Caisse Nationale de l'Assurance Maladie, Direction de la Stratégie des Etudes et des Statistiques, F-75986, Paris Cedex 20, France.
Direction de la Recherche, des Etudes, de l'Evaluation et des Statistiques (Drees), 75015, Paris, France.
BMC Health Serv Res. 2023 Aug 23;23(1):901. doi: 10.1186/s12913-023-09861-2.
Nationwide data for children for short-stay hospitalisation (SSH) and associated factors are scarce. This retrospective study of children in France < 18 years of age followed after their birth or birthday in 2018 focused on at least one annual SSH, stay < 1 night or ≥ 1 night, or 30-day readmission ≥ 1 night.
Children were selected from the national health data system (SNDS), which includes data on long-term chronic disease (LTD) status with full reimbursement and complementary universal coverage based on low household income (CMUC). Uni and multivariate quasi-Poisson regression were applied for each outcome.
Among 13.211 million children (94.4% population, 51.2% boys), CMUC was identified for 17.5% and at least one LTD for 4% (0-<1 year: 1.5%; 14-<18 year: 5.2%). The most frequent LTDs were pervasive developmental diseases (0.53%), asthma (0.24%), epilepsy (0.17%), and type 1 diabetes (0.15%). At least one SSH was found for 8.8%: SSH < 1 night (4.9%), SSH ≥ 1 night (4.5%), readmission (0.4%). Children with at least one SSH were younger (median 6 vs. 9 years) and more often had CMUC (21%), a LTD (12%), an emergency department (ED) visit (56%), or various primary healthcare visits than all children. Those with a SSH ≥1 night vs. < 1 night were older (median: 9 vs. 4 years). They had the same frequency of LTD (13.4%) but more often an ED visit (78% vs. 42%). Children with readmissions were younger (median 3 years). They had the highest levels of CMUC (29.3%), LTD (34%), EDs in their municipality (35% vs. 29% for the whole population) and ED visits (87%). In adjusted analysis, each outcome was significantly less frequent among girls than boys and more frequent for children with CMUC. LTDs with the largest association with SSH < 1 night were cystic fibrosis, sickle cell diseases (SCD), diabetes type 1, those with SSH ≥1 night type 1 diabetes epilepsy and SCD, and those for readmissions lymphoid leukaemia, malignant neoplasm of the brain, and SCD. Among all SSH admissions of children < 10 years, 25.8% were potentially preventable.
Higher SSH and readmission rates were found for children with certain LTD living in low-income households, suggesting the need or increase of specific policy actions and research.
法国缺乏儿童短期住院（SSH）的全国性数据及其相关因素。本研究回顾了 2018 年出生或生日后在法国的<18 岁儿童，主要关注至少一次年度 SSH、住院<1 晚或≥1 晚或 30 天内再次住院≥1 晚。
从国家健康数据系统（SNDS）中选择儿童，该系统包括长期慢性疾病（LTD）状态的数据，包括根据家庭收入（CMUC）高低全额报销和补充全民覆盖的 LTD 状态数据。对每种结果应用单变量和多变量拟泊松回归。
在 1.321 亿名儿童（94.4%的人口，51.2%的男孩）中，CMUC 为 17.5%，至少有一种 LTD 为 4%（0-<1 岁：1.5%；14-<18 岁：5.2%）。最常见的 LTD 是广泛发育障碍（0.53%）、哮喘（0.24%）、癫痫（0.17%）和 1 型糖尿病（0.15%）。发现至少有一次 SSH 的儿童为 8.8%：SSH<1 晚（4.9%）、SSH≥1 晚（4.5%）、再入院（0.4%）。有 SSH 的儿童年龄较小（中位数 6 岁比 9 岁），且更常伴有 CMUC（21%）、LTD（12%）、急诊就诊（56%）或各种初级保健就诊，与所有儿童相比。SSH≥1 晚的儿童比 SSH<1 晚的儿童年龄更大（中位数：9 岁比 4 岁）。他们的 LTD 频率相同（13.4%），但急诊就诊的频率更高（78%比 42%）。再次入院的儿童年龄较小（中位数 3 岁）。CMUC 比例最高（29.3%）、LTD（34%）、本市的急诊就诊率（35%比总人口的 29%）和急诊就诊率（87%）最高。在调整后的分析中，与男孩相比，女孩各结局的发生频率显著较低，而 CMUC 儿童的发生频率较高。与 SSH<1 晚相关性最大的 LTD 包括囊性纤维化、镰状细胞病（SCD）、1 型糖尿病、SSH≥1 晚的 1 型糖尿病、癫痫和 SCD、以及再入院的淋巴白血病、脑恶性肿瘤和 SCD。在所有 SSH 住院的<10 岁儿童中，25.8%是潜在可预防的。
患有某些 LTD 且生活在低收入家庭的儿童 SSH 和再入院率较高，表明需要或增加特定的政策行动和研究。
