Department of Pediatrics, University of Washington, Seattle, Washington, USA.
Seattle Children's Research Institute, Seattle, Washington, USA.
J Rural Health. 2023 Jun;39(3):611-616. doi: 10.1111/jrh.12746. Epub 2023 Jan 29.
We aimed to identify temporal trends and differences in urban and rural pediatric interfacility transfers (IFTs) before and during the COVID-19 pandemic.
We conducted a cross-sectional analysis of IFT among children <18 years from January 2019 to June 2022 using the Pediatric Health Information System. The primary outcome was IFTs from general hospitals to referral children's hospitals. The primary exposure was patient rurality, defined by Rural-Urban Commuting Area codes. We categorized IFTs into medical, surgical, and mental health diagnoses and analyzed trends by month. We calculated observed-to-expected (O-E) ratios of pre-pandemic (March 2019-Feb 2020) transfers compared to pandemic year 1 (March 2020-Feb 2021) and year 2 (March 2021-February 2022) using Poisson modeling.
Of 419,250 IFTs, 18.8% (n = 78,751) were experienced by rural-residing children. The O-E ratio of IFT in year 1 for urban children was 14.0% (95% confidence interval [CI] 13.8, 14.2) and 14.8% (95% CI 14.4, 15.3) for rural children compared to pre-pandemic (P = .0001). In year 2, transfers rebounded with IFTs for rural-residing children increasing more than urban-residing children (101.7% [95% CI 100.1, 103.4] compared to 90.7% [95% CI 89.0, 90.4], P < .0001). For mental-health indications in year 2, rural transfer ratios were higher than urban, 126.8% (95% CI, 116.7, 137.6) compared to 113.7% (95% CI 109.9, 117.6), P = .0168.
Pediatric IFTs decreased dramatically during pandemic year 1. In year 2, while medical and surgical transfers continued to lag pre-pandemic volumes, transfers for mental health indications significantly exceeded pre-pandemic levels, particularly among rural-residing children.
本研究旨在确定 COVID-19 大流行前后，城乡间儿科院内转院（IFT）的时间趋势和差异。
我们使用儿科健康信息系统（Pediatric Health Information System），对 2019 年 1 月至 2022 年 6 月期间<18 岁的儿童的 IFT 进行了一项横断面分析。主要结局为一般医院向转诊儿童医院的 IFT。主要暴露因素为患者居住地的城乡分类（以农村-城市通勤区代码表示）。我们将 IFT 分为医疗、手术和心理健康诊断，并按月分析趋势。我们使用泊松模型计算了大流行前（2019 年 3 月至 2020 年 2 月）与大流行年 1（2020 年 3 月至 2021 年 2 月）和年 2（2021 年 3 月至 2022 年 2 月）相比，医疗转移的观察到的与预期的（O-E）比值。
在 419250 例 IFT 中，18.8%（n=78751）为农村居住儿童经历。城市儿童在大流行年 1 的 IFT 的 O-E 比值为 14.0%（95%可信区间[CI]为 13.8%，14.2%），农村儿童为 14.8%（95%CI 为 14.4%，15.3%），与大流行前相比（P=0.0001）。在大流行年 2，农村居住儿童的转移量比城市居住儿童增加更多，出现反弹（101.7%[95%CI 为 100.1%，103.4%]，而 90.7%[95%CI 为 89.0%，90.4%]，P<0.0001）。2022 年，对于心理健康指标，农村转院率高于城市，为 126.8%（95%CI，116.7%，137.6%），而城市为 113.7%（95%CI，109.9%，117.6%），P=0.0168。
COVID-19 大流行第一年，儿科 IFT 显著下降。在大流行年 2，尽管医疗和手术转移仍落后于大流行前水平，但心理健康指标的转移量明显超过大流行前水平，尤其是农村居住儿童。
