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Illness associated with child day care: a study of incidence and cost
D M Bell1, D W Gleiber, A A Mercer
1Department of Pediatrics, Memphis State University.
Insights
Day care centers pose higher infection risks for young children, leading to increased hospitalizations and medical costs. The number of children in a room is the strongest predictor of illness risk.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Economics
Background:
- Childcare settings are common for young children.
- Understanding infection risks and economic impacts associated with different childcare arrangements is crucial for public health.
- Previous studies have not fully elucidated the comparative risks and costs across various childcare settings.
Purpose of the Study:
- To identify risk factors for infection in children under 36 months across different childcare settings.
- To quantify the economic costs associated with infections in these settings.
- To compare hospitalization rates and parental absenteeism related to childcare type.
Main Methods:
- Prospective study of 843 children under 36 months enrolled in a prepaid health plan.
- Data collected on infections diagnosed, hospitalizations, and medical care costs.
- Statistical analysis to determine adjusted rates of infection, relative risks, and mean costs by childcare setting.
Main Results:
- Children in day care centers experienced higher infection rates and were 4.5 times more likely to be hospitalized, primarily for tympanostomy tube placement.
- The number of children in a room was the strongest predictor of illness risk.
- Mean monthly medical costs were higher in high-risk settings ($32.94) compared to others ($19.78).
- Parental absenteeism was 40% due to child illness, with more days lost for parents using day care centers.
Conclusions:
- Day care centers present elevated infection risks and associated economic burdens for young children and their families.
- Childcare policies should consider the impact of group size and setting on child health outcomes.
- Further research into mitigating infection transmission in childcare settings is warranted.
Abstract:
We studied 843 children under 36 months of age enrolled in a prepaid health plan from September 1985 through March 1986, to identify characteristics of day care which might be risk factors for infection and to describe the resulting economic costs. Children cared for in their own home had a mean of 2.03 infections diagnosed during the study period. Adjusted rates of excess infection (95 per cent CI) for children cared for in other settings were: -.09 (-.73, .54) in relatives' homes; .10 (-.51, .71) in day care homes; .79 (.13, 1.45) in day care centers; .60 (-.24, 1.46) in mother's day out programs; and .66 (-.01, 1.34) in multiple settings. Children in day care centers were 4.5 times more likely to be hospitalized than those in other settings (95 per cent CI = 1.55, 13.00), primarily due to an increased rate of tympanostomy tube placement (relative risk 3.79, 95 per cent CI = 1.04, 13.36). The strongest predictor of illness risk was the number of other children in the room. The mean monthly cost of medical care was $32.94 for children in the highest risk settings compared with $19.78 for those in other settings. Illness in a child in our study accounted for 40 per cent of parental absenteeism from work; the mean number of days lost per month was 0.52 for parents of children in day care centers compared with 0.37 for those of children in other forms of full time care outside the home.