Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
J Pediatr. 2013 Oct;163(4):1127-33.e3. doi: 10.1016/j.jpeds.2013.05.002. Epub 2013 Jun 12.
To examine temporal trends in the US incidence of childhood asthma hospitalizations, in-hospital mortality, mechanical ventilation use, and hospital charges between 2000 and 2009.
This was a serial, cross-sectional analysis of a nationally representative sample of children hospitalized with acute asthma. The Kids Inpatient Database was used to identify children aged <18 years with asthma by International Classification of Diseases, Ninth Revision, Clinical Modification code 493.xx. Outcome measures were asthma hospitalization incidence, in-hospital mortality, mechanical ventilation use, and hospital charges. We examined temporal trends of each outcome, accounting for sampling weights. Hospital charges were adjusted for inflation to 2009 US dollars.
The 4 separate years (2000, 2003, 2006, and 2009) of national discharge data included a total of 592805 weighted discharges with asthma. Between 2000 and 2009, the rate of asthma hospitalization in US children decreased from 21.1 to 18.4 per 10000 person-years (13% decrease; Ptrend < .001). Mortality declined significantly after adjusting for confounders (OR for comparison of 2009 with 2000, 0.37; 95% CI, 0.17-0.79). In contrast, there was an increase in the use of mechanical ventilation (from 0.8% to 1.0%, a 28% increase; Ptrend < .001). Nationwide hospital charges also increased from $1.27 billion to $1.59 billion (26% increase; Ptrend < .001); this increase was driven by a rise in the geometric mean of hospital charges per discharge, from $5940 to $8410 (42% increase; Ptrend < .001).
Between 2000 and 2009, we found significant declines in asthma hospitalization and in-hospital mortality among US children. In contrast, mechanical ventilation use and hospital charges for asthma increased significantly over this same period.
研究 2000 年至 2009 年美国儿童哮喘住院、住院死亡率、机械通气使用和住院费用的时间趋势。
这是一项对全国代表性儿童哮喘急性住院患者的连续、横断面分析。使用儿科住院数据库（Kids Inpatient Database），通过国际疾病分类，第九版临床修订版（International Classification of Diseases, Ninth Revision, Clinical Modification）代码 493.xx 识别出年龄<18 岁的哮喘患儿。结局指标包括哮喘住院发病率、住院死亡率、机械通气使用和住院费用。我们在考虑抽样权重的情况下，检查了每个结局的时间趋势。住院费用根据 2009 年的通胀率进行了调整。
4 个单独的年份（2000 年、2003 年、2006 年和 2009 年）的全国出院数据共包括 592805 例加权哮喘出院病例。2000 年至 2009 年，美国儿童哮喘住院率从每 10000 人年 21.1 例下降到 18.4 例（下降 13%；Ptrend<0.001）。在校正混杂因素后，死亡率显著下降（2009 年与 2000 年相比的比值比为 0.37；95%CI，0.17-0.79）。相比之下，机械通气的使用增加（从 0.8%增加到 1.0%，增加 28%；Ptrend<0.001）。全国范围内的医院费用也从 12.7 亿美元增加到 15.9 亿美元（增加 26%；Ptrend<0.001）；这一增长是由每例出院的医院费用的几何平均值从 5940 美元增加到 8410 美元（增加 42%；Ptrend<0.001）所致。
2000 年至 2009 年期间，我们发现美国儿童哮喘住院和住院死亡率显著下降。相比之下，在此期间，哮喘的机械通气使用和医院费用显著增加。
