Rivera-Sepulveda Andrea, Garcia-Rivera Enid J
Division of Pediatric Emergency Medicine, Department of Pediatrics, Saint Louis University School of Medicine, 1402 S. Grand Boulevard - Glennon Hall, Room 2717, 63104 Saint Louis, MO USA.
School of Health Professions, University of Puerto Rico Medical Sciences Campus, and School of Medicine, San Juan, Puerto Rico.
Trop Med Health. 2017 Oct 2;45:24. doi: 10.1186/s41182-017-0064-7. eCollection 2017.
Little is known about the epidemiology of bronchiolitis as a clinical diagnosis and its impact on emergency department visits and hospitalizations in tropical and semitropical regions. We described the epidemiology of bronchiolitis emergency visits and hospitalizations, its temporal trend and geographic distribution in Puerto Rico between 2010 and 2014.
We performed a retrospective descriptive analysis of a representative sample of privately insured children with bronchiolitis from January 2010 to December 2014. Data was provided by the largest private health insurer in Puerto Rico and identified children < 24 months of age with bronchiolitis by code 466, 466.11, and 466.19. Chi-square and one-way ANOVA compared sex, age, diagnosis, and severity across the years. Joinpoint Poisson regression analysis evaluated the temporal trend distribution of bronchiolitis hospitalizations per calendar year. A value less than 0.05 was statistically significant.
During the study period, the annual proportion of emergency department visits and hospitalizations due to bronchiolitis increased from 3 to 5%, and 26 to 38%, respectively. The annual incidence rate of hospitalizations was 3.2 per 1000 privately insured children < 24 months. Non-RSV bronchiolitis was the most frequent diagnosis (51%). Hospitalizations occurred year-round, but increased significantly from August through December. Most children hospitalized resided in the metropolitan San Juan (35%) and surrounding urban areas. Total hospital charges decreased from $3.78 to $3.74 million, with an average cost per hospitalization of $4320.12 (11.3% increase; = 0.0015).
This is the first study that evaluates the epidemiological characteristics of bronchiolitis in a primarily Hispanic population, living in a tropical country, and using data from a privately insured population. We found a small but significant increase in proportion of emergency visits and hospitalizations. Temporal trend shows year-round hospitalizations with an earlier seasonal peak and longer duration, consistent with Puerto Rico's seasonal rainfall throughout the study period. Further studies are needed to elucidate whether this epidemiologic pattern can also be seen in publicly insured children and whether Hispanic ethnicity is a risk factor for increased hospitalizations or is related to health disparities in the US healthcare system.
作为一种临床诊断，关于细支气管炎的流行病学及其对热带和亚热带地区急诊科就诊及住院情况的影响，人们了解甚少。我们描述了2010年至2014年期间波多黎各细支气管炎急诊就诊和住院的流行病学情况、其时间趋势及地理分布。
我们对2010年1月至2014年12月期间有细支气管炎的参保儿童代表性样本进行了回顾性描述性分析。数据由波多黎各最大的私人健康保险公司提供，通过代码466、466.11和466.19识别出年龄小于24个月的细支气管炎患儿。采用卡方检验和单因素方差分析比较各年份的性别、年龄、诊断及严重程度。连接点泊松回归分析评估每年细支气管炎住院的时间趋势分布。P值小于0.05具有统计学意义。
在研究期间，因细支气管炎导致的急诊科就诊和住院的年度比例分别从3%增至5%和从26%增至38%。每1000名年龄小于24个月的参保儿童中，住院的年发病率为3.2例。非呼吸道合胞病毒（RSV）引起的细支气管炎是最常见的诊断（51%）。住院全年都有发生，但从8月至12月显著增加。大多数住院儿童居住在圣胡安大都市区（35%）及周边城市地区。住院总费用从378万美元降至374万美元，每次住院平均费用为4320.12美元（增加11.3%；P = 0.0015）。
这是第一项评估生活在热带国家的主要为西班牙裔人群中细支气管炎流行病学特征，并使用参保人群数据的研究。我们发现急诊就诊和住院比例有小幅但显著的增加。时间趋势显示全年都有住院情况，季节性高峰出现得更早且持续时间更长，这与研究期间波多黎各的季节性降雨情况一致。需要进一步研究以阐明在参保儿童中是否也能看到这种流行病学模式，以及西班牙裔种族是否是住院增加的危险因素或与美国医疗保健系统中的健康差异有关。
