Barritt A Sidney, Lee Brian, Runge Thomas, Schmidt Monica, Jhaveri Ravi
Division of Gastroenterology, Department of Medicine, UNC School of Medicine, Chapel Hill, NC.
Health Services & Outcomes Research, The Children's Mercy Hospitals and Clinics, Kansas City, MO.
J Pediatr. 2018 Jan;192:159-164. doi: 10.1016/j.jpeds.2017.09.016. Epub 2017 Nov 6.
To evaluate the impact of substance abuse on pediatric hepatitis C virus (HCV) prevalence, we examined geographic and demographic data on inpatient hospitalizations in children with HCV.
We examined hospitalizations in children using the Kids' Inpatient Database, a part of the Healthcare Cost and Utilization Project. We identified cases using the International Classification of Diseases, 9th edition, codes for HCV infection during 2006, 2009, and 2012. Nonparametric tests for trend were used to calculate trend statistics.
From 2006 to 2012 nationally, the number of hospitalizations of children with HCV increased 37% (2.69 to 3.69 per 10 000 admissions; P < .001). The mean age of children hospitalized was 17.6 years (95% CI, 17.4-17.8). HCV cases among those 19-20 years of age represented 68% of the total HCV diagnoses, with a 54% increase over the years sampled (P < .001 for trend). The burden of HCV in children was highest in whites, those in the lowest income quartile, and in the Northeast and Southern regions of the US (all P < .0001). The prevalence of substance use among children with HCV increased from 25% in 2006 to 41% in 2012 (P < .001).
The increases of HCV in hospitalized children are largely in teenagers, highly associated with substance abuse, and concentrated in Northeast and Southern states. These results strongly suggest that public health efforts to prevent and treat HCV will also need to include adolescents.
为评估药物滥用对儿童丙型肝炎病毒(HCV)流行率的影响,我们研究了HCV感染儿童住院治疗的地理和人口统计学数据。
我们使用儿童住院数据库(医疗保健成本和利用项目的一部分)研究儿童住院情况。我们通过国际疾病分类第九版编码识别出2006年、2009年和2012年期间HCV感染病例。采用非参数趋势检验来计算趋势统计量。
2006年至2012年期间,全国范围内HCV感染儿童的住院人数增加了37%(从每10000例入院病例中的2.69例增至3.69例;P < 0.001)。住院儿童的平均年龄为17.6岁(95%可信区间,17.4 - 17.8)。19 - 20岁年龄段的HCV病例占HCV确诊病例总数的68%,在抽样年份中增加了54%(趋势P < 0.001)。HCV在白人、收入最低四分位数人群以及美国东北部和南部地区儿童中的负担最高(所有P < 0.0001)。HCV感染儿童中药物使用的流行率从2006年的25%增至2012年的41%(P < 0.001)。
住院儿童中HCV感染人数的增加主要集中在青少年,与药物滥用高度相关,并集中在美国东北部和南部各州。这些结果强烈表明,预防和治疗HCV的公共卫生努力也需要纳入青少年群体。