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Prevalence of and Spending on Ear, Nose, Throat, and Respiratory Infections Among Children With Chronic Complex
Peter J Dunbar1, Sarah A Sobotka2, Jonathan Rodean3
1Department of Medicine, Brigham and Women's Hospital (PJ Dunbar), Boston, Mass.
Insights
Children with complex chronic conditions (CCC) experience higher rates of ear, nose, throat, and respiratory infections (ENTRI) and incur disproportionately high healthcare spending. Those with multiple CCCs face increased lower-airway infections and greater inpatient costs.
Area of Science:
- Pediatric Healthcare
- Infectious Diseases
- Chronic Illness Management
Background:
- Ear, nose, throat, and respiratory infections (ENTRI) impact children differently based on their health status.
- Children with complex chronic conditions (CCC) may face unique challenges with ENTRI.
Purpose of the Study:
- To compare the prevalence and healthcare spending of ENTRI in children with and without CCCs.
- To analyze how the number of CCCs influences ENTRI prevalence and associated costs.
Main Methods:
- Retrospective analysis of over 3.8 million children from US Medicaid programs in 2018.
- Categorization of CCCs using Feudtner's system.
- Comparison of ENTRI prevalence and spending using statistical tests and logistic regression.
Main Results:
- Children with CCCs had higher ENTRI prevalence (57.7%) compared to those without (43.5%).
- Children with CCCs accounted for nearly a quarter of total ENTRI spending ($145.8 million).
- ENTRI prevalence and inpatient spending increased significantly with the number of CCCs, particularly for lower-airway infections.
Conclusions:
- Children with CCCs represent a significant burden of ENTRI care and spending.
- Increased complexity of CCCs correlates with higher ENTRI prevalence, especially lower-airway infections, and greater inpatient costs.
- Findings can guide clinical counseling and future research for managing ENTRI in children with CCCs.
Objective:
Ear, nose, throat, and respiratory infections (ENTRI) may affect children with complex chronic conditions (CCC) differently than their peers. We compared ENTRI prevalence and spending in children with and without CCCs.
Methods:
Retrospective analysis of 3,880,456 children ages 0-to-18 years enrolled in 9 US state Medicaid programs in 2018 contained in the IBM Watson Marketscan Database. Type and number of CCCs were distinguished with Feudtner's system. ENTRI prevalence, defined as ≥1 healthcare encounters for ENTRI, and Medicaid spending on ENTRI were compared by CCC using chi-square tests and logistic regression.
Results:
ENTRIs were greater in children with vs. without a CCC (57.7% vs 43.5% [P < .001]). Children with a CCC (5.5%, n = 213,425) accounted for nearly one-fourth ($145.8 million [US]) of total spending on ENTRI. Aside from throat and sinus infection, ENTRI prevalence increased with number of CCCs (P < .001). For example, as number of CCCs increased from zero to ≥3, lower-airway infection increased from 12.5% to 37.5%, P < .001 (OR 4.10; 95% CI 3.95-4.26). ENTRI spending attributable to inpatient care increased from 9.7% to 92.8% (P < .001) as the number of CCCs increased from zero to ≥3.
Conclusion:
Most children with a CCC pursued care for ENTRI in 2018 and these children accounted for a disproportionate share of ENTRI spending. Children with multiple CCCs had a high prevalence of lower-airway infection; most of their ENTRI spending was for inpatient care. Providers can use these findings to counsel patients and families and to inform future investigations on how best to manage ENTRI in children with CCCs.
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