title: Impact of early daycare on healthcare resource use related to upper respiratory tract infections during childhood: prospective WHISTLER cohort study.
abstract: BACKGROUND
  Daycare attendance is an established risk factor for upper respiratory tract infections (URTI) and acute otitis media (AOM). Whether this results in higher use of healthcare resources during childhood remains unknown. We aim to assess the effect of first year daycare attendance on the timing and use of healthcare resources for URTI and AOM episodes during early childhood.
  
  
  METHODS
  In the Wheezing-Illnesses-STudy-LEidsche-Rijn birth cohort, 2,217 children were prospectively followed up to age six years. Children were categorized according to first-year daycare attendance (yes versus no) and age at entry when applicable (age 0 to 2 months, 3 to 5 months and 6 to 12 months). Information on general practitioner (GP) diagnosed URTI and AOM, GP consultations, antibiotic prescriptions and specialist referral was collected from medical records. Daycare attendance was recorded by monthly questionnaires during the first year of life.
  
  
  RESULTS
  First-year daycare attendees and non-attendees had similar total six-year rates of GP-diagnosed URTI and AOM episodes (59/100 child-years, 95% confidence interval 57 to 61 versus 56/100 child-years, 53 to 59). Daycare attendees had more GP-diagnosed URTI and AOM episodes before the age of one year and fewer beyond the age of four years than non-attendees (Pinteraction <0.001). Daycare attendees had higher total six-year rates for GP consultation (adjusted rate ratio 1.15, 1.00 to 1.31) and higher risk for specialist referrals (hazard ratio: 1.43, 1.01 to 2.03). The number of antibiotic prescriptions in the first six years of life was only significantly increased among children who entered daycare between six to twelve months of age (rate ratio 1.32, 1.04 to 1.67). This subgroup of child-care attendees also had the highest overall URTI and AOM incidence rates, GP consultation rates and risk for specialist referral.
  
  
  CONCLUSIONS
  Children who enter daycare in the first year of life, have URTI and AOM at an earlier age, leading to higher use of healthcare resources compared to non-attendees, especially when entering daycare between six to twelve months. These findings emphasize the need for improved prevention strategies in daycare facilities to lower infection rates at the early ages.
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6,131, PO Box 85500, 3508 GA Utrecht, The Netherlands. M.L.A.deHoog@umcutrecht.nl.
authors: Marieke L A
authors: ML
authors: de Hoog
authors: Roderick P
authors: RP
authors: Venekamp
authors: Cornelis K
authors: CK
authors: van der Ent
authors: Anne
authors: A
authors: Schilder
authors: Elisabeth Am
authors: EA
authors: Sanders
authors: Roger Amj
authors: RA
authors: Damoiseaux
authors: Debby
authors: D
authors: Bogaert
authors: Cuno Spm
authors: CS
authors: Uiterwaal
authors: Henriette A
authors: HA
authors: Smit
authors: Patricia
authors: P
authors: Bruijning-Verhagen
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D010033:Otitis Media / Q000191:economics / Q000453:epidemiology*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000191:economics / Q000453:epidemiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents