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Bammert P, Schüttig W, Novelli A, Iashchenko I, Spallek J, Blume M, Diehl K, Moor I, Dragano N, Sundmacher L. The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review. Int J Equity Health 2024; 23:37. [PMID: 38395914 PMCID: PMC10885500 DOI: 10.1186/s12939-024-02122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. METHODS We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. RESULTS Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. CONCLUSIONS Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.
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Affiliation(s)
- Philip Bammert
- Chair of Health Economics, Technical University of Munich, Munich, Germany.
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Iryna Iashchenko
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Lausitz Center for Digital Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Irene Moor
- Institute of Medical Sociology, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
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Tessema ZT, Tesema GA, Ahern S, Earnest A. A Systematic Review of Areal Units and Adjacency Used in Bayesian Spatial and Spatio-Temporal Conditional Autoregressive Models in Health Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6277. [PMID: 37444123 PMCID: PMC10341419 DOI: 10.3390/ijerph20136277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
Advancements in Bayesian spatial and spatio-temporal modelling have been observed in recent years. Despite this, there are unresolved issues about the choice of appropriate spatial unit and adjacency matrix in disease mapping. There is limited systematic review evidence on this topic. This review aimed to address these problems. We searched seven databases to find published articles on this topic. A modified quality assessment tool was used to assess the quality of studies. A total of 52 studies were included, of which 26 (50.0%) were on infectious diseases, 10 (19.2%) on chronic diseases, 8 (15.5%) on maternal and child health, and 8 (15.5%) on other health-related outcomes. Only 6 studies reported the reasons for using the specified spatial unit, 8 (15.3%) studies conducted sensitivity analysis for prior selection, and 39 (75%) of the studies used Queen contiguity adjacency. This review highlights existing variation and limitations in the specification of Bayesian spatial and spatio-temporal models used in health research. We found that majority of the studies failed to report the rationale for the choice of spatial units, perform sensitivity analyses on the priors, or evaluate the choice of neighbourhood adjacency, all of which can potentially affect findings in their studies.
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Affiliation(s)
- Zemenu Tadesse Tessema
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Getayeneh Antehunegn Tesema
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Mendes ADCL, de Souza TA, Medeiros ADA, Barbosa IR. Pneumonia in Children under 5 Years: Temporal Trends and Spatial Patterns of Hospitalizations in Brazil. Am J Trop Med Hyg 2023; 108:916-926. [PMID: 37011891 PMCID: PMC10160880 DOI: 10.4269/ajtmh.21-0664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 05/31/2022] [Indexed: 04/05/2023] Open
Abstract
This study aimed to identify temporal and spatial patterns in the distribution of hospitalization rates for pneumonia in children under 5 years in Brazil. An ecological study was developed using data from the Unified Health System of hospitalizations for pneumonia in children under 5 years in Brazil from 2000 to 2019. Hospitalization rates per 1,000 children were calculated and Joinpoint Regression analyzed the temporal trends. Different spatial analysis techniques were performed. Annual rates of 25 hospitalizations per 1,000 children were observed in 2000 and of 13.83 per 1,000 children in 2019, with a significant downward trend for the country (annual percentage change = -3.4%; 95% confidence interval: -3.8 to -3.0) and for the regions. There was weak spatial autocorrelation; however, there were regions with high rates of hospitalization in the south region and clusters of low rates in the northeast and southeast. Clusters of areas with high hospitalization rates were observed in areas of favorable socioeconomic conditions and provision of health services in the interior of southern Brazil. There is a decreasing trend in hospitalizations for pneumonia in general; however, there are clusters of high rates in the south of Brazil.
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Affiliation(s)
| | - Talita Araujo de Souza
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Arthur de Almeida Medeiros
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Isabelle Ribeiro Barbosa
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Determinants of Pneumonia mortality in Bogota, Colombia: A spatial Econometrics Approach. Spat Spatiotemporal Epidemiol 2023. [DOI: 10.1016/j.sste.2023.100581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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5
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Identifying the climatic drivers of honey bee disease in England and Wales. Sci Rep 2021; 11:21953. [PMID: 34754028 PMCID: PMC8578631 DOI: 10.1038/s41598-021-01495-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/26/2021] [Indexed: 11/09/2022] Open
Abstract
Honey bee colony health has received considerable attention in recent years, with many studies highlighting multifactorial issues contributing to colony losses. Disease and weather are consistently highlighted as primary drivers of colony loss, yet little is understood about how they interact. Here, we combined disease records from government honey bee health inspections with meteorological data from the CEDA to identify how weather impacts EFB, AFB, CBP, varroosis, chalkbrood and sacbrood. Using R-INLA, we determined how different meteorological variables influenced disease prevalence and disease risk. Temperature caused an increase in the risk of both varroosis and sacbrood, but overall, the weather had a varying effect on the six honey bee diseases. The risk of disease was also spatially varied and was impacted by the meteorological variables. These results are an important step in identifying the impacts of climate change on honey bees and honey bee diseases.
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Oyana TJ, Minso J, Jones TL, McCullers JA, Arnold SR, Cormier SA. Particulate matter exposure predicts residence in high-risk areas for community acquired pneumonia among hospitalized children. Exp Biol Med (Maywood) 2021; 246:1907-1916. [PMID: 34053235 DOI: 10.1177/15353702211014456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Particulate matter exposure is a risk factor for lower respiratory tract infection in children. Here, we investigated the geospatial patterns of community-acquired pneumonia and the impact of PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 µm) on geospatial variability of pneumonia in children. We performed a retrospective analysis of prospectively collected population-based surveillance study data of community-acquired pneumonia hospitalizations among children <18 years residing in the Memphis metropolitan area, who were enrolled in the Centers for Disease Control and Prevention sponsored Etiology of Pneumonia in the Community (EPIC) study from January 2010 to June 2012. The outcome measure, residence in high- and low-risk areas for community-acquired pneumonia, was determined by calculating pneumonia incidence rates and performing cluster analysis to identify areas with higher/lower than expected rates of community-acquired pneumonia for the population at risk. High PM2.5 was defined as exposure to PM2.5 concentrations greater than the mean value (>10.75 μg/m3), and low PM2.5 is defined as exposure to PM2.5 concentrations less than or equal to the mean value (≤10.75 μg/m3). We also assessed the effects of age, sex, race/ethnicity, history of wheezing, insurance type, tobacco smoke exposure, bacterial etiology, and viral etiology of infection. Of 810 (96.1%) subjects with radiographic community-acquired pneumonia, who resided in the Memphis metropolitan area and had addresses which were successfully geocoded (Supplementary Figure F2), 220 (27.2%) patients were identified to be from high- (n = 126) or low-risk (n = 94) community-acquired pneumonia areas. Community-acquired pneumonia in Memphis metropolitan area had a non-homogenous geospatial pattern. PM2.5 was associated with residence in high-risk areas for community-acquired pneumonia. In addition, children with private insurance and bacterial, as opposed to viral, etiology of infection had a decreased risk of residence in a high-risk area for community-acquired pneumonia. The results from this paper suggest that environmental exposures as well as social risk factors are associated with childhood pneumonia.
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Affiliation(s)
- Tonny J Oyana
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jagila Minso
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Tamekia L Jones
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.,Children's Foundation Research Institute, Memphis, TN 38105, USA
| | - Jonathan A McCullers
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.,Children's Foundation Research Institute, Memphis, TN 38105, USA.,Le Bonheur Children's Hospital, Memphis, TN 38103, USA
| | - Sandra R Arnold
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.,Children's Foundation Research Institute, Memphis, TN 38105, USA.,Le Bonheur Children's Hospital, Memphis, TN 38103, USA
| | - Stephania A Cormier
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.,Children's Foundation Research Institute, Memphis, TN 38105, USA.,Le Bonheur Children's Hospital, Memphis, TN 38103, USA.,Department of Biological Sciences, Louisiana State University and Pennington Biomedical Research Center, Baton Rouge, LA 70803, USA
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Pina JC, Alves LS, Arroyo LH, Arcêncio RA, Gondim EC, Furtado MCDC, de Mello DF. Using geo-spatial analysis for assessing the risk of hospital admissions due to community-acquired pneumonia in under-5 children and its association with socially vulnerable areas (Brazil). BMC Pediatr 2020; 20:502. [PMID: 33138791 PMCID: PMC7606062 DOI: 10.1186/s12887-020-02398-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background The concentration of under-5 child morbidity and mortality due to pneumonia in developing countries reflects the social inequities. This study aimed to map and assess the spatial risk for hospitalization due to Community-Acquired Pneumonia in children under 5 years of age and its association with vulnerable areas. Methods Ecological study in the city of Ribeirão Preto, state of São Paulo, Brazil. The study population consisted of hospitalized under-5 children, diagnosed with community-acquired pneumonia, in Ribeirão Preto-São Paulo-Brazil, from 2012 to 2013. Data were collected in different databases, by a trained team, between March 2012 and August 2013 and from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics. The 956 urban census tracts were considered as the units of analysis. The incidence of cases per 10,000 inhabitants was calculated by census tracts during the study period. For the identification of the spatial risk clusters, the Kernel density estimator and the Getis-Ord Gi* technique were performed. Generalized additive models were used to verify the association between areas with social vulnerability and the occurrence of childhood pneumonia. Results The study included 265 children under the age of five, hospitalized due to community-acquired pneumonia. A concentration of cases was identified in the regions with greater social vulnerability (low income, poor housing conditions and homelessness), as well as a lower occurrence of cases in the most developed and economically privileged area of the city. The majority of the children lived in territories served by traditional primary healthcare units, in which the health surveillance and family and community focus are limited. It is important to highlight that the tracts with the highest degrees of vulnerability, such as those identified as high vulnerability (urban) and very high vulnerability (subnormal urban clusters). Conclusions The results contribute to the comprehension of the social factors involved in child hospitalization due to pneumonia, based on the analysis of the spatial distribution. This approach revealed a strategic tool for diagnosing the disparities as well presenting evidences for the planning in health and strength health care system in achieving equity, welfare and social protection of children. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12887-020-02398-x.
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Affiliation(s)
- Juliana Coelho Pina
- Federal University of Santa Catarina, Campus Universitário Reitor João David Ferreira Lima, Trindade, Florianópolis, SC, CEP: 88040-900, Brazil.
| | - Luana Seles Alves
- University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil
| | - Luiz Henrique Arroyo
- University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil
| | - Ricardo Alexandre Arcêncio
- University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil
| | - Ellen Cristina Gondim
- University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil
| | - Maria Cândida de Carvalho Furtado
- University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil
| | - Débora Falleiros de Mello
- University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil
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Cavallazzi R, Furmanek S, Arnold FW, Beavin LA, Wunderink RG, Niederman MS, Ramirez JA. The Burden of Community-Acquired Pneumonia Requiring Admission to ICU in the United States. Chest 2020; 158:1008-1016. [PMID: 32298730 DOI: 10.1016/j.chest.2020.03.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/31/2020] [Accepted: 03/14/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A paucity of studies have assessed the epidemiology of community-acquired pneumonia (CAP) that require ICU admission. We conducted a study on this group of patients with the primary objective of defining the incidence, epidemiology, and mortality rate of CAP in the ICUs in Louisville, Kentucky. The secondary objective was to estimate the number of patients who were hospitalized and the number of deaths that were associated with CAP in ICU in the United States. RESEARCH QUESTIONS What is epidemiology of CAP in the ICU in Louisville, Kentucky, and the projected incidence in the United States? STUDY DESIGN AND METHODS This was a secondary analysis of a prospective population-based cohort study. The setting was all nine adult hospitals in Louisville, Kentucky. The annual incidence of CAP in the ICU per 100,000 adults was calculated for the whole adult population of Louisville. The number of patients who were hospitalized because of CAP in ICU in the United States was estimated by multiplying the Louisville incidence rate of CAP in ICU by the 2014 US adult population. RESULTS From a total of 7,449 unique patients who were hospitalized with CAP, 1,707 patients (23%) were admitted to the ICU. The incidence of CAP in the ICU was 145 cases per 100,000 population of adults. Cases of CAP in the ICU were clustered in patients from areas of the city with high poverty. The mortality rate of patients with CAP in ICU was 27% at 30 days and 47% at one year. In the United States, the estimated number of patients who were hospitalized with CAP requiring the ICU was 356,326 per year, and the estimated number of deaths at 30 days and one year were 96,206 and 167,474, respectively. INTERPRETATION Almost one in five patients who are hospitalized with CAP requires intensive care. Poverty is associated with CAP in the ICU. Nearly one-half of patients with CAP in the ICU will die within one year. Because of its significant burden, CAP in the ICU should be a high priority in research agenda and health policy.
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Affiliation(s)
- Rodrigo Cavallazzi
- Divisions of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, KY.
| | - Stephen Furmanek
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
| | - Forest W Arnold
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
| | - Leslie A Beavin
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
| | - Richard G Wunderink
- Pulmonary and Critical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY
| | - Julio A Ramirez
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
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Michel M, Alberti C, Carel JC, Chevreul K. Association of Pediatric Inpatient Socioeconomic Status With Hospital Efficiency and Financial Balance. JAMA Netw Open 2019; 2:e1913656. [PMID: 31626320 PMCID: PMC6813670 DOI: 10.1001/jamanetworkopen.2019.13656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE In health care systems in which hospital reimbursement is based on a national mean length of stay (LOS), disadvantaged patients with an increased LOS may be a source of inefficiency. This implication has been reported in adult patients, but pediatric data have been scarce. OBJECTIVE To examine the association of patient socioeconomic status with hospital efficiency and financial balance in pediatrics. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained data from the French national hospital discharge database covering a 3-year period, from January 1, 2012, to December 31, 2014. Statistical analyses were performed between June 2016 and December 2018. All inpatient stays in hospital pediatric wards in mainland France by children older than 28 days or younger than 18 years (n = 4 121 187) were included. Admissions with coding errors or missing values for social disadvantage and/or cost calculations were excluded. EXPOSURE Social disadvantage was estimated with an ecological indicator, the FDep, available at the patient's postcode of residence and divided into national quintiles. MAIN OUTCOMES AND MEASURES Efficiency was assessed through the variations in patient LOS compared with different national mean LOS (for pediatric patients, pediatric patients with a similar condition, and pediatric patients with a similar condition and severity level). Hospital financial balance was assessed at the admission level through the ratio of production costs to revenues and at the hospital level through the difference between aggregated revenues and production costs. Multivariate regression models examined the association between these indicators and socioeconomic status. RESULTS A total of 4 121 187 admissions were included (2 336 540 [56.7%] male; mean [SD] age, 7.4 [5.8] years). In all, 1 561 219 patients (37.9%) were in the 2 most disadvantaged quintiles. Patient LOS was shorter than the national mean LOS (mean [SD], 1.73 [4.21] days) for patients in the least disadvantaged quintile and longer for those in the more disadvantaged quintile (mean [SD], 1.67 [4.33] days vs 1.82 [4.14] days). This difference was higher for diagnosis related groups that included both adult and pediatric patients (mean [SD], 1.46 [4.22] days vs 1.61 [4.13] days) compared with those dedicated to pediatric patients (2.22 [4.13] days vs 2.12 [4.53] days). Patients in the most disadvantaged quintile were associated with a 3.2% increase in LOS (odds ratio, 1.0322; 95% CI, 1.0302-1.0341) compared with the national mean LOS. Social disadvantage was also associated with a significant increase in financial deficit for hospitals with 20% to 60% of patients in the 2 most disadvantaged quintiles (estimate: -€146 389; 95% CI, -€279 566 to -€13 213). CONCLUSIONS AND RELEVANCE Patient socioeconomic status appears to be statistically significantly associated with an increase in LOS and cost in French hospitals with pediatric departments. This finding suggests that initiating reform in hospital payment methods may improve resource allocation efficiency and equity in access to pediatric care.
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Affiliation(s)
- Morgane Michel
- Unité de Recherche Clinique en Économie de la Santé Eco Ile de France, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
| | - Corinne Alberti
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
- Inserm, Centre d'Investigation Clinique (CIC) 1426, Paris, France
| | - Jean-Claude Carel
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Department of Pediatric Endocrinology and Diabetology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Inserm, NeuroDiderot, Université de Paris, Paris, France
| | - Karine Chevreul
- Unité de Recherche Clinique en Économie de la Santé Eco Ile de France, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
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Ooi JM, Eg KP, Chinna K, Nathan AM, de Bruyne JA, Thavagnanam S. Predictive risk factors for complicated pneumonia in Malaysian children. J Paediatr Child Health 2019; 55:406-410. [PMID: 30198175 DOI: 10.1111/jpc.14213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/29/2018] [Accepted: 08/07/2018] [Indexed: 02/03/2023]
Abstract
AIM To investigate baseline characteristics associated with complicated community-acquired pneumonia (CAPc) in Malaysian children. CAPc, such as pleural effusion and/or empyema, is on the rise, especially in Southeast Asian children, and the reasons for this are unknown. METHODS A retrospective study was conducted on all children aged 2-16 years who were admitted to the University Malaya Medical Centre with community-acquired pneumonia between 2012 and 2014. RESULTS In this study, of the 343 children, 58 (17%) developed CAPc. Chinese ethnicity (P < 0.001), reduced breastfeeding duration (P = 0.003), not receiving outpatient antibiotic (P < 0.001) and exposure to parental smoking (P < 0.001) were identified as risk factors for CAPc. Markedly increased respiratory rate (P = 0.021) and thrombocytosis (P < 0.001) were noted as the clinical parameters for CAPc. CONCLUSION This study identifies some modifiable risk to reduce the burden of pneumonia complications.
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Affiliation(s)
- Jian Min Ooi
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kah Peng Eg
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Paediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University Malaysia, Kuala Lumpur, Malaysia
| | - Anna M Nathan
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Paediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Jessie A de Bruyne
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Paediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Surendran Thavagnanam
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Paediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
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Yaeger JP, Moore KA, Melly SJ, Lovasi GS. Associations of Neighborhood-Level Social Determinants of Health with Bacterial Infections in Young, Febrile Infants. J Pediatr 2018; 203:336-344.e1. [PMID: 30244985 DOI: 10.1016/j.jpeds.2018.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/02/2018] [Accepted: 08/09/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine the sociodemographic characteristics of one population of young, febrile infants and identify associations between neighborhood-level social determinants of health (SDHs) with bacterial infections. STUDY DESIGN This was a retrospective cross sectional study of all infants ≤90 days old with a temperature of ≥38°C who presented in 2014 to the emergency department of an urban children's hospital in a large east coast city. The primary outcome was the presence of a bacterial infection, defined as a positive urine, blood, or cerebrospinal fluid culture that was treated clinically as a pathogen. The home address of each infant was geocoded and linked to neighborhood data based on census tract. Neighborhood-level SDHs included deprivation index, median household income, poverty, childhood poverty, social capital, and crowded housing. Associations were estimated using generalized estimating equations and negative binomial regression analysis. Models were adjusted for age, prematurity, and race/ethnicity. RESULTS Of 232 febrile infants, the median age was 54 days, 58% were male, 49% were Hispanic, and 88% had public health insurance; 31 infants (13.4%) had a bacterial infection. In the adjusted analyses, the risk of bacterial infection among infants from neighborhoods with high rates of childhood poverty was >3 times higher (relative risk, 3.16; 95% CI, 1.04-9.6) compared with infants from neighborhoods with low rates of childhood poverty. CONCLUSIONS Our findings suggest that SDHs may be associated with bacterial infections in young, febrile infants. If confirmed in subsequent studies, the inclusion of SDHs in predictive tools may improve accuracy in detecting bacterial infections among young, febrile infants.
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Affiliation(s)
- Jeffrey P Yaeger
- Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA.
| | - Kari A Moore
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Steven J Melly
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Gina S Lovasi
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA
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Munday JD, van Hoek AJ, Edmunds WJ, Atkins KE. Quantifying the impact of social groups and vaccination on inequalities in infectious diseases using a mathematical model. BMC Med 2018; 16:162. [PMID: 30253772 PMCID: PMC6156851 DOI: 10.1186/s12916-018-1152-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Social and cultural disparities in infectious disease burden are caused by systematic differences between communities. Some differences have a direct and proportional impact on disease burden, such as health-seeking behaviour and severity of infection. Other differences-such as contact rates and susceptibility-affect the risk of transmission, where the impact on disease burden is indirect and remains unclear. Furthermore, the concomitant impact of vaccination on such inequalities is not well understood. METHODS To quantify the role of differences in transmission on inequalities and the subsequent impact of vaccination, we developed a novel mathematical framework that integrates a mechanistic model of disease transmission with a demographic model of social structure, calibrated to epidemiologic and empirical social contact data. RESULTS Our model suggests realistic differences in two key factors contributing to the rates of transmission-contact rate and susceptibility-between two social groups can lead to twice the risk of infection in the high-risk population group relative to the low-risk population group. The more isolated the high-risk group, the greater this disease inequality. Vaccination amplified this inequality further: equal vaccine uptake across the two population groups led to up to seven times the risk of infection in the high-risk group. To mitigate these inequalities, the high-risk population group would require disproportionately high vaccination uptake. CONCLUSION Our results suggest that differences in contact rate and susceptibility can play an important role in explaining observed inequalities in infectious diseases. Importantly, we demonstrate that, contrary to social policy intentions, promoting an equal vaccine uptake across population groups may magnify inequalities in infectious disease risk.
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Affiliation(s)
- James D Munday
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK. .,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Albert Jan van Hoek
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - W John Edmunds
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Katherine E Atkins
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Global Health, Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
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Roussel A, Michel M, Lefevre-Utile A, De Pontual L, Faye A, Chevreul K. Impact of social deprivation on length of stay for common infectious diseases in two French university-affiliated general pediatric departments. Arch Pediatr 2018; 25:359-364. [PMID: 30041884 DOI: 10.1016/j.arcped.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/14/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Adult deprived patients consume more healthcare resources than others, particularly in terms of increased length of stay (LOS) and costs. Very few pediatric studies have focused on LOS, although the effect of deprivation could be greater in children due to the vulnerability of this population. Our objective was to compare LOS between deprived and nondeprived children hospitalized for acute infectious diseases in two university-affiliated pediatric departments located in a low-income area of northern Paris. METHODS We performed a prospective observational multicenter study in two university-affiliated hospitals, Hôpital Robert-Debré and Hôpital Jean-Verdier. All the patients under 15 years of age admitted to the general pediatric department for pneumonia, bronchiolitis, gastroenteritis, or pyelonephritis between 20 October 2016 and 20 March 2017 were included. Deprivation was assessed with an individual questionnaire and score (EPICES). Endpoints included length of stay, costs, and readmission rates at 15 days in each quintile of deprivation. Multivariate regression assessed the association between deprivation and each endpoint. RESULTS A total of 556 patients were included in the study and 540 were analyzed. Sixty percent were boys and the mean age was 9 months±18. Bronchiolitis was the most frequent diagnosis (67.8%). Fifty-six percent of patients were considered to be deprived based on the EPICES questionnaire. Mean LOS was 4.6±3.5 days and we found no significant difference in LOS between the different deprivation quintiles (P=0.83). Multivariate regression did not show an association between LOS and deprivation. CONCLUSION There was no difference between deprived and nondeprived patients in terms of LOS. Deprivation may therefore impact hospitals in other ways such as admission rates. The impact of deprivation during hospitalization for chronic diseases should also be investigated.
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Affiliation(s)
- A Roussel
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France; Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France.
| | - M Michel
- Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France; URC Eco Île-de-France, DRCD, Assistance publique-Hôpitaux de Paris, Hôtel Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
| | - A Lefevre-Utile
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - L De Pontual
- Service de pédiatrie générale, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, avenue du 14-Juillet, 93143 Bondy cedex, France
| | - A Faye
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France; Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France
| | - K Chevreul
- Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France; URC Eco Île-de-France, DRCD, Assistance publique-Hôpitaux de Paris, Hôtel Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
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14
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Spatial variation of pneumonia hospitalization risk in Twin Cities metro area, Minnesota. Epidemiol Infect 2017; 145:3274-3283. [PMID: 29039282 DOI: 10.1017/s0950268817002291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Fine resolution spatial variability in pneumonia hospitalization may identify correlates with socioeconomic, demographic and environmental factors. We performed a retrospective study within the Fairview Health System network of Minnesota. Patients 2 months of age and older hospitalized with pneumonia between 2011 and 2015 were geocoded to their census block group, and pneumonia hospitalization risk was analyzed in relation to socioeconomic, demographic and environmental factors. Spatial analyses were performed using Esri's ArcGIS software, and multivariate Poisson regression was used. Hospital encounters of 17 840 patients were included in the analysis. Multivariate Poisson regression identified several significant associations, including a 40% increased risk of pneumonia hospitalization among census block groups with large, compared with small, populations of ⩾65 years, a 56% increased risk among census block groups in the bottom (first) quartile of median household income compared to the top (fourth) quartile, a 44% higher risk in the fourth quartile of average nitrogen dioxide emissions compared with the first quartile, and a 47% higher risk in the fourth quartile of average annual solar insolation compared to the first quartile. After adjusting for income, moving from the first to the second quartile of the race/ethnic diversity index resulted in a 21% significantly increased risk of pneumonia hospitalization. In conclusion, the risk of pneumonia hospitalization at the census-block level is associated with age, income, race/ethnic diversity index, air quality, and solar insolation, and varies by region-specific factors. Identifying correlates using fine spatial analysis provides opportunities for targeted prevention and control.
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Gajewska M, Lewtak K, Scheres J, Albrecht P, Goryński P. Trends in Hospitalization of Children with Bacterial Pneumonia in Poland. Cent Eur J Public Health 2017; 24:188-192. [PMID: 27755860 DOI: 10.21101/cejph.a4164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/26/2016] [Indexed: 11/15/2022]
Abstract
AIM The aim of the study was to evaluate the hospitalization trends in children aged 0-6 suffering from bacterial pneumonia in the years 2007-2011 in Poland. METHODS The data pertained to the hospitalized patients diagnosed with the diseases registered as J13-J15 according to ICD-10. RESULTS In the years 2007-2011, the hospitalization rate increased from 16.3/10,000 to 44.1/10,000 for boys and from 13.8/10,000 to 33.0/10,000 for girls. The most frequently hospitalized children were between 1 and 2 years of age (90.6/10,000 for boys and 58.0/10,000 for girls in 2011). The average length of stay (LOS) of the investigated children fell from 10.1 days in 2007 to 8.2 days in 2011. The longest stays were recorded for the youngest children, under 2 years of age (from almost 11 days in 2007 to around 9 days in 2011). CONCLUSION Bacterial pneumonia is a serious problem of public health and especially babies are at high risk of this disease. Given the effects of vaccinations against Streptococcus pneumoniae conducted all over the world and to a limited extend in Poland as well, further steps towards vaccinating children against pneumococci should be taken in Poland.
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Affiliation(s)
- Małgorzata Gajewska
- Department of Health Promotion and Postgraduate Education, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Katarzyna Lewtak
- Department of Health Promotion and Postgraduate Education, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Jacques Scheres
- Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Organization, Health Economics and Hospital Management, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Piotr Albrecht
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Poland
| | - Paweł Goryński
- Centre for Monitoring and Analyses of Population Health Status and Health Care System, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
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Lothrop N, Hussaini K, Billheimer D, Beamer P. Community-level characteristics and environmental factors of child respiratory illnesses in Southern Arizona. BMC Public Health 2017; 17:516. [PMID: 28545417 PMCID: PMC5445507 DOI: 10.1186/s12889-017-4424-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/15/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lower respiratory illnesses (LRIs) and asthma are common diseases in children <5 years of age. Few studies have investigated the relationships between multiple, home-based social and environmental risk factors and asthma and LRIs in children. Of those that have, none have focused exclusively on children <5 years of age, who are more physiologically vulnerable and spend more time at home compared to older children. Further, no studies have done so at the community level. METHODS We modeled relationships between emergency department visits and hospitalization rates for asthma and LRIs for children <5 years and geographic risk factors, including socio-economic and housing characteristics, ambient air pollution levels, and population density in Maricopa and Pima Counties, Arizona, from 2005 to 2009. We used a generalized linear model with a negative binomial observation distribution and an offset for the population of very young children in each tract. To reduce multicollinearity among predictors, socio-economic characteristics, and ambient air pollutant levels were combined into unit-less indices using the principal components analysis (PCA). Housing characteristics variables did not exhibit moderate-to-high correlations and thus were not included in PCA. Spatial autocorrelation among regression model residuals was assessed with the Global Moran's I test. RESULTS Following the regression analyses, almost all predictors were significantly related to at least one disease outcome. Lower socio-economic status (SES) and reduced population density were associated with asthma hospitalization rates and both LRI outcomes (p values <0.001). After adjusting for differences between counties, Pima County residence was associated with lower asthma and LRI hospitalization rates. No spatial autocorrelation was found among multiple regression model residuals (p values >0.05). CONCLUSIONS Our study revealed complex, multi-factorial associations between predictors and outcomes. Findings indicate that many rural areas with lower SES have distinct factors for childhood respiratory diseases that require further investigation. County-wide differences in maternal characteristics or agricultural land uses (not tested here) may also play a role in Pima County residence protecting against hospitalizations, when compared to Maricopa County. By better understanding this and other relationships, more focused public health interventions at the community level could be developed to reduce and better control these diseases in children <5 years, who are more physiologically vulnerable.
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Affiliation(s)
- Nathan Lothrop
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., PO 245210, Tucson, AZ 85724 USA
| | - Khaleel Hussaini
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., PO 245210, Tucson, AZ 85724 USA
- Biomedical Informatics, College of Medicine, University of Arizona, Tucson, AZ 85724 USA
| | - Dean Billheimer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., PO 245210, Tucson, AZ 85724 USA
- BIO5 Institute, University of Arizona, Tucson, AZ 85724 USA
| | - Paloma Beamer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., PO 245210, Tucson, AZ 85724 USA
- BIO5 Institute, University of Arizona, Tucson, AZ 85724 USA
- Arizona Respiratory Center, University of Arizona, Tucson, AZ 85724 USA
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Beck AF, Florin TA, Campanella S, Shah SS. Geographic Variation in Hospitalization for Lower Respiratory Tract Infections Across One County. JAMA Pediatr 2015; 169:846-54. [PMID: 26192102 PMCID: PMC4786371 DOI: 10.1001/jamapediatrics.2015.1148] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Bronchiolitis and pneumonia are leading causes of pediatric hospitalizations. Identifying geographic patterns in hospitalization rates across small geographic areas could be particularly relevant to targeted patient-level and population-level health care. OBJECTIVE To determine whether lower respiratory tract infection hospitalization rates varied geographically across a single county and whether such variability was associated with socioeconomic conditions. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of children hospitalized at one institution for lower respiratory tract infections between January 1, 2010, and December 31, 2013. The setting was Cincinnati Children's Hospital Medical Center, a large, academic, stand-alone pediatric facility located in Hamilton County, Ohio. During the study period, 99.6% of in-county children hospitalized for lower respiratory tract infections were admitted to Cincinnati Children's Hospital Medical Center. Participants were children younger than 2 years who were hospitalized with bronchiolitis and children younger than 18 years who were hospitalized with pneumonia. Patients were identified using discharge diagnosis codes and then geocoded to their home census tract. EXPOSURES Primary exposures, linked to each geocoded patient, included census tract-level socioeconomic measures obtained from the 2008 to 2012 American Community Survey (eg, adult educational attainment, unemployment, and poverty). Patient-level variables examined included demographics, presence of a complex chronic condition, length of stay, and cost. MAIN OUTCOMES AND MEASURES We calculated bronchiolitis and pneumonia hospitalization rates for Hamilton County and for each of 222 in-county census tracts. Associations between hospitalization rate quintiles and underlying socioeconomic conditions were assessed using the Kruskal-Wallis test. Geographic clustering was assessed using the Getis-Ord Gi* statistic. RESULTS There were 1495 bronchiolitis hospitalizations and 1231 pneumonia hospitalizations during the study period. The county rates were 17.5 (range across census tracts, 0-71.4) hospitalizations per 1000 children per year for bronchiolitis and 1.6 (range across census tracts, 0-4.3) hospitalizations per 1000 children per year for pneumonia. There was significant variation in the median hospitalization rates by census tract quintile for bronchiolitis (32.8, 20.8, 14.0, 10.4, and 5.1 per 1000) and for pneumonia (3.3, 2.1, 1.4, 0.9, and 0.3 per 1000). There were also significant, graded differences in socioeconomic measures by hospitalization rate quintile. Hot spots were localized to inner-city, impoverished neighborhoods. CONCLUSIONS AND RELEVANCE Bronchiolitis and pneumonia hospitalization rates varied considerably in ways that were related to underlying socioeconomic conditions. Clinical and public health interventions, targeted accordingly, could improve patient-level and population-level management of acute conditions at a reduced cost.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd A Florin
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Suzanne Campanella
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2currently a student at Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Samir S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Hatisuka MFDB, Arruda GOD, Fernandes CAM, Marcon SS. Análise da tendência das taxas de internações por pneumonia bacteriana em crianças e adolescentes. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo Analisar a distribuição e a tendência das taxas de internações por pneumonia bacteriana em crianças e adolescentes. Métodos Estudo ecológico de séries temporais com dados secundários obtidos no Sistema de Informações Hospitalares do Sistema Único de Saúde. Foram calculados coeficientes de internação para 10.000 habitantes, por triênio. Para análise de tendência utilizaram-se modelos de regressão polinomial. Resultados As maiores taxas de internação ocorreram na Macrorregião de Saúde Oeste, entre o segundo e o quarto triênio. As taxas foram maiores na faixa etária de um a quatro anos e no sexo masculino, durante todo o período. Observou-se tendência crescente das internações em crianças menores de um ano. Conclusão As taxas de internação por pneumonia diferem por macrorregional de saúde, idade e sexo, sendo maior na região oeste, em crianças do sexo masculino e com idade entre um e quatro anos, com tendência crescente entre os menores de um ano.
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Elemraid MA, Thomas MF, Blain AP, Rushton SP, Spencer DA, Gennery AR, Clark JE. Risk factors for the development of pleural empyema in children. Pediatr Pulmonol 2015; 50:721-6. [PMID: 24692118 DOI: 10.1002/ppul.23041] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/28/2014] [Indexed: 11/11/2022]
Abstract
Pediatric pleural empyema has increased substantially over the past 20 years and reasons for this rise remain not fully explained. We investigated potential risk factors for the development of empyema in children by examining a cohort of patients with community-acquired pneumonia. Demographic, clinical, and socioeconomic characteristics, use of Ibuprofen prior to presentation and selected potential epidemiological risk factors were analyzed. Data were collected from a prospective etiological study of radiologically confirmed pneumonia in hospitalized children aged ≤16 years. One hundred sixty children were enrolled; 56% were male and 69% aged <5 years. Empyema complication developed in 40 (25%) children. Children with empyema were more frequently prescribed Ibuprofen prior to admission to hospital than those without (82% vs. 46.2%; OR 1.94, 97.5% credible interval 0.80-3.18). Bacterial infection was strongly associated with the development of empyema (OR 3.34, 97.5% credible interval 1.70-5.14). In contrast age, sex, maternal age, parental smoking, level of socioeconomic status, nursery attendance, asthma, household characteristics (bedrooms and number of occupants) were not significantly different between groups. In conclusion, children with pneumonia who developed empyema had more often received Ibuprofen prior to hospitalization and confirmed bacterial infection. We suggest a population-based study involving both primary and secondary care settings would help to investigate the role of Ibuprofen use in modulating the course of disease in children with pneumonia.
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Affiliation(s)
- Mohamed A Elemraid
- Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Matthew F Thomas
- Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Alasdair P Blain
- Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stephen P Rushton
- Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David A Spencer
- Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew R Gennery
- Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Julia E Clark
- Department of Paediatric Infectious Disease, Royal Children's Hospital, Brisbane, Australia
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