PURPOSE OF THE STUDY.
The goal of this study was to examine temporal trends in the US incidence of childhood asthma hospitalizations, in-hospital mortality, mechanical ventilation use, and hospital charges between 2000 and 2009.
This serial, cross-sectional analysis included a nationally representative sample of children hospitalized with acute asthma. The Kids Inpatient Database was used to identify children aged <18 years with asthma by using International Classification of Diseases, Ninth Revision, Clinical Modification, code 493.xx.
Outcome measures were asthma hospitalization incidence, in-hospital mortality, mechanical ventilation use, and hospital charges. Temporal trends of each outcome, accounting for sampling weights, were analyzed. Hospital charges were adjusted for inflation to 2009 US dollars.
The 4 separate years (2000, 2003, 2006, and 2009) of national discharge data included a total of 592 805 weighted discharges with asthma. Between 2000 and 2009, the rate of asthma hospitalization in US children decreased from 21.1 to 18.4 per 10 000 person-years (13% decrease; Ptrend < .001). Mortality declined significantly after adjusting for confounders (odds ratio for comparison of 2009 with 2000: 0.37 [95% confidence interval: 0.17–0.79]). In contrast, there was an increase in the use of mechanical ventilation (from 0.8% to 1.0% [28% increase]; Ptrend < .001). Nationwide hospital charges also increased from $1.27 billion to $1.59 billion (26% increase; Ptrend < .001); this increase was driven by a rise in the geometric mean of hospital charges per discharge, from $5940 to $8410 (42% increase; Ptrend < .001).
Between 2000 and 2009, significant declines in asthma hospitalization and in-hospital mortality were noted among US children. In contrast, mechanical ventilation use and hospital charges for asthma increased significantly over this same period.
This article is a very interesting analysis of trends in hospital mortality, mechanical ventilator use, hospital charges, and childhood asthma hospitalizations in the United States between 2000 and 2009. These data demonstrate that asthma hospitalizations and mortality declined significantly. There was an increase in mechanical ventilation use over this time period, which might reflect a more aggressive approach to management of severe asthma exacerbations in children. Although the results of this study suggest that progress has been made in reducing the impact of severe acute asthma in children in the United States, overall charges per discharge for asthma hospitalizations increased markedly; nationwide hospital charges increased by 26%. This increase most likely reflects more aggressive management of sicker patients. The large asthma burden in the United States presents an ongoing public health and health education challenge, and further studies are needed to find more cost-effective strategies and in-patient protocols to meet this challenge.
- Copyright © 2014 by the American Academy of Pediatrics