Department of Pediatrics, Division of Nephrology, University of Alabama Birmingham, Birmingham, Alabama, 35233, USA.
Department of Epidemiology, University of North Carolina Gillings School of Public Health, Chapel Hill, NC, USA.
Pediatr Nephrol. 2020 Jun;35(6):1085-1096. doi: 10.1007/s00467-020-04470-1. Epub 2020 Jan 29.
Acute kidney injury (AKI) significantly increases morbidity and mortality for hospitalized children, yet sociodemographic risk factors for pediatric AKI are poorly described. We examined sociodemographic differences in pediatric AKI amongst a national cohort of hospitalized children.
Secondary analysis of the most recent (2012) Kids' Inpatient Database (KID) from the Agency for Healthcare Research and Quality. Study sample weights were used to obtain national estimates of AKI (defined by administrative data). KID is a nationally representative sample of pediatric discharges throughout the USA. Linear risk regression models were used to assess the relationship between our primary exposures (race/ethnicity, health insurance, household urbanization, gender, and age) and the diagnosis of AKI, adjusting for comorbidities.
A total of 1,699,841 hospitalizations met our study criteria. In 2012, AKI occurred in approximately 12.3/1000 pediatric hospitalizations, which translates to almost 30,000 children nationally. Asian/Pacific Islander, African-American, and Hispanic children were at slightly increased risk for AKI compared to Caucasian children (adjusted risk difference (RD) 4.5 per 1000 hospitalizations, 95% confidence interval (CI) 2.9-6.0; 2.5/1000 hospitalizations, 95% CI 1.7-3.3; and 1.7/1000 hospitalizations, 95% CI 0.9-2.5, respectively). Uninsured children were more likely to suffer AKI compared to children with any health insurance (e.g., no insurance versus Medicaid: adjusted RD 14.4/1000 hospitalizations, 95% CI 12.7-16.2). Based on these national estimates, one episode of AKI might be prevented if 70 (95% CI 62-79) hospitalized children without insurance were provided with Medicaid.
Pediatric AKI occurs more frequently in racial minority and uninsured children, factors linked to lower socioeconomic status.
急性肾损伤（AKI）显著增加住院儿童的发病率和死亡率，但儿科 AKI 的社会人口学危险因素描述不佳。我们在住院儿童的全国队列中检查了 AKI 的社会人口学差异。
对医疗保健研究和质量局的最新（2012 年）儿童住院数据库（KID）进行二次分析。使用研究样本权重获得 AKI 的全国估计值（通过行政数据定义）。KID 是美国各地儿科出院的全国代表性样本。线性风险回归模型用于评估我们的主要暴露因素（种族/民族、健康保险、家庭城市化、性别和年龄）与 AKI 诊断之间的关系，同时调整了合并症。
共有 1699841 例住院符合我们的研究标准。2012 年，AKI 发生在大约 12.3/1000 例儿科住院中，这意味着全国有近 30000 名儿童。与白人儿童相比，亚洲/太平洋岛民、非裔美国人和西班牙裔儿童的 AKI 风险略高（调整后的风险差异（RD）每 1000 例住院增加 4.5，95%置信区间（CI）2.9-6.0；每 1000 例住院增加 2.5，95%CI 1.7-3.3；每 1000 例住院增加 1.7，95%CI 0.9-2.5）。与任何健康保险相比，没有保险的儿童更有可能发生 AKI（例如，没有保险与医疗补助：调整后的 RD 每 1000 例住院增加 14.4，95%CI 12.7-16.2）。根据这些全国估计，每 70 例（95%CI 62-79）没有保险的住院儿童如果获得医疗补助，就可能预防一次 AKI 发作。
在社会经济地位较低的少数族裔和没有保险的儿童中，儿科 AKI 更常见。
