PHILADELPHIA– Infectious diseases played a primary role in 16% of pediatric hospitalizations between 1997 and 2009, and remain a leading cause of pediatric hospitalizations and health care expenditures, but the proportion of hospitalizations associated with an infectious disease declined by 18% during the study period, according to an analysis of the Kids’ Inpatient Database.
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Fewer pediatric hospitaliztions from infectious disease could be related to the introduction of pneumococcal and rotavirus vaccines.
Periods of decline were temporally associated with the introduction of pneumococcal and rotavirus vaccines, Chris Stockmann of the University of Utah Health Sciences Center, Salt Lake City, reported at an annual scientific meeting on infectious diseases.
Infectious diseases were second only to newborn deliveries as a cause of pediatric hospitalizations during the study period, Mr. Stockmann said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.
The burden was highest among children under age 5 years, who accounted for about 75% of all infectious disease hospitalizations; those under age 3 months accounted for 15%.
Eight diagnoses accounted for more than 80% of the hospitalizations. The most common were pneumonia and bronchiolitis, followed by urinary tract infections, other upper respiratory tract infections, intestinal infections, other viral infections, sepsis, and meningitis. Respiratory infections accounted for about two-thirds of all hospitalizations, he said.
Pneumonia was the leading cause of hospitalizations across all age groups. The second leading cause was bronchiolitis in those under age 5 years, and UTI in those aged 5 years and older.
“A smattering of other conditions, including intestinal infections, viral infections, and meningitis, also make an appearance in the top 4,” he said.
Over time, pneumonia, bronchiolitis, and other upper respiratory tract infections decreased by 15% to 30%, and the intestinal infection rate was nearly halved.
The decrease in pneumonia hospitalizations coincided with the introduction of the 7-valent pneumococcal conjugate vaccine in 2000, and the introduction of the rotavirus vaccine in 2007. The introduction of these vaccines also was associated with a reduction in intestinal infection hospitalizations, he said.
During the study period, the overall charge for all infectious disease hospitalizations was $4.3 billion per year nationally. At the patient level, the mean charge was just under $15,000, and the mean length of stay was just over 3 days, Mr. Stockmann said.
Total hospital charges were driven by pneumonia and bronchiolitis, but at the individual patient level, sepsis and meningitis were the most expensive conditions, he noted.
The data for this analysis were derived from the National Inpatient Survey’s Kids’ Inpatient Database (KID), owned and operated by the Agency for Healthcare Research and Quality, and maintained by the Healthcare Cost and Utilization Project. Currently, 3,500 hospitals in 44 states contribute data to KID, which is released every 3 years; data for this study were available for 1997, 2000, 2003, 2006, and 2009 and were weighted with a complex survey design to more than 36 million discharges nationwide.
The findings underscore the need for additional efforts to reduce the burden of pediatric respiratory tract infections, Mr. Stockmann said. “We would posit that respiratory viral vaccines may play a key role in that,” he said.
Mr. Stockmann reported having no disclosures.