Increasing Burden and Risk Factors for Bronchiolitis-Related Medical Visits in Infants Enrolled in a State Health Care Insurance Plan

Abstract

OBJECTIVE To estimate the year-round burden of healthcare visits attributable to bronchiolitis and identify risk factors for bronchiolitis in term, healthy infants. PATIENTS AND METHODS We conducted a population-based, retrospective cohort study of 103,670 term, non-low birth weight infants enrolled in Tennessee Medicaid, 1995 to 2003. We followed infants through the first year of life. Risk factors for bronchiolitis during infancy and rates of inpatient, emergency department, and outpatient visits during the study period were calculated using claims data. RESULTS Over the 9 study years, rates of bronchiolitis visits per 1000 infant years were: 238 (outpatient), 77 (emergency department), and 71 (hospitalization). Average annual rates of bronchiolitis visits increased 41% from 188 to 265/1000 infant years from 1996-1997 to 2002-2003 (test of trend, p<.001). Analysis of the linear trend in 500 gram increments demonstrated a negative association between increasing birth weight and bronchiolitis diagnosis (p<0.0001). There was a significant, negative trend between maternal age and infant bronchiolitis diagnosis. Compared to infants of mothers aged 20-29 years, infants of mothers aged 15-19 had a small increase in risk of having a bronchiolitis visit (Hazard ratio 1.05, 95% Confidence Interval 1.01-1.09), while infants of older mothers were less likely to have a visit including women aged 30-39 (Hazard ratio 0.76, 95% Confidence Interval 0.72-0.79) and 40-44 (Hazard ratio 0.54, 95% CI 0.43-0.68). CONCLUSIONS The disease burden of bronchiolitis is substantial with increasing rates of all types of visits among term, otherwise healthy infants enrolled in Tennessee Medicaid from 1995 to 2003. Protective factors in this cohort of term infants included higher birth weight and older maternal age.

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