Increasing burden and risk factors for bronchiolitis-related medical visits in infants enrolled in a state health care insurance plan
Increasing burden and risk factors for bronchiolitis-related medical visits in infants enrolled in a state health care insurance plan
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DOI：
10.1542/peds.2007-2087
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发表时间：
2008-07-01
期刊：
影响因子：
8
通讯作者：
Hartert, Tina V.
中科院分区：
文献类型：
--
作者：
Carroll, Kecia N.;Gebretsadik, Tebeb;Hartert, Tina V.
目标.目的是估计由于细支气管炎导致的全年医疗保健就诊负担，并确定足月健康婴儿细支气管炎的危险因素。我们对1995-2003年参加田纳西州医疗补助计划的103670名足月非低出生体重儿进行了一项以人群为基础的回顾性队列研究。我们监测了婴儿出生后的第一年。通过使用索赔数据计算婴儿期毛细支气管炎的危险因素以及研究期间住院、急诊和门诊就诊率。在9个研究年中，细支气管炎就诊率为每1000婴儿年238次门诊就诊，每1000婴儿年77次急诊就诊，每1000婴儿年71次住院。从1996-1997年到2002-2003年，细支气管炎的平均年就诊率增加了41%，从每1000个婴儿年188次就诊增加到每1000个婴儿年265次就诊。对500 g增量的线性趋势分析表明，出生体重增加与毛细支气管炎诊断呈负相关。母亲年龄与婴儿毛细支气管炎诊断呈显著负相关。与20 - 29岁母亲的婴儿相比，15 - 19岁母亲的婴儿发生毛细支气管炎的风险略有增加，而年龄较大的母亲（30-39岁或40-44岁）的婴儿发生毛细支气管炎的风险较低。细支气管炎的疾病负担是巨大的，在1995年至2003年期间参加田纳西州医疗补助计划的足月健康婴儿中，所有类型的就诊率都在增加。该足月婴儿队列的保护因素包括较高的出生体重和较大的产妇年龄。
OBJECTIVES. The goals were to estimate the year-round burden of health care visits attributable to bronchiolitis and to identify risk factors for bronchiolitis in term healthy infants.METHODS. We conducted a population-based, retrospective cohort study of 103 670 term, non-low birth weight infants enrolled in Tennessee Medicaid in 1995-2003. We monitored infants through the first year of life. Risk factors for bronchiolitis during infancy and rates of inpatient, emergency department, and outpatient visits during the study period were calculated by using claims data.RESULTS. Over the 9 study years, rates of bronchiolitis visits were 238 outpatient visits per 1000 infant-years, 77 emergency department visits per 1000 infant-years, and 71 hospitalizations per 1000 infant-years. Average annual rates of bronchiolitis visits increased 41%, from 188 visits per 1000 infant-years to 265 visits per 1000 infantyears, from 1996-1997 to 2002-2003. Analysis of the linear trend in 500-g increments demonstrated a negative association between increasing birth weight and bronchiolitis diagnosis. There was a significant negative trend between maternal age and infant bronchiolitis diagnosis. Compared with infants of mothers 20 to 29 years of age, infants of mothers 15 to 19 years of age had a small increase in risk of having a bronchiolitis visit, whereas infants of older mothers ( 30-39 or 40-44 years of age) were less likely to have a visit.CONCLUSIONS. The disease burden of bronchiolitis is substantial, with increasing rates of all types of visits among term, otherwise-healthy infants enrolled in Tennessee Medicaid between 1995 and 2003. Protective factors in this cohort of term infants included higher birth weight and older maternal age.