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Published on: December 10, 2013
Respiratory tract infection-related healthcare utilisation in children with Down's syndrome
Logan Manikam1,2, Anne G M Schilder3,4, Monica Lakhanpaul5,6
1UCL Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK. logan.manikam.10@alumni.ucl.ac.uk.
Insights
Children with Down's syndrome (DS) experience significantly more respiratory tract infections (RTIs) and healthcare visits than other children. This highlights a substantial burden on families and necessitates further research for optimized care.
Area of Science:
- Pediatric Health
- Genetics and Disease
- Healthcare Utilization Research
Background:
- Children with Down's syndrome (DS) are susceptible to respiratory tract infections (RTIs) due to unique physiological and immunological factors.
- Existing data on healthcare utilization for RTIs in children with DS, particularly in primary care, remains limited.
Purpose of the Study:
- To quantify and compare RTI-related healthcare utilization between children with DS and matched controls without DS.
- To analyze differences in primary and secondary care usage for RTIs in these groups.
Main Methods:
- A retrospective cohort study utilizing linked electronic health records (CALIBER) from 1997-2010 in England.
- Inclusion of 992 children with DS and 4874 matched controls.
- Poisson regression and Wald tests were employed to compare consultation, hospitalization, and prescription rates, alongside admission risks and length of stay.
Main Results:
- Children with DS showed significantly higher rates of GP consultations (aRR 1.73), hospitalizations (aRR 5.70), and antibiotic prescriptions (aRR 2.34) for RTIs compared to controls.
- The risk of hospital admission following a GP consultation for an RTI was higher in children with DS (2%) versus controls (0.7%).
Conclusions:
- Children with DS exhibit substantially elevated healthcare utilization for RTIs across primary and secondary care settings.
- The findings underscore a significant healthcare burden on families of children with DS, indicating a need for targeted research into care optimization.
Purpose:
Children with Down's syndrome (DS) are prone to respiratory tract infections (RTIs) due to anatomical variation, immune system immaturity and comorbidities. However, evidence on RTI-related healthcare utilisation, especially in primary care, is incomplete. In this retrospective cohort study, we use routinely collected primary and secondary care data to quantify RTI-related healthcare utilisation in children with DS and matched controls without DS.
Methods:
Retrospective cohort study of 992 children with DS and 4874 matched controls attending English general practices and hospitals as identified in Clinical disease research using LInked Bespoke studies and Electronic health Records (CALIBER) from 1997 to 2010. Poisson regression was used to calculate consultation, hospitalisation and prescription rates, and rate ratios. Wald test was used to compare risk of admission following consultation. The Wilcoxon rank-sum test was used to compare length of stay by RTI type and time-to-hospitalisation.
Results:
RTI-related healthcare utilisation is significantly higher in children with DS than in controls in terms of GP consultations (adjusted RR 1.73; 95% CI 1.62-1.84), hospitalisations (adjusted RR 5.70; 95% CI 4.82-6.73), and antibiotic prescribing (adjusted RR 2.34; 95% CI 2.19-2.49). Two percent of children with DS presenting for an RTI-related GP consultation were subsequently admitted for an RTI-related hospitalisation, compared to 0.7% in controls.
Conclusions:
Children with DS have higher rates of GP consultations, hospitalisations and antibiotic prescribing compared to controls. This poses a significant burden on families. Further research is recommended to characterise healthcare behaviours and clinical decision-making, to optimise care for this at risk group.
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