Health insurance and length of stay for children hospitalized with community‐acquired pneumonia

Abstract

BACKGROUND Disparities in patterns of care and outcomes for ambulatory-care sensitive childhood conditions such as community-acquired pneumonia (CAP) persist. However, the influence of insurance status on length of stay (LOS) for children hospitalized with CAP remains unexplored. METHODS Secondary analysis of children (<18 years) hospitalized with CAP sampled in the Kids’ Inpatient Database (KID) for years 1997, 2000, 2003, and 2006. Insurance status (private, public, uninsured) was based on claims data. Hospital LOS was calculated in days. Taking into account the complex sampling design, negative binomial regression models produced adjusted estimates of incidence rate ratios (IRR) for hospital LOS for children by insurance status. RESULTS There was little variation in the categories of insurance status of children hospitalized with CAP between 1997 and 2006, with at least 40% privately insured, at least 40% publicly insured, and at least 5% uninsured in each sampled year. In all years, publicly insured children had a significantly longer hospital stay than privately insured children, and uninsured children had a significantly shorter hospital stay than privately insured children. These observed differences persisted after multivariate adjustment. CONCLUSIONS Differences in LOS between uninsured, publicly insured, and privately insured children with CAP raise concerns about potential differences in hospital discharge practices related to insurance status and type. As healthcare reform is implemented, policy makers should strengthen efforts to reduce these disparities in order to achieve health for the population.

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

“…These findings are in line with several previous studies, 12,18,35,36 and are likely due to multiple factors that may include worse disease severity on presentation. 37 Additional research is necessary to understand whether there are differences in processes of care, quality of care, or other outcomes related to inpatient management for children with different insurance coverage.…”

“…37 Additional research is necessary to understand whether there are differences in processes of care, quality of care, or other outcomes related to inpatient management for children with different insurance coverage. 18 For both asthma and LRI, we found hospitalizations to large, urban-teaching hospitals had higher risk of prolonged LOS and complications. Similar associations have been found in analyses of children admitted for pneumonia, 18 common pediatric conditions, 21 and all-cause pediatric hospitalizations.…”

“…Odds of prolonged LOS decreased 2% and complications decreased 5% for every year of age, making the odds of these events up to 85% higher in infants. Pati et al 18 also found risks of prolonged LOS were highest in the youngest children admitted for pneumonia. Possible reasons include more severe disease courses in younger children or greater variation in care of young children, such as in the use of pulse oximetry.…”

“…These variables were chosen based on previous studies showing potential associations. 11,12,16,[18][19][20][21] Discharge quarter was included to account for seasonal variation in respiratory hospitalizations.…”

Treatment of Mycoplasma Pneumonia: A Systematic Review

“…1 Specifically, wide variations in antibiotic prescribing practices exist among physicians, often because the causative agent is not identified. 2 For this reason, recent evidence-based pediatric CAP practice guidelines published by the Infectious Diseases Society of America (IDSA) recommend that children hospitalized with CAP be tested for Mycoplasma pneumoniae.…”