美国儿童哮喘住院患者预后的社会经济差异
2025/11/28
摘要
背景：本研究估计了美国儿童哮喘住院的成本和住院时间；根据收入核对住院时间和成本的差异；并量化由个人、环境和社区因素介导的这种关系的比例。
方法：本研究采用美国国家住院患者样本（2016年-2019年）的横断面数据来检查儿科（5-17岁）哮喘入院的医院服务提供成本（2020美元）和住院时间（天），N=150,845。根据收入估算成本和住院时间的差异。因果中介分析用于量化潜在中介因素（哮喘严重程度、共病、烟草/烟雾暴露、保险或医院容量）在解释差异中的作用。
结果：每年的入院总费用为2.6亿美元。每次入院的平均费用和住院时间分别为6884美元（95%置信区间：6682, 7086）和2天（95%置信区间：2.09, 2.15）。与生活在高收入地区的人相比，生活在低收入地区的个人住院时间增加了3%，成本降低了3%。严重持续性哮喘和吸烟/烟草暴露在收入－住院时间（20%和17%）和收入-成本（-29%和-21%）关系之间的差异中占最大比例。医院容量是收入和成本之间唯一的正中介（10%）。
结论：与高收入地区的儿童患者相比，低收入地区的儿科患者的住院时间更长，成本更低。消除哮喘严重程度和吸烟/烟草暴露方面与收入相关差异的干预措施可能会缩小住院时间差距，同时扩大成本差距。上述研究结果表明低收入患者的成本更低。
Socioeconomic Disparities in Inpatient Outcomes Among US Pediatric Asthma Hospitalizations.
Barry LE, Habib M, Heaney LG, Nianogo RA.
Abstract
BACKGROUND:This study estimates the cost and length of stay (LOS) of pediatric asthma hospitalizations in the US; examines disparities in LOS and cost according to income; and quantifies the proportion of this relationship mediated by individual, environmental, and community factors.
METHODS:Cross-sectional data from the US National Inpatient Sample (2016-2019) were used to examine the hospital service delivery cost (USD 2020) and LOS (days) of pediatric (5-17 years) asthma admissions, N=150,845. Disparities in cost and LOS according to income were estimated. Causal mediation analysis was used to quantify the role of potential mediators (asthma severity, comorbidity, tobacco/smoke exposure, insurance, or hospital capacity) in explaining disparities.
RESULTS:The total cost of admissions was $260 million annually. The average cost and LOS per admission were $6884 (95%CI: 6682, 7086) and 2 days (95%CI: 2.09, 2.15). Individuals living in lower income areas had a 3% increase in LOS and a 3% decrease in costs compared to those who live in higher-income areas. Severe persistent asthma and exposure to smoke/tobacco mediated the largest proportion of disparities between the income-LOS (20% & 17%) and income-cost (-29% & -21%) relationships. Hospital capacity was the only positive mediator between income and cost (10%).
CONCLUSION:Pediatric patients from lower income areas have longer LOS and lower costs compared to those from higher income areas. Interventions to eliminate income-related differences in asthma severity and smoke/tobacco exposure may narrow LOS disparities while widening cost disparities; revealing even lower costs among lower income patients.
背景：本研究估计了美国儿童哮喘住院的成本和住院时间；根据收入核对住院时间和成本的差异；并量化由个人、环境和社区因素介导的这种关系的比例。
方法：本研究采用美国国家住院患者样本（2016年-2019年）的横断面数据来检查儿科（5-17岁）哮喘入院的医院服务提供成本（2020美元）和住院时间（天），N=150,845。根据收入估算成本和住院时间的差异。因果中介分析用于量化潜在中介因素（哮喘严重程度、共病、烟草/烟雾暴露、保险或医院容量）在解释差异中的作用。
结果：每年的入院总费用为2.6亿美元。每次入院的平均费用和住院时间分别为6884美元（95%置信区间：6682, 7086）和2天（95%置信区间：2.09, 2.15）。与生活在高收入地区的人相比，生活在低收入地区的个人住院时间增加了3%，成本降低了3%。严重持续性哮喘和吸烟/烟草暴露在收入－住院时间（20%和17%）和收入-成本（-29%和-21%）关系之间的差异中占最大比例。医院容量是收入和成本之间唯一的正中介（10%）。
结论：与高收入地区的儿童患者相比，低收入地区的儿科患者的住院时间更长，成本更低。消除哮喘严重程度和吸烟/烟草暴露方面与收入相关差异的干预措施可能会缩小住院时间差距，同时扩大成本差距。上述研究结果表明低收入患者的成本更低。
（中日友好医院呼吸与危重症医学科 张婧媛 摘译 林江涛 审校）
（Respir Med. 2025 Nov 11:108501. doi: 10.1016/j.rmed.2025.108501.）
Socioeconomic Disparities in Inpatient Outcomes Among US Pediatric Asthma Hospitalizations.
Barry LE, Habib M, Heaney LG, Nianogo RA.
Abstract
BACKGROUND:This study estimates the cost and length of stay (LOS) of pediatric asthma hospitalizations in the US; examines disparities in LOS and cost according to income; and quantifies the proportion of this relationship mediated by individual, environmental, and community factors.
METHODS:Cross-sectional data from the US National Inpatient Sample (2016-2019) were used to examine the hospital service delivery cost (USD 2020) and LOS (days) of pediatric (5-17 years) asthma admissions, N=150,845. Disparities in cost and LOS according to income were estimated. Causal mediation analysis was used to quantify the role of potential mediators (asthma severity, comorbidity, tobacco/smoke exposure, insurance, or hospital capacity) in explaining disparities.
RESULTS:The total cost of admissions was $260 million annually. The average cost and LOS per admission were $6884 (95%CI: 6682, 7086) and 2 days (95%CI: 2.09, 2.15). Individuals living in lower income areas had a 3% increase in LOS and a 3% decrease in costs compared to those who live in higher-income areas. Severe persistent asthma and exposure to smoke/tobacco mediated the largest proportion of disparities between the income-LOS (20% & 17%) and income-cost (-29% & -21%) relationships. Hospital capacity was the only positive mediator between income and cost (10%).
CONCLUSION:Pediatric patients from lower income areas have longer LOS and lower costs compared to those from higher income areas. Interventions to eliminate income-related differences in asthma severity and smoke/tobacco exposure may narrow LOS disparities while widening cost disparities; revealing even lower costs among lower income patients.
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