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Trends in Incidence and Drug Prescriptions for Croup in Children Under 5 Years of Age: A 2002-2019 Population-Based
Bo Hee Kim1, Eun Kyo Ha2, Hana Yoo3
1Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
Insights
Croup incidence in Korean children significantly increased from 2002 to 2019. Antibiotic use decreased while epinephrine prescriptions rose, with primary care facilities showing longer hospital stays and higher medication use.
Area of Science:
- Pediatrics
- Epidemiology
- Public Health
Background:
- Tracking national croup trends is crucial for effective childhood health management.
- This study provides insights into childhood croup incidence and treatment patterns in South Korea.
Purpose of the Study:
- To analyze the incidence and drug prescription trends of croup in Korean children over a 20-year period (2002-2019).
- To identify factors influencing croup incidence and changes in medication use.
Main Methods:
- A population-based study using the National Health Insurance Service-National Sample Cohort (479,783 children < 5 years).
- Calculated age-specific and age-adjusted incidence rates and analyzed trends using orthogonal polynomial contrasts.
- Assessed changes in the use of inhaled steroids, systemic steroids, inhaled epinephrine, antibiotics, and short-acting bronchodilators via generalized binomial logistic regression.
Main Results:
- Croup-related emergency visits increased from 16.1 to 98.3 per 10,000 person-years between 2002 and 2019 (P < 0.001).
- Antibiotic and oxygen use decreased, while nebulized epinephrine and multiple drug prescriptions increased.
- Primary care centers showed greater increases in prescription usage and hospitalization duration compared to tertiary care institutions.
Conclusions:
- Croup incidence has risen significantly in Korean children over the past two decades.
- Treatment patterns have shifted towards increased epinephrine use and decreased antibiotic prescriptions.
- Primary care facilities are associated with longer hospitalizations and higher medication utilization for croup.
Background:
Tracking national croup trends can provide important insights for childhood health management. This study aimed to analyze the incidence and drug prescription trends in Korean children over a two-decade period.
Methods:
This population-based study encompassed 479,783 children aged < 5 years from 2002-2019, utilizing the National Health Insurance Service-National Sample Cohort. We identified participants with a primary croup diagnosis who were admitted to or visited the emergency room. Age-specific and age-adjusted incidence rates/10,000 person-years were calculated. We assessed using orthogonal polynomial contrasts and stratified by various factors (sex, age, residential area, economic status, comorbidities, and healthcare facility types). We observed changes in the use of five medications: inhaled steroids, systemic steroids, inhaled epinephrine, antibiotics, and short-acting bronchodilators. Generalized binomial logistic regression was used to analyze factors influencing prescription strategies.
Results:
In 2002, the croup-related visits were 16.1/10,000 person-years, increasing to 98.3 in 2019 (P for trend < 0.001). This trend persisted, regardless of age, sex, region, and economic status. Children with comorbid atopic dermatitis or asthma maintained consistent croup rates, while those without comorbidities increased. Treatment trends showed decreasing antibiotic (73-47%) and oxygen use (21.3-3.4%), with increasing nebulized epinephrine (9.3-41.5%) and multiple drug prescriptions (67.8-80.3%). Primary care centers exhibited a greater increase in prescription usage and hospitalization duration than did tertiary healthcare institutions.
Conclusion:
Over the past two decades, croup incidence has risen, accompanied by increased epinephrine use and decreased antibiotic prescriptions. Longer hospitalization and higher medication use were mainly observed in primary care facilities.
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