Geographic Variation in Hospitalization for Lower Respiratory Tract Infections Across One County

Abstract

IMPORTANCE Bronchiolitis and pneumonia are leading causes of pediatric hospitalizations. Identifying geographic patterns in hospitalization rates across small geographic areas could be particularly relevant to targeted patient-level and population-level health care.OBJECTIVE To determine whether lower respiratory tract infection hospitalization rates varied geographically across a single county and whether such variability was associated with socioeconomic conditions. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of children hospitalized at one institution for lower respiratory tract infections between January 1, 2010, and December 31, 2013. The setting was Cincinnati Children's Hospital Medical Center, a large, academic, stand-alone pediatric facility located in Hamilton County, Ohio. During the study period, 99.6% of in-county children hospitalized for lower respiratory tract infections were admitted to Cincinnati Children's Hospital Medical Center. Participants were children younger than 2 years who were hospitalized with bronchiolitis and children younger than 18 years who were hospitalized with pneumonia. Patients were identified using discharge diagnosis codes and then geocoded to their home census tract.EXPOSURES Primary exposures, linked to each geocoded patient, included census tract-level socioeconomic measures obtained from the 2008 to 2012 American Community Survey (eg, adult educational attainment, unemployment, and poverty). Patient-level variables examined included demographics, presence of a complex chronic condition, length of stay, and cost. MAIN OUTCOMES AND MEASURESWe calculated bronchiolitis and pneumonia hospitalization rates for Hamilton County and for each of 222 in-county census tracts. Associations between hospitalization rate quintiles and underlying socioeconomic conditions were assessed using the Kruskal-Wallis test. Geographic clustering was assessed using the Getis-Ord Gi* statistic.RESULTS There were 1495 bronchiolitis hospitalizations and 1231 pneumonia hospitalizations during the study period. The county rates were 17.5 (range across census tracts, 0-71.4) hospitalizations per 1000 children per year for bronchiolitis and 1.6 (range across census tracts, 0-4.3) hospitalizations per 1000 children per year for pneumonia. There was significant variation in the median hospitalization rates by census tract quintile for bronchiolitis (32.8, 20.8, 14.0, 10.4, and 5.1 per 1000) and for pneumonia (3.3, 2.1, 1.4, 0.9, and 0.3 per 1000). There were also significant, graded differences in socioeconomic measures by hospitalization rate quintile. Hot spots were localized to inner-city, impoverished neighborhoods. CONCLUSIONS AND RELEVANCEBronchiolitis and pneumonia hospitalization rates varied considerably in ways that were related to underlying socioeconomic conditions. Clinical and public health interventions, targeted accordingly, could improve patient-level and population-level management of acute conditions at a reduced cost.

Solar radiation, air pollution, and bronchiolitis hospitalizations in Chile: An ecological study

“…In addition, significant hotspots of bronchiolitis hospitalizations in this county were noted in high-poverty areas of the inner city. 43 The present study has some limitations. As it is an ecological study, the observed associations do not prove causality.…”

“…In another study performed in Ohio, USA, the population in the highest quintile of bronchiolitis hospitalization rates had significantly lower annual household income than that of lower hospitalization rate quintiles. In addition, significant hotspots of bronchiolitis hospitalizations in this county were noted in high‐poverty areas of the inner city …”

Location, Location, Location: Teaching About Neighborhoods in Pediatrics

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“…1,2 Likewise, one’s neighborhood has been shown to shape multiple health outcomes including life expectancy. 3,4 Pediatric residency training on the social determinants of health (SDH) currently focuses on understanding the effect of poverty on child health with less attention to neighborhood location and the relevant, available resources that reside within local communities. Previous curricula examining the disparities that exist across local neighborhoods have primarily taken the form of short-term windshield surveys or asset mapping.…”

Spatial variation of pneumonia hospitalization risk in Twin Cities metro area, Minnesota

“…Adult bacteremic pneumococcal pneumonia and infant risk of developing pneumonia have both been associated with lower income and education [7]. Similarly, pneumonia hospitalization rates have been significantly associated with socioeconomic deprivation [8, 9], and geographic variation in pneumonia hospitalization has been associated with underlying socioeconomic conditions [8]. However, whether spatial variability is also linked to other demographic and environmental factors beyond socioeconomic status and education is not well described.…”