PEDIATRICS Vol. 106 No. 6 December 2000, pp. 1413-1421
Trends in Intussusception-Associated Hospitalizations and Deaths Among US Infants
Received Feb 9, 2000; accepted Apr 18, 2000.
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From the * Viral Gastroenteritis Section, Division of Viral and
Rickettsial Diseases, Centers for Disease Control and Prevention, US
Department of Health and Human Services, Atlanta, Georgia;
Preventive Medicine Residency Program, Centers for Disease Control
and Prevention, Atlanta, Georgia; § Office of the Director, Division of
Viral and Rickettsial Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia; Disease Investigations and
Surveillance Branch, Division of Communicable Disease Control,
California Department of Health Services, Berkeley, California;
¶ Epidemiology Resource Center, Indiana State Department of Health,
Indianapolis, Indiana; # Indian Health Service, US Department of Health
and Human Services, Rockville, Maryland; and the ** Division of Public
Health, Georgia Department of Human Resources, Atlanta, Georgia.
Context. The newly licensed tetravalent rhesus-human reassortant rotavirus vaccine has been withdrawn following reports of intussusception among vaccinated infants.
Objective. To describe the epidemiology of intussusception-associated hospitalizations and deaths among US infants.
Design. This retrospective cohort study examined hospital discharge data from the National Hospital Discharge Survey for 1988-1997, Indian Health Service (IHS) for 1980-1997, California for 1990-1997, Indiana for 1994-1998, Georgia for 1997-1998, and MarketScan for 1993-1996, and mortality data from the national multiple cause-of-death data for 1979-1997 and linked birth/infant death data for 1995-1997.
Patients. Infants (<1 year old) with an International Classification of Diseases, Ninth Revision, Clinical Modification code for intussusception (560.0) listed on their hospital discharge or mortality record, respectively.
Results. During 1994-1996, annual rates for intussusception-associated infant hospitalization varied among the data sets, being lowest for the IHS (18 per 100 000; 95% confidence interval [CI] = 9-35 per 100 000) and greatest for the National Hospital Discharge Survey (56 per 100 000; 95% CI = 33-79 per 100 000) data sets. Rates among IHS infants declined from 87 per 100 000 during 1980-1982 to 12 per 100 000 during 1995-1997 (relative risk =7.6, 95% CI = 3.2-18.2). Intussusception-associated hospitalizations were uncommon in the first 2 months of life, peaked from 5 to 7 months old, and showed no consistent seasonality. Intussusception-associated infant mortality rates declined from 6.4 per 1 000 000 live births during 1979-1981 to 2.3 per 1 000 000 live births during 1995-1997 (relative risk = 2.8, 95% CI = 1.8-4.3). Infants whose mothers were <20 years old, nonwhite, unmarried, and had an education level below grade 12 years were at an increased risk for intussusception-associated death.
Conclusions. Intussusception-associated hospitalization rates varied among the data sets and decreased substantially over time in the IHS data. Although intussusception-associated infant deaths in the United States have declined substantially over the past 2 decades, some deaths seem to be related to reduced access to, or delays in seeking, health care and are potentially preventable.intussusception, hospitalizations, deaths, risk factors, infants. .
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