Prevalence and costs of US pediatric hospitalizations, 2022

Pediatric hospitalizations represent an evolving component of US healthcare utilization. The coronavirus disease 2019 (COVID-19) pandemic hastened rising mental health visits and shrinking rural hospital capacity. Understanding contemporary patterns in pediatric hospitalizations is critical to inform health system planning and policy decisions.

To describe the most common and costly diagnoses among US pediatric hospitalizations in 2022, using 2016-2019 data to contextualize trends in admission volume and cost.

We conducted a cross-sectional analysis of nonlive birth admissions for children (<18 years) using the 2022 Kids' Inpatient Database, the largest US all-payer pediatric inpatient data set, supplemented by an evaluation of volume trends from 2016 to 2019. We evaluated the most common and costly diagnoses in 2022 and evaluated trends in volumes and costs from the prior study years.

There were 1.78 million pediatric hospitalizations in 2016, 1.69 million in 2019, and 1.59 million in 2022, representing a 10.5% overall decline. In 2022, the most common diagnoses were bronchiolitis (7.0%), major depressive disorder (5.2%), and respiratory failure (5.0%). Mental health conditions (major depressive disorder, mood disorder, and suicide and self-inflicted injury) comprised three of the 20 most frequent diagnoses. Inflation-adjusted costs increased from $32.1 billion in 2016 to $35.9 billion in 2022. The costliest conditions in 2022 included respiratory failure, septicemia, and chemotherapy. Rural hospitals represented only 3.1% of admissions in 2022, down from 4.5% in 2016.

Pediatric inpatient care is increasingly centralized in urban and children's hospitals. Respiratory and mental health conditions are among the common conditions requiring hospitalization. These findings highlight the need for stronger regional coordination to support access to pediatric care for these common conditions.