title: National trends in health care utilization and racial and socioeconomic disparities in pediatric pyogenic arthritis.
abstract: OBJECTIVE
  To determine national trends and putative racial and socioeconomic disparities in health care utilization in pediatric patients with pyogenic arthritis over a 13-year period.
  
  
  METHODS
  We assessed trends in length of hospital stay, hospital disposition, and inflation-adjusted charges for pediatric patients hospitalized with pyogenic arthritis based on 13 consecutive years (1988-2000) of the Nationwide Inpatient Sample. Patients with an International Classification of Diseases, Ninth Revision code of pyogenic arthritis were selected for this study. Trends in health care utilization were analyzed, stratified by age, prematurity, joint location, socioeconomic status, and race.
  
  
  RESULTS
  The median length of stay (LOS) decreased from 10 to 5 days in 1988 and 2000, respectively (P < 0.05). Whites had a shorter mean LOS (7.8 days) than nonwhites (10.7 days; P < 0.05). For both whites and nonwhites, LOS decreased significantly (P < 0.05), but the difference between the 2 groups remained constant. For patients with a higher socioeconomic status, LOS was shorter (P'< 0.05). The percentage of patients discharged to home'health care increased from 3.8% in 1988 to 18.9% in 2000 (P'< 0.05), but the increase was much greater for whites than nonwhites (P < 0.05). Inflation adjusted total charges increased over time, from a median total charge of 10,098 dollars in 1988 to a median total charge of 11,155 dollars in 2000 (P < 0.05).
  
  
  CONCLUSIONS
  There was a trend toward decreased health care utilization, but no decrease in charges for pediatric pyogenic arthritis from 1988 to 2000. Racial disparities still exist, with little improvement over time.
authors.affiliation: Department of Surgery, Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Josh
authors.initials: J
authors.lastname: Freedman
authors.forename: Ulrich
authors.initials: U
authors.lastname: Guller
authors.forename: Daniel Kelly
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Higgins
authors.forename: Deng
authors.initials: D
authors.lastname: Pan
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
mesh_terms: D000293:Adolescent; D000328:Adult; D001170:Arthritis, Infectious / Q000191:economics / Q000208:ethnology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D017722:Hospital Charges / Q000639:trends; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D011785:Quality Assurance, Health Care / Q000639:trends*; D044469:Racial Groups; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014600:Utilization Review / Q000639:trends*