Factors associated with hospital admission and 30-day readmission for children less than 18 years of age in 2018 in France: a one-year nationwide observational study

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

One-year emergency department visits for children < 18 years of age, associated factors and frequency of primary general practitioner or pediatrician visits before: a French observational study (2018–19)

“…For some LTD, we can suppose that parents are well educated about the signs of chronic disease decompensation but they are not always with the child (school…). For the same population, another analysis pointed that among children with one hospitalisation during the study year, 56% had an ED visit, 42% if the hospitalisation was less than one night, 78% if the hospitalisation was for one night or more and 87% if it was a readmission > 1 night before 30 days [ 34 ].…”

Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study

“…The greatest decrease in specialist visits with deprivation was found for psychiatrists, whereas deprived children had more LTDs and SSH diagnoses for mental diseases and admissions to psychiatric hospitals, with two peaks. The first occurred at approximately 10 years of age, mainly for LTDs, and the second larger peak arose for children from 11 to 16 years of age with perhaps other acute or chronic psychiatric diseases, such as depression, pervasive developmental disorders, or eating disorders [ 38 ]. However, children can be exclusively followed by medical-psycho-pedagogical or medico-psychological centres with the visits supported by the centres and thus not identifiable.…”