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Published on: January 26, 2019
Healthcare Utilization Among Infants Covered by Medicaid and Newly Diagnosed With Respiratory Syncytial Virus
Mina Suh1, Naimisha Movva1, Xiaohui Jiang1
1EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA.
Insights
Infants with Medicaid have higher respiratory syncytial virus (RSV) encounters, particularly in emergency departments and outpatient settings. This highlights disparities in healthcare access and burden across different racial groups.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Infants with Medicaid insurance have higher hospitalization rates for respiratory syncytial virus (RSV) compared to those with commercial insurance.
- Previous studies on RSV burden in infants have primarily focused on inpatient settings, limiting understanding of overall healthcare utilization.
Purpose of the Study:
- To describe healthcare encounters for respiratory syncytial virus (RSV) across all settings among infants covered by Medicaid and the Children's Health Insurance Program.
- To examine differences in RSV encounter rates by healthcare setting and race/ethnicity.
Main Methods:
- A birth cohort study analyzed Medicaid claims for infants in seven US states (AZ, CA, FL, MI, NC, NY, TX) from 2016-2018.
- International Classification of Diseases, Tenth Revision (ICD-10) codes were used to identify first RSV diagnoses.
- Encounters on the day of first diagnosis were examined by setting and, in select states, by race/ethnicity.
Main Results:
- A total of 80,945 infants were diagnosed with RSV.
- The highest encounter rates were observed in emergency departments (ED) in five states and outpatient settings in two states.
- Significant racial disparities in outpatient and ED encounter rates were found in California, North Carolina, and Florida, with hospitalization rates being similar across groups.
Conclusions:
- This study is the first to detail the burden of RSV by healthcare setting and race/ethnicity.
- Medicaid-enrolled infants newly diagnosed with RSV experience the highest burden in emergency department and outpatient settings.
- Findings underscore the need to address healthcare disparities for RSV in vulnerable infant populations.
Background:
Infants covered by Medicaid have higher respiratory syncytial virus (RSV) hospitalization rates than those with commercial insurance, but findings are limited to the inpatient setting. This birth cohort study describes healthcare encounters for RSV across all settings among infants covered by Medicaid and the Children's Health Insurance Program.
Methods:
Medicaid claims for infants born and residing in Arizona (AZ), California (CA), Florida (FL), Michigan (MI), North Carolina (NC), New York (NY), and Texas (TX) were analyzed for first diagnosis of RSV in 2016-2018 using International Classification of Diseases, Tenth Revision codes. Encounters on the day of first diagnosis were examined by setting in 7 states and by setting and race in CA, FL, and NC.
Results:
A total of 80 945 infants were diagnosed with RSV in 7 states in 2016-2018. The highest encounter rates for first RSV diagnosis were in the emergency department (ED) in 5 states (11.0-33.4 per 1000 in AZ, CA, FL, MI, and NY) and outpatient setting in 2 states (54.8 and 68.5 per 1000 in TX and NC). Significantly higher outpatient encounter rates were found in CA and NC for White infants compared to non-White infants. In NC, ED encounter rates were significantly higher for non-White infants than White infants, whereas in CA, the rates were comparable. In these 2 states, hospitalization rates were similar across groups. In FL, compared with White infants, non-White infants had significantly higher encounter rates in each setting on the day of first RSV diagnosis.
Conclusions:
This is the first study to describe the burden of RSV by setting and race. Medicaid infants who are newly diagnosed with RSV have the highest burden in ED and outpatient settings.
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