Inpatient burden of pediatric dermatology in the United States

It is known that inpatient care accounts for a significant portion of health care expenditures, but the national burden of inpatient pediatric dermatology is poorly characterized. We sought to assess risk factors, conditions, and financial costs associated with pediatric hospitalizations for skin disease.

We performed a cross-sectional study of pediatric dermatology hospitalizations using the 2012 Kids' Inpatient Database, which samples 80% of non-birth-related pediatric admissions from 44 states to generate national estimates. The demographic characteristics of children admitted for dermatologic and nondermatologic conditions were compared, and the financial costs of these admissions were analyzed.

In 2012, there were 74 229 (95% confidence interval (CI) = 68 620-79 978) pediatric dermatology hospitalizations, accounting for 4.2% of all pediatric admissions and $379.8 million (95% CI = $341.3-418.4 million) in health care costs. Bacterial infections (n = 59 115, 95% CI = 54 669-63 561), viral diseases (n = 3812, 95% CI = 3457-4167), and noncancerous skin growths (n = 2931, 95% CI = 2318-3545) were the most common conditions requiring hospitalization. The highest mean cost per hospitalization was for admissions for cutaneous lymphomas ($58 294, 95% CI = $31 694-84 893), congenital skin abnormalities ($24 186, 95% CI = $16 645-31 728), and ulcers ($17 064, 95% CI = $14 683-19 446). Pediatric dermatology hospitalizations were most strongly associated with living in a low-income community (odds ratio (OR) = 1.22, 95% CI = 1.16-1.29) and the South (OR = 1.32, 95% CI = 1.19-1.46) and being uninsured (OR = 1.35, 95% CI = 1.26-1.45) or having Medicaid insurance (OR = 1.17, 95% CI = 1.13-1.22).

Skin disease is a common cause of hospitalizations in children, and there are disparities in these admissions that could reflect inadequate access to outpatient pediatric dermatologists.