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Variations in rates of hospitalization of children in three urban communities
J M Perrin1, C J Homer, D M Berwick
1Children's Service, Massachusetts General Hospital, Boston 02114.
Insights
Children in Boston and New Haven experienced higher hospitalization rates than those in Rochester in 1982. These variations in pediatric hospitalization rates may impact healthcare costs and quality.
Area of Science:
- Pediatric Health Services Research
- Healthcare Economics
- Public Health Policy
Background:
- Hospitalization represents a significant component of child healthcare expenditures.
- Variations in hospitalization rates across different regions can lead to substantial differences in healthcare costs.
- Understanding these variations is crucial for optimizing pediatric care delivery and resource allocation.
Purpose of the Study:
- To compare pediatric hospitalization rates across three U.S. cities: Boston, Rochester (New York), and New Haven (Connecticut) in 1982.
- To identify specific medical conditions contributing to observed differences in hospitalization frequency.
- To provide data that can inform discussions on the cost and quality of pediatric healthcare.
Main Methods:
- Retrospective analysis of pediatric hospitalization data from 1982 in Boston, Rochester, and New Haven.
- Calculation of relative risks (RR) for hospitalization comparing Boston and New Haven to Rochester.
- Stratification of analysis by diagnostic categories and specific conditions.
Main Results:
- Boston children had more than double the hospitalization rate of Rochester children (RR, 2.65).
- New Haven children had an intermediate hospitalization rate (RR, 1.80) compared to Rochester.
- Significant variations in hospitalization rates were observed for conditions like asthma, toxic ingestions, and head injuries, while rates for uniformly treated conditions like femur fractures were similar.
Conclusions:
- Substantial geographic variations in pediatric hospitalization rates exist, even among demographically similar communities.
- Factors such as socioeconomic status and access to primary care may contribute to these disparities.
- Further research is needed to determine the implications of these findings for the cost and quality of pediatric care.
Abstract:
Hospitalization accounts for a large portion of the expenditures for child health care, and differences in the rate of hospitalization may produce important variations in the cost of that care. We studied the rates of hospitalization in Boston, Rochester (N.Y.), and New Haven (Conn.) in 1982. We assigned the risk of hospitalization in Rochester a score of 1.00. Boston children were hospitalized at more than twice the rate of Rochester children for most medical diagnostic categories (relative risk, 2.65; 95 percent confidence interval, 2.53 to 2.78), and the rate for the New Haven group was intermediate (relative risk, 1.80; 95 percent confidence interval, 1.68 to 1.93). Rates of inpatient surgery differed less (Boston relative risk, 1.12; New Haven relative risk, 0.93). The relative risks of hospitalization (as compared with Rochester children) for Boston and New Haven children, respectively, were 3.8 and 2.3 for asthma, 6.1 and 2.9 for toxic ingestions, and 2.6 and 2.7 for head injuries. Fractures of the femur, appendicitis, and bacterial meningitis (conditions uniformly treated in the hospital) had similar rates of hospitalization across the three cities, but the relative risk of hospitalization for aseptic meningitis was 3.7 in Boston. The rates of hospitalization of children in all three communities were below the national averages in 1982. Although this study does not define the reasons for the variation in rates of hospitalization, it is possible that they were related in part to differences in socioeconomic status or access to primary care. The implications of these data for the cost and quality of pediatric care therefore remain to be determined.