Socioeconomic Status and Bronchiolitis Severity Among Hospitalized Infants

Zheng, David X.; Mitri, Elie J.; Garg, Vebhav; Crifase, Cassandra C.; Sullivan, Ashley F.; Espinola, Janice A.; Camargo, Carlos A.

doi:10.1016/j.acap.2019.06.003

Cited by 9 publications

(10 citation statements)

References 31 publications

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“…Moreover, our sample consisted of infants with severe bronchiolitis. Although bronchiolitis is the most common reason for hospitalization of US infants, 17 our findings may be less generalizable to other infant populations.…”

Section: Discussioncontrasting

confidence: 72%

A comparison of case definitions for infant atopic dermatitis in a multicenter prospective cohort study

Zheng

Geller

Robinson

et al. 2021

Health Science Reports

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Section: Discussioncontrasting

confidence: 72%

A comparison of case definitions for infant atopic dermatitis in a multicenter prospective cohort study

Zheng

Geller

Robinson

et al. 2021

Health Science Reports

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“…This finding of sIgE as a potential risk factor for increased severity is supported by a previous study that looked at the effects of injected human immunoglobulin on patients with severe bronchiolitis and found that treatment with IVIG decreased serum IgE levels, as well as bronchiolitis severity 10 . Identifying clinical markers of bronchiolitis severity is also important, as bronchiolitis hospitalizations occur in 2%–3% of all US infants 17 . Improving outcomes for these children is needed, and the current study supports the goal of developing targeted therapies and preventing future respiratory/allergy diseases.…”

Section: Discussionsupporting

confidence: 56%

“…10 Identifying clinical markers of bronchiolitis severity is also important, as bronchiolitis hospitalizations occur in 2%-3% of all US infants. 17 Improving outcomes for these children is needed, and the current study supports the goal of developing targeted therapies and preventing future respiratory/allergy diseases.…”

Section: T a B L Ementioning

confidence: 73%

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Blood eosinophils, specific immunoglobulin E, and bronchiolitis severity

Mitri

Zheng

Garg

et al. 2021

Pediatric Pulmonology

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Background: Bronchiolitis is the leading cause of hospitalization for United States infants. Blood eosinophil and serum specific IgE (sIgE) levels are separately linked to clinical severity but few studies have examined these biomarkers together.Objective: Among infants hospitalized for bronchiolitis, we investigated the association between (1) blood eosinophilia and severity, (2) sIgE sensitization and severity, and (3) interaction between the two biomarkers on severity.Methods: We enrolled 1016 infants hospitalized for bronchiolitis between 2011 and 2014 across 17 U.S. hospitals into a prospective cohort study. Of those, 873 (86%) had eosinophils measured and all had sIgE levels from blood collected at hospitalization. We investigated higher bronchiolitis severity using intensive care therapy as the outcome (i.e., intensive care unit admission, intubation, and/or receipt of continuous positive pressure ventilation).Results: Among 873 infants in the analytic cohort, 18% had blood eosinophilia of ≥3%, and 20% were positive for sIgE. With regard to bronchiolitis severity, 15% received intensive care therapy. In unadjusted analyses, eosinophils ≥3% was not associated with intensive care therapy, while sIgE was associated with a significantly higher risk (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.08-1.92; p = .01).In a multivariable model for intensive care therapy, eosinophilia remained unassociated with severity, and sIgE remained associated (OR: 1.60, 95% CI:1.05-2.45; p = .03). Also, sIgE did not modify the association between eosinophil level and intensive care therapy (p interaction = .14). Conclusion:Blood eosinophilia of ≥3% was not associated with bronchiolitis severity. By contrast, sIgE was independently associated with bronchiolitis severity and did not modify the association between eosinophil level and severity.

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“…14 In a subsequent prospective study of the same MARC network, estimated median household income from ZIP code was most strongly associated with PICU admission. Perhaps counterintuitively, patients with high estimated median household income had twice the odds of an intensive 15 In another study with a broader population of respiratory failure encompassing patients 2 weeks to 17 years old presenting to the ICU, estimated median income from a census tract level was not associated with illness severity upon PICU admission. 11 In our study we find no association with estimated income with PICU admission or hospital LOS.…”

Section: Discussionmentioning

confidence: 97%

Association of Socioeconomic Factors and Severity of Bronchiolitis Hospitalizations

Parlar-Chun,

Hafeez

2023

Clin Pediatr (Phila)

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It is unclear if socioeconomic status (SES) factors influence severity of illness of patients hospitalized with bronchiolitis. This study was conducted to identify SES factors including the Center for Disease Control and Prevention’s Social Vulnerability Composite Index (SVI), estimated income, proportion of minority, proportion of living below poverty, insurance status, and number of household members associated with length of stay (LOS) and intensive care unit admission. Infants hospitalized at a tertiary care urban center for bronchiolitis were identified using International Classification of Diseases codes. Federal information processing system codes were identified from home address and paired with SVI and 2018 census tract. Other measures of SES were obtained from the Federal Financial Institutions Examination Council. Number of household members, insurance, age, sex, and history of prematurity were recorded from patient chart. Length of stay was modeled with mixed effects negative binomial regression and pediatric intensive care unit (PICU) admission with mixed effects logistic regression with random intercept at the census tract and adjustment for clinical factors. A total of 417 infants had median age of 144 days (interquartile range (IQR): 61, 357) and 136 (33%) were born premature. Median LOS was 62 hours (24, 136) with 97 (23%) patients admitted to the PICU. Median household members were 4 (4, 5). For each increase in household member, there was 7% increase in LOS (incidence rate ratio 1.07, 95% confidence interval: 1-1.14, P = .038). Social Vulnerability Composite Index, subcategories, insurance status, estimated income, percent of minority, and percent of poverty did not show any associations with length of hospitalization or PICU admission. Increasing number of household members may be associated with increased bronchiolitis hospital LOS. We find no associations with other SES measures.

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Socioeconomic Status and Bronchiolitis Severity Among Hospitalized Infants

Cited by 9 publications

References 31 publications

A comparison of case definitions for infant atopic dermatitis in a multicenter prospective cohort study

A comparison of case definitions for infant atopic dermatitis in a multicenter prospective cohort study

Blood eosinophils, specific immunoglobulin E, and bronchiolitis severity

Association of Socioeconomic Factors and Severity of Bronchiolitis Hospitalizations

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