Division of Primary Care Pediatrics, State University of New York at Stony Brook School of Medicine, and Stony Brook Long Island Children's Hospital, Stony Brook, New York 11794-8111, USA.
J Hosp Med. 2012 Apr;7(4):304-10. doi: 10.1002/jhm.959. Epub 2011 Oct 3.
Disparities in patterns of care and outcomes for ambulatory-care sensitive childhood conditions such as community-acquired pneumonia (CAP) persist. However, the influence of insurance status on length of stay (LOS) for children hospitalized with CAP remains unexplored.
Secondary analysis of children (<18 years) hospitalized with CAP sampled in the Kids' Inpatient Database (KID) for years 1997, 2000, 2003, and 2006. Insurance status (private, public, uninsured) was based on claims data. Hospital LOS was calculated in days. Taking into account the complex sampling design, negative binomial regression models produced adjusted estimates of incidence rate ratios (IRR) for hospital LOS for children by insurance status.
There was little variation in the categories of insurance status of children hospitalized with CAP between 1997 and 2006, with at least 40% privately insured, at least 40% publicly insured, and at least 5% uninsured in each sampled year. In all years, publicly insured children had a significantly longer hospital stay than privately insured children, and uninsured children had a significantly shorter hospital stay than privately insured children. These observed differences persisted after multivariate adjustment.
Differences in LOS between uninsured, publicly insured, and privately insured children with CAP raise concerns about potential differences in hospital discharge practices related to insurance status and type. As healthcare reform is implemented, policy makers should strengthen efforts to reduce these disparities in order to achieve health for the population.
在社区获得性肺炎（CAP）等门诊护理敏感儿童疾病的护理模式和结果方面仍然存在差异。然而，保险状况对因 CAP 住院儿童的住院时间（LOS）的影响仍未得到探索。
对 1997 年、2000 年、2003 年和 2006 年在儿童住院数据库（KID）中抽样的因 CAP 住院的儿童进行二次分析。保险状况（私人、公共、无保险）基于索赔数据。住院 LOS 以天数计算。考虑到复杂的抽样设计，负二项回归模型产生了按保险状况调整的住院 LOS 发生率比（IRR）的调整估计值。
1997 年至 2006 年间，因 CAP 住院的儿童的保险状况类别变化不大，每年至少有 40%的儿童有私人保险，至少有 40%的儿童有公共保险，至少有 5%的儿童没有保险。在所有年份中，公共保险的儿童住院时间明显长于私人保险的儿童，而无保险的儿童住院时间明显短于私人保险的儿童。这些观察到的差异在多变量调整后仍然存在。
CAP uninsured、publicly insured 和 privately insured 儿童的 LOS 差异引起了人们对与保险状况和类型相关的出院实践差异的关注。随着医疗改革的实施，政策制定者应加强努力，减少这些差异，以实现全民健康。
