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Community household income and resource utilization for common inpatient pediatric conditions.
Pediatrics. 2013 Dec; 132(6):e1592-601.Ped

Abstract

BACKGROUND AND OBJECTIVE

Child health is influenced by biomedical and socioeconomic factors. Few studies have explored the relationship between community-level income and inpatient resource utilization for children. Our objective was to analyze inpatient costs for children hospitalized with common conditions in relation to zip code-based median annual household income (HHI).

METHODS

Retrospective national cohort from 32 freestanding children's hospitals for asthma, diabetes, bronchiolitis and respiratory syncytial virus, pneumonia, and kidney and urinary tract infections. Standardized cost of care for individual hospitalizations and across hospitalizations for the same patient and condition were modeled by using mixed-effects methods, adjusting for severity of illness, age, gender, and race. Main exposure was median annual HHI. Posthoc tests compared adjusted standardized costs for patients from the lowest and highest income groups.

RESULTS

From 116,636 hospitalizations, 4 of 5 conditions had differences at the hospitalization and at the patient level, with lowest-income groups having higher costs. The individual hospitalization level cost differences ranged from $187 (4.1%) to $404 (6.4%). Patient-level cost differences ranged from $310 to $1087 or 6.5% to 15% higher for the lowest-income patients. Higher costs were typically not for laboratory, imaging, or pharmacy costs. In total, patients from lowest income zip codes had $8.4 million more in hospitalization-level costs and $13.6 million more in patient-level costs.

CONCLUSIONS

Lower community-level HHI is associated with higher inpatient costs of care for 4 of 5 common pediatric conditions. These findings highlight the need to consider socioeconomic status in health care system design, delivery, and reimbursement calculations.

Authors+Show Affiliations

MBA, MSHP, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, CHOP North, Room 1516, Philadelphia, PA 19104. fieldston@email.chop.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

24276839

Citation

Fieldston, Evan S., et al. "Community Household Income and Resource Utilization for Common Inpatient Pediatric Conditions." Pediatrics, vol. 132, no. 6, 2013, pp. e1592-601.
Fieldston ES, Zaniletti I, Hall M, et al. Community household income and resource utilization for common inpatient pediatric conditions. Pediatrics. 2013;132(6):e1592-601.
Fieldston, E. S., Zaniletti, I., Hall, M., Colvin, J. D., Gottlieb, L., Macy, M. L., Alpern, E. R., Morse, R. B., Hain, P. D., Sills, M. R., Frank, G., & Shah, S. S. (2013). Community household income and resource utilization for common inpatient pediatric conditions. Pediatrics, 132(6), e1592-601. https://doi.org/10.1542/peds.2013-0619
Fieldston ES, et al. Community Household Income and Resource Utilization for Common Inpatient Pediatric Conditions. Pediatrics. 2013;132(6):e1592-601. PubMed PMID: 24276839.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Community household income and resource utilization for common inpatient pediatric conditions. AU - Fieldston,Evan S, AU - Zaniletti,Isabella, AU - Hall,Matthew, AU - Colvin,Jeffrey D, AU - Gottlieb,Laura, AU - Macy,Michelle L, AU - Alpern,Elizabeth R, AU - Morse,Rustin B, AU - Hain,Paul D, AU - Sills,Marion R, AU - Frank,Gary, AU - Shah,Samir S, Y1 - 2013/11/25/ PY - 2013/11/27/entrez PY - 2013/11/28/pubmed PY - 2014/1/29/medline KW - health care finance KW - hospital costs KW - hospitalization KW - hospitalized child KW - pediatric hospital KW - resource utilization KW - socioeconomic status SP - e1592 EP - 601 JF - Pediatrics JO - Pediatrics VL - 132 IS - 6 N2 - BACKGROUND AND OBJECTIVE: Child health is influenced by biomedical and socioeconomic factors. Few studies have explored the relationship between community-level income and inpatient resource utilization for children. Our objective was to analyze inpatient costs for children hospitalized with common conditions in relation to zip code-based median annual household income (HHI). METHODS: Retrospective national cohort from 32 freestanding children's hospitals for asthma, diabetes, bronchiolitis and respiratory syncytial virus, pneumonia, and kidney and urinary tract infections. Standardized cost of care for individual hospitalizations and across hospitalizations for the same patient and condition were modeled by using mixed-effects methods, adjusting for severity of illness, age, gender, and race. Main exposure was median annual HHI. Posthoc tests compared adjusted standardized costs for patients from the lowest and highest income groups. RESULTS: From 116,636 hospitalizations, 4 of 5 conditions had differences at the hospitalization and at the patient level, with lowest-income groups having higher costs. The individual hospitalization level cost differences ranged from $187 (4.1%) to $404 (6.4%). Patient-level cost differences ranged from $310 to $1087 or 6.5% to 15% higher for the lowest-income patients. Higher costs were typically not for laboratory, imaging, or pharmacy costs. In total, patients from lowest income zip codes had $8.4 million more in hospitalization-level costs and $13.6 million more in patient-level costs. CONCLUSIONS: Lower community-level HHI is associated with higher inpatient costs of care for 4 of 5 common pediatric conditions. These findings highlight the need to consider socioeconomic status in health care system design, delivery, and reimbursement calculations. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/24276839/Community_household_income_and_resource_utilization_for_common_inpatient_pediatric_conditions_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=24276839 DB - PRIME DP - Unbound Medicine ER -