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Burden of ED visits for infectious disease among US children ‘enormous’
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Based on emergency department visits, rehospitalization, and associated costs, the burden of infectious diseases among U.S. children appears to be significant, according to recent findings.
“The increase in life expectancy during the twentieth century was largely due to reductions in infectious disease mortality among children,” Kohei Hasegawa, MD, MPH, from the department of emergency medicine at Massachusetts General Hospital, and colleagues wrote. “However, the epidemiologic transition to chronic diseases is not complete; [infectious diseases] remain a major public health burden in the U.S.”
In the cross-sectional analysis, researchers evaluated data from the 2011 Nationwide Emergency Department Sample (NEDS), an aspect of the Healthcare Cost and Utilization Project (HCUP). The NEDS is a national sample of all hospital based emergency departments (EDs) in the US. The researchers identified all ED visits for patients aged ≤ 19 years who had an ICD-9 CM code for an infectious disease as a primary diagnosis. The study’s primary outcome measures were infectious disease-related ED visits and hospitalizations resulting from ED visits. The researchers estimated the frequencies of these events (with 95% CIs) as the weighted number of infectious disease-related ED visits and hospitalizations per 100,000 US children of the same age group per year.
They found that in 2011, there were 1,914,509 infectious disease-related ED visits among children in the U.S., which correlated with a weighted estimate of 8,524,357 ED visits. These infectious disease-related ED visits represented 27.6% of all pediatric ED visits.
Infectious disease-related ED visits occurred with a frequency of 10,290 visits per 100,000 children. The most frequent infectious disease-related diagnoses were as follows: upper respiratory infection (41%); otitis media (18%) and lower respiratory infection (14%). Children with Medicaid accounted for 62% of overall infectious disease-related visits, and 35% of visits were by children in the lowest quartile of household income.
Of the visits to the ED that were related to infectious diseases, 424,725 (5%) led to hospitalization, equaling 513 hospitalizations per 100,000 children. Lower respiratory infection was the diagnosis most frequently associated with hospitalization, and was responsible for 40% of all infectious disease-related hospital admissions from the ED. There was a median $718 charge per ED visit, which amounted to total annual charges of $9.6 billion.
According to the researchers, these findings should motivate both policymakers and researchers to address the “enormous” burden of infectious disease-related pediatric ED visits.
“Our findings should encourage policy makers to continue efforts to curb morbidity by preventable [infectious diseases]; the work is not yet done,” Hasegawa and colleagues wrote. “For researchers, our observations should prompt further investigation of the particular needs and health care barriers in the vulnerable population to further reduce the inequalities in health care.”
Disclosure: The researchers report no relevant disclosures.
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