Variations in pediatric asthma hospitalization rates and costs between and within Nordic countries.
BACKGROUND
We assessed variations in hospitalization parameters and costs among asthmatic children in four Nordic countries by geographic location and age groups.


METHODS
Cross-sectional, county-level aggregate data on asthma-related hospitalizations in 1999, obtained from public national databases for children < 15 years old from Denmark, Sweden, Norway, and Finland, together with country-specific asthma management cost were used to estimate the incidence of first hospital admission (per 1,000), length of hospital stay (LOS), and hospitalization cost. Longitudinal patient-specific data from 1998/1999 were used to calculate the relative hazard of readmission (RHR) using a multivariate Cox proportional hazards model.


RESULTS
Nordic incidence of first hospital admission in 1999 was 2.17 per 1,000 children, readmission was noted in 16% of the patients, mean LOS was 2.64 days, and total hospitalization cost was almost 14 million dollars. Hospitalization incidence, RHR, and costs were significantly higher in children < 5 years old compared with school children 6 to 14 years old. Hospital LOS, incidence of first hospital admission, and cost per child were the highest in Denmark, though RHR did not differ significantly from Sweden.


CONCLUSIONS
Large variations in all parameters were observed between and within countries. Given the similarities among the four countries studied, these results may, among other reasons, indicate different efficiencies of the various asthma management plans between and within them. The presented measures of hospitalization patterns could prove to be valuable quality-of-care measures to guide further improvements in asthma management.
Kocevar
Vasilisa Sazonov
VS
Department of Pharmacy Practice, Purdue University, West Lafayette, IN, USA.
Bisgaard
Hans
H
Jönsson
Linus
L
Valovirta
Erkka
E
Kristensen
Frederik
F
Yin
Donald D
DD
Thomas
Joseph
J
D000293:Adolescent; D001249:Asthma / Q000191:economics* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003718:Denmark / Q000453:epidemiology; D005387:Finland / Q000453:epidemiology; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D009664:Norway / Q000453:epidemiology; D010359:Patient Readmission; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology