those admitted in 2012 had 37% reduced odds of death, compared with those admitted in 2000.

The median length of a hospital stay, 2 days, did not change across time, and the median cost for each hospitalization increased 9.6%, from $3,452 in 2003 to $3,784 in 2012. Nationwide, however, infectious disease hospitalizations cost $4.4 billion in 2012.

The research was funded by the National Institutes of Health. Information on disclosures was not provided.

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