Lower household income associated with higher pediatric inpatient costs

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1. Lower community-level annual household income was found to be associated with inpatient pediatric costs 4.1-8.3% higher than those of treated children with higher household incomes. This was observed among children treated for 5 common pediatric conditions.

2. Length of stay for hospitalizations due to asthma and diabetes was found to be higher in patients with lower household incomes.

Evidence Rating Level: 2 (Good)

Study Rundown: Among adults, lower socioeconomic status (SES) has been associated with a higher risk of hospitalization and longer lengths of hospitalization, a relationship thought to be due to interplay between social, environmental, and biomedical factors. There is a dearth of data, however, specifically evaluating the relationship between hospital resource utilization and SES among children. In this study, researchers investigated hospital inpatient costs and hospital length of stay (LOS) for children treated from a variety of SES. Study authors found that patients from zip codes with lower median household incomes were 3.3 times more likely to have public insurance and higher aggregate inpatient costs of care when compared to patients from areas with higher median household incomes.  Variation in cost was attributed to increased length of stay for patients with lower household incomes admitted with a  diagnoses of asthma, diabetes, and bronchiolitis. Aggregated differences in cost burden were greatest in the treatment of chronic illnesses, such as diabetes and asthma. In total, the excess aggregated cost of hospitalizations among children from households with the lowest median income was $8.4 million across the 32 hospitals surveyed.  This study is limited by the use of zip code-related income data as a proxy for family household income, a measure which may reflect neighborhood health in addition to the impact of individual SES. These findings demonstrate greater cost burden for socioeconomically disadvantaged children and their families, suggesting that SES should be considered when designing service delivery and reimbursement strategies.

Click to read the study in Pediatrics

Relevant Reading: The social determinants of child health: variations across health outcomes – a population-based cross-sectional analysis

In-Depth [retrospective cohort]: Data from 32 freestanding pediatric hospitals within Pediatric Health Information System, a database of administrative data from freestanding pediatric hospitals across the country, were included for the evaluation of differences in standardized cost of hospitalization. Data was adjusted for illness severity, age, gender, and race, and patients were stratified by average household income associated with their residential zip code. Hospitalizations between 2010 and 2011 for 5 common diagnoses (diabetes, asthma, bronchiolitis, pneumonia, and urinary tract infections) were included. These represented 9.2% of hospitalizations during the study period. Median household incomes were collected from the 2010 US census and based off of patient household zip code, with the lowest income category considered 1.5 times the US poverty limit and the highest income level considered greater than 3 times the poverty level. Patients from zip codes with the lowest SES were 3.3 times more likely to have public insurance than commercial coverage (RR = 3.3, 95% CI: 3.2-3.4). Asthma hospitalizations were 5.6% more costly for patients with the lowest SES ($4,477 v. $4,241, p < 0.001), diabetes hospitalizations were 6.4% more expensive ($6,896 v. $6,292, p = 0.012), hospitalizations for bronchiolitis were 8.3% higher ($4,612 v. $4,259, p = 0.001), and hospitalizations for pneumonia were found to be 4.1% more costly ($4,732 v. $4,545, p = 0.009). No significant cost differences were seen across income categories for urinary tract infection hospitalizations. An aggregate estimated standardized cost difference across income levels for hospitalizations evaluated in this study totaled $8.4 million.

By Emilia Hermann and Leah H. Carr

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