title: Racial/ethnic differences in hospital use and cost among a statewide population of children with Down syndrome.
abstract: Children with Down syndrome (DS) use hospital services more often than children without DS, but data on racial/ethnic variations are limited. This study generated population-based estimates of hospital use and cost to 3 years of age by race/ethnicity among children with DS in Massachusetts using birth certificates linked to birth defects registry and hospital discharge data from 1999 to 2004. Hospital use (≥ 1 post-birth hospitalization and median days hospitalized birth and post-birth) and reasons for hospitalization were compared across maternal race/ethnicity using relative risk (RR) and Wilcoxon rank sums tests, as appropriate. Costs were calculated in 2011 United States dollars. Greater hospital use was observed among children with DS with Hispanic vs. Non-Hispanic White (NHW) mothers (post-birth hospitalization: RR 1.4; median days hospitalized: 20.0 vs. 11.0, respectively). Children with DS and congenital heart defects of Non-Hispanic Black (NHB) mothers had significantly greater median days hospitalized than their NHW counterparts (24.0 vs. 16.0, respectively). Respiratory diagnoses were listed more often among children with Hispanic vs. NHW mothers (50.0% vs. 29.1%, respectively), and NHBs had more cardiac diagnoses (34.1% vs. 21.5%, respectively). The mean total hospital cost was nine times higher among children with DS ($40,075) than among children without DS ($4053), and total costs attributable to DS were almost $18 million. Median costs were $22,781 for Hispanics, $18,495 for NHBs, and $13,947 for NHWs. Public health interventions should address the higher rates of hospital use and hospitalizations for respiratory and cardiac diseases among racial/ethnic minority children with DS in Massachusetts.
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA; Center for Education and Human Services, Education Division, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA. Electronic address: taletha.derrington@sri.com.
authors.forename: Taletha Mae
authors.initials: TM
authors.lastname: Derrington
authors.forename: Milton
authors.initials: M
authors.lastname: Kotelchuck
authors.forename: Katrina
authors.initials: K
authors.lastname: Plummer
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.forename: Angela E
authors.initials: AE
authors.lastname: Lin
authors.forename: Candice
authors.initials: C
authors.lastname: Belanoff
authors.forename: Mikyong
authors.initials: M
authors.lastname: Shin
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
authors.forename: Scott D
authors.initials: SD
authors.lastname: Grosse
mesh_terms: D001719:Birth Certificates; D044383:Black People / Q000706:statistics & numerical data; D002675:Child, Preschool; D004314:Down Syndrome / Q000191:economics / Q000208:ethnology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
keywords: Congenital heart defects; Down syndrome; Hospital cost; Hospital use; Racial/ethnic disparities
references.citation: J Pediatr. 2011 Feb;158(2):194-200.e1
references.pmid: 20934710
references.citation: Arch Intern Med. 2007 Sep 24;167(17):1846-52
references.pmid: 17893305
references.citation: J Pediatr. 2006 Jun;148(6):806-812
references.pmid: 16769392
references.citation: Rev Epidemiol Sante Publique. 2003 Dec;51(6):617-27
references.pmid: 14967994
references.citation: J Pediatr. 2012 May;160(5):827-31.e1
references.pmid: 22177993
references.citation: Pediatrics. 2006 Oct;118(4):1633-9
references.pmid: 17015556
references.citation: Birth Defects Res A Clin Mol Teratol. 2007 Sep;79(9):657-63
references.pmid: 17696161
references.citation: Birth Defects Res A Clin Mol Teratol. 2007 Nov;79(11):743-53
references.pmid: 17990334
references.citation: J Asthma. 2008 Dec;45(10):916-22
references.pmid: 19085583
references.citation: Obstet Gynecol. 2007 Mar;109(3):669-77
references.pmid: 17329519
references.citation: Chest. 2009 Oct;136(4):1063-1071
references.pmid: 19567492
references.citation: Birth Defects Res A Clin Mol Teratol. 2009 Nov;85(11):925-34
references.pmid: 19830851
references.citation: Matern Child Health J. 2002 Sep;6(3):169-79
references.pmid: 12236664
references.citation: Public Health Rep. 2009 May-Jun;124(3):447-53
references.pmid: 19445422
references.citation: Am J Public Health. 2006 Feb;96(2):358-62
references.pmid: 16380574
references.citation: Am J Med Genet A. 2008 Dec 1;146A(23):2998-3010
references.pmid: 19006076
references.citation: J Perinatol. 2005 Nov;25(11):737-42
references.pmid: 16163368
references.citation: J Pediatr. 2011 Oct;159(4):535-40.e2
references.pmid: 21658713
references.citation: Lancet. 2002 Mar 23;359(9311):1019-25
references.pmid: 11937181
references.citation: MMWR Morb Mortal Wkly Rep. 2007 Jan 19;56(2):25-9
references.pmid: 17230142
references.citation: Am J Epidemiol. 1997 Jan 15;145(2):134-47
references.pmid: 9006310
references.citation: Am J Med Genet. 1998 Jun 5;77(5):431-8
references.pmid: 9632176
references.citation: J Allergy Clin Immunol. 2010 Mar;125(3):636-42
references.pmid: 20226297
references.citation: Ethn Health. 2006 Aug;11(3):247-63
references.pmid: 16774877
references.citation: MMWR Morb Mortal Wkly Rep. 2001 Jun 8;50(22):463-5
references.pmid: 11414598
references.citation: J Pediatr. 2011 Aug;159(2):222-6
references.pmid: 21414631
references.citation: Ann Epidemiol. 2006 Jan;16(1):1-10
references.pmid: 16039875
references.citation: Pediatrics. 2009 Jun;123(6):e996-1004
references.pmid: 19482751
references.citation: J Pediatr. 2008 Aug;153(2):241-6
references.pmid: 18534234
references.citation: Ann Allergy Asthma Immunol. 2008 Jun;100(6):545-50
references.pmid: 18592817
references.citation: J Intellect Disabil Res. 2007 Dec;51(Pt 12):1030-8
references.pmid: 17991010
references.citation: Am J Prev Med. 2010 Apr;38(4 Suppl):S550-6
references.pmid: 20331957
references.citation: Adv Pediatr. 2012;59(1):137-57
references.pmid: 22789577
references.citation: Acad Pediatr. 2012 Sep-Oct;12(5):436-44
references.pmid: 22922047
references.citation: Dev Med Child Neurol. 2005 Mar;47(3):171-6
references.pmid: 15739721