Geographic variation in hospitalization for lower respiratory tract infections across one county

Andrew F. Beck*, Todd A. Florin, Suzanne Campanella, Samir S. Shah

*Corresponding author for this work

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

IMPORTANCE Bronchiolitis and pneumonia are leading causes of pediatric hospitalizations. Identifying geographic patterns in hospitalization rates across small geographic areas could be particularly relevant to targeted patient-level and population-level health care. OBJECTIVE To determine whether lower respiratory tract infection hospitalization rates varied geographically across a single county and whether such variability was associated with socioeconomic conditions. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of children hospitalized at one institution for lower respiratory tract infections between January 1, 2010, and December 31, 2013. The setting was Cincinnati Childrens Hospital Medical Center, a large, academic, stand-alone pediatric facility located in Hamilton County, Ohio. During the study period, 99.6%of in-county children hospitalized for lower respiratory tract infections were admitted to Cincinnati Childrens Hospital Medical Center. Participants were children younger than 2 years who were hospitalized with bronchiolitis and children younger than 18 years who were hospitalized with pneumonia. Patients were identified using discharge diagnosis codes and then geocoded to their home census tract. EXPOSURES Primary exposures, linked to each geocoded patient, included census tractlevel socioeconomic measures obtained from the 2008 to 2012 American Community Survey (eg, adult educational attainment, unemployment, and poverty). Patient-level variables examined included demographics, presence of a complex chronic condition, length of stay, and cost. MAIN OUTCOMES AND MEASURES We calculated bronchiolitis and pneumonia hospitalization rates for Hamilton County and for each of 222 in-county census tracts. Associations between hospitalization rate quintiles and underlying socioeconomic conditions were assessed using the Kruskal-Wallis test. Geographic clustering was assessed using the Getis-Ord Gistatistic. RESULTS There were 1495 bronchiolitis hospitalizations and 1231 pneumonia hospitalizations during the study period. The county rates were 17.5 (range across census tracts, 0-71.4) hospitalizations per 1000 children per year for bronchiolitis and 1.6 (range across census tracts, 0-4.3) hospitalizations per 1000 children per year for pneumonia. There was significant variation in the median hospitalization rates by census tract quintile for bronchiolitis (32.8, 20.8, 14.0, 10.4, and 5.1 per 1000) and for pneumonia (3.3, 2.1, 1.4, 0.9, and 0.3 per 1000). There were also significant, graded differences in socioeconomic measures by hospitalization rate quintile. Hot spots were localized to inner-city, impoverished neighborhoods. CONCLUSIONS AND RELEVANCE Bronchiolitis and pneumonia hospitalization rates varied considerably in ways that were related to underlying socioeconomic conditions. Clinical and public health interventions, targeted accordingly, could improve patient-level and population-level management of acute conditions at a reduced cost.

Original languageEnglish (US)
Pages (from-to)846-854
Number of pages9
JournalJAMA Pediatrics
Volume169
Issue number9
DOIs
StatePublished - Sep 1 2015

Fingerprint

Respiratory Tract Infections
Hospitalization
Bronchiolitis
Censuses
Pneumonia
Geographic Mapping
Hospitalized Child
Pediatrics
Population
Costs and Cost Analysis
Unemployment
Poverty
Health Status
Cluster Analysis
Length of Stay
Public Health
Demography
Delivery of Health Care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Beck, Andrew F. ; Florin, Todd A. ; Campanella, Suzanne ; Shah, Samir S. / Geographic variation in hospitalization for lower respiratory tract infections across one county. In: JAMA Pediatrics. 2015 ; Vol. 169, No. 9. pp. 846-854.
@article{98975ccef9e34877b51b50c14a8ea246,
title = "Geographic variation in hospitalization for lower respiratory tract infections across one county",
abstract = "IMPORTANCE Bronchiolitis and pneumonia are leading causes of pediatric hospitalizations. Identifying geographic patterns in hospitalization rates across small geographic areas could be particularly relevant to targeted patient-level and population-level health care. OBJECTIVE To determine whether lower respiratory tract infection hospitalization rates varied geographically across a single county and whether such variability was associated with socioeconomic conditions. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of children hospitalized at one institution for lower respiratory tract infections between January 1, 2010, and December 31, 2013. The setting was Cincinnati Childrens Hospital Medical Center, a large, academic, stand-alone pediatric facility located in Hamilton County, Ohio. During the study period, 99.6{\%}of in-county children hospitalized for lower respiratory tract infections were admitted to Cincinnati Childrens Hospital Medical Center. Participants were children younger than 2 years who were hospitalized with bronchiolitis and children younger than 18 years who were hospitalized with pneumonia. Patients were identified using discharge diagnosis codes and then geocoded to their home census tract. EXPOSURES Primary exposures, linked to each geocoded patient, included census tractlevel socioeconomic measures obtained from the 2008 to 2012 American Community Survey (eg, adult educational attainment, unemployment, and poverty). Patient-level variables examined included demographics, presence of a complex chronic condition, length of stay, and cost. MAIN OUTCOMES AND MEASURES We calculated bronchiolitis and pneumonia hospitalization rates for Hamilton County and for each of 222 in-county census tracts. Associations between hospitalization rate quintiles and underlying socioeconomic conditions were assessed using the Kruskal-Wallis test. Geographic clustering was assessed using the Getis-Ord Gistatistic. RESULTS There were 1495 bronchiolitis hospitalizations and 1231 pneumonia hospitalizations during the study period. The county rates were 17.5 (range across census tracts, 0-71.4) hospitalizations per 1000 children per year for bronchiolitis and 1.6 (range across census tracts, 0-4.3) hospitalizations per 1000 children per year for pneumonia. There was significant variation in the median hospitalization rates by census tract quintile for bronchiolitis (32.8, 20.8, 14.0, 10.4, and 5.1 per 1000) and for pneumonia (3.3, 2.1, 1.4, 0.9, and 0.3 per 1000). There were also significant, graded differences in socioeconomic measures by hospitalization rate quintile. Hot spots were localized to inner-city, impoverished neighborhoods. CONCLUSIONS AND RELEVANCE Bronchiolitis and pneumonia hospitalization rates varied considerably in ways that were related to underlying socioeconomic conditions. Clinical and public health interventions, targeted accordingly, could improve patient-level and population-level management of acute conditions at a reduced cost.",
author = "Beck, {Andrew F.} and Florin, {Todd A.} and Suzanne Campanella and Shah, {Samir S.}",
year = "2015",
month = "9",
day = "1",
doi = "10.1001/jamapediatrics.2015.1148",
language = "English (US)",
volume = "169",
pages = "846--854",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "9",

}

Geographic variation in hospitalization for lower respiratory tract infections across one county. / Beck, Andrew F.; Florin, Todd A.; Campanella, Suzanne; Shah, Samir S.

In: JAMA Pediatrics, Vol. 169, No. 9, 01.09.2015, p. 846-854.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Geographic variation in hospitalization for lower respiratory tract infections across one county

AU - Beck, Andrew F.

AU - Florin, Todd A.

AU - Campanella, Suzanne

AU - Shah, Samir S.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - IMPORTANCE Bronchiolitis and pneumonia are leading causes of pediatric hospitalizations. Identifying geographic patterns in hospitalization rates across small geographic areas could be particularly relevant to targeted patient-level and population-level health care. OBJECTIVE To determine whether lower respiratory tract infection hospitalization rates varied geographically across a single county and whether such variability was associated with socioeconomic conditions. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of children hospitalized at one institution for lower respiratory tract infections between January 1, 2010, and December 31, 2013. The setting was Cincinnati Childrens Hospital Medical Center, a large, academic, stand-alone pediatric facility located in Hamilton County, Ohio. During the study period, 99.6%of in-county children hospitalized for lower respiratory tract infections were admitted to Cincinnati Childrens Hospital Medical Center. Participants were children younger than 2 years who were hospitalized with bronchiolitis and children younger than 18 years who were hospitalized with pneumonia. Patients were identified using discharge diagnosis codes and then geocoded to their home census tract. EXPOSURES Primary exposures, linked to each geocoded patient, included census tractlevel socioeconomic measures obtained from the 2008 to 2012 American Community Survey (eg, adult educational attainment, unemployment, and poverty). Patient-level variables examined included demographics, presence of a complex chronic condition, length of stay, and cost. MAIN OUTCOMES AND MEASURES We calculated bronchiolitis and pneumonia hospitalization rates for Hamilton County and for each of 222 in-county census tracts. Associations between hospitalization rate quintiles and underlying socioeconomic conditions were assessed using the Kruskal-Wallis test. Geographic clustering was assessed using the Getis-Ord Gistatistic. RESULTS There were 1495 bronchiolitis hospitalizations and 1231 pneumonia hospitalizations during the study period. The county rates were 17.5 (range across census tracts, 0-71.4) hospitalizations per 1000 children per year for bronchiolitis and 1.6 (range across census tracts, 0-4.3) hospitalizations per 1000 children per year for pneumonia. There was significant variation in the median hospitalization rates by census tract quintile for bronchiolitis (32.8, 20.8, 14.0, 10.4, and 5.1 per 1000) and for pneumonia (3.3, 2.1, 1.4, 0.9, and 0.3 per 1000). There were also significant, graded differences in socioeconomic measures by hospitalization rate quintile. Hot spots were localized to inner-city, impoverished neighborhoods. CONCLUSIONS AND RELEVANCE Bronchiolitis and pneumonia hospitalization rates varied considerably in ways that were related to underlying socioeconomic conditions. Clinical and public health interventions, targeted accordingly, could improve patient-level and population-level management of acute conditions at a reduced cost.

AB - IMPORTANCE Bronchiolitis and pneumonia are leading causes of pediatric hospitalizations. Identifying geographic patterns in hospitalization rates across small geographic areas could be particularly relevant to targeted patient-level and population-level health care. OBJECTIVE To determine whether lower respiratory tract infection hospitalization rates varied geographically across a single county and whether such variability was associated with socioeconomic conditions. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of children hospitalized at one institution for lower respiratory tract infections between January 1, 2010, and December 31, 2013. The setting was Cincinnati Childrens Hospital Medical Center, a large, academic, stand-alone pediatric facility located in Hamilton County, Ohio. During the study period, 99.6%of in-county children hospitalized for lower respiratory tract infections were admitted to Cincinnati Childrens Hospital Medical Center. Participants were children younger than 2 years who were hospitalized with bronchiolitis and children younger than 18 years who were hospitalized with pneumonia. Patients were identified using discharge diagnosis codes and then geocoded to their home census tract. EXPOSURES Primary exposures, linked to each geocoded patient, included census tractlevel socioeconomic measures obtained from the 2008 to 2012 American Community Survey (eg, adult educational attainment, unemployment, and poverty). Patient-level variables examined included demographics, presence of a complex chronic condition, length of stay, and cost. MAIN OUTCOMES AND MEASURES We calculated bronchiolitis and pneumonia hospitalization rates for Hamilton County and for each of 222 in-county census tracts. Associations between hospitalization rate quintiles and underlying socioeconomic conditions were assessed using the Kruskal-Wallis test. Geographic clustering was assessed using the Getis-Ord Gistatistic. RESULTS There were 1495 bronchiolitis hospitalizations and 1231 pneumonia hospitalizations during the study period. The county rates were 17.5 (range across census tracts, 0-71.4) hospitalizations per 1000 children per year for bronchiolitis and 1.6 (range across census tracts, 0-4.3) hospitalizations per 1000 children per year for pneumonia. There was significant variation in the median hospitalization rates by census tract quintile for bronchiolitis (32.8, 20.8, 14.0, 10.4, and 5.1 per 1000) and for pneumonia (3.3, 2.1, 1.4, 0.9, and 0.3 per 1000). There were also significant, graded differences in socioeconomic measures by hospitalization rate quintile. Hot spots were localized to inner-city, impoverished neighborhoods. CONCLUSIONS AND RELEVANCE Bronchiolitis and pneumonia hospitalization rates varied considerably in ways that were related to underlying socioeconomic conditions. Clinical and public health interventions, targeted accordingly, could improve patient-level and population-level management of acute conditions at a reduced cost.

UR - http://www.scopus.com/inward/record.url?scp=84941241888&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941241888&partnerID=8YFLogxK

U2 - 10.1001/jamapediatrics.2015.1148

DO - 10.1001/jamapediatrics.2015.1148

M3 - Article

C2 - 26192102

AN - SCOPUS:84941241888

VL - 169

SP - 846

EP - 854

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 9

ER -