title: Health insurance and length of stay for children hospitalized with community-acquired pneumonia.
abstract: BACKGROUND
  Disparities in patterns of care and outcomes for ambulatory-care sensitive childhood conditions such as community-acquired pneumonia (CAP) persist. However, the influence of insurance status on length of stay (LOS) for children hospitalized with CAP remains unexplored.
  
  
  METHODS
  Secondary analysis of children (<18 years) hospitalized with CAP sampled in the Kids' Inpatient Database (KID) for years 1997, 2000, 2003, and 2006. Insurance status (private, public, uninsured) was based on claims data. Hospital LOS was calculated in days. Taking into account the complex sampling design, negative binomial regression models produced adjusted estimates of incidence rate ratios (IRR) for hospital LOS for children by insurance status.
  
  
  RESULTS
  There was little variation in the categories of insurance status of children hospitalized with CAP between 1997 and 2006, with at least 40% privately insured, at least 40% publicly insured, and at least 5% uninsured in each sampled year. In all years, publicly insured children had a significantly longer hospital stay than privately insured children, and uninsured children had a significantly shorter hospital stay than privately insured children. These observed differences persisted after multivariate adjustment.
  
  
  CONCLUSIONS
  Differences in LOS between uninsured, publicly insured, and privately insured children with CAP raise concerns about potential differences in hospital discharge practices related to insurance status and type. As healthcare reform is implemented, policy makers should strengthen efforts to reduce these disparities in order to achieve health for the population.
authors.affiliation: Division of Primary Care Pediatrics, State University of New York at Stony Brook School of Medicine, and Stony Brook Long Island Children's Hospital, Stony Brook, New York 11794-8111, USA. susmita.pati@stonybrook.edu
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lorch
authors.forename: Grace E
authors.initials: GE
authors.lastname: Lee
authors.forename: Seth
authors.initials: S
authors.lastname: Sheffler-Collins
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000639:trends*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D017057:Medically Uninsured; D011014:Pneumonia / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies