National Rates of Diarrhea-Associated Ambulatory Visits in Children

• Published in: The Journal of pediatrics 2009-07, Vol.155 (1), p.56-61
• Main Authors: Pont, Stephen J., MD, MPH, Grijalva, Carlos G., MD, MPH, Griffin, Marie R., MD, MPH, Scott, Theresa A., MS, Cooper, William O., MD, MPH
• Format: Article
• Language: English
• Subjects: Ambulatory Care - statistics & numerical data; Biological and medical sciences; Black or African American; Black People - statistics & numerical data; Child, Preschool; Diarrhea - epidemiology; Diarrhea - virology; Emergency Service, Hospital - statistics & numerical data; Female; General aspects; Health Surveys; Humans; Infant; Infant, Newborn; Insurance, Health - statistics & numerical data; Male; Medicaid - statistics & numerical data; Medical sciences; Pediatrics; Rotavirus Infections - epidemiology; Seasons; United States - epidemiology; White People - statistics & numerical data
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2009.01.075

Objective To estimate national rates of ambulatory healthcare visits due to diarrhea- and rotavirus-associated illness before the introduction of rotavirus vaccine. Study design Annual rates for diarrhea-associated visits in children age < 5 years were calculated for 1995-2004 using National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and US Census Bureau data. Rates by age, race, and time period were compared using Poisson regression. Results Annual rates of outpatient and emergency department (ED) visits for 1995-2004 were 955 (95% confidence interval [CI] = 803 to 1107) and 314 (95% CI = 278 to 350)/10 000 person-years, respectively. Annual outpatient ( P = .470) and ED ( P = .734) visit rates remained stable from 1995 to 2004. Outpatient visits were less frequent in African Americans than Caucasians (716/10 000 person-years vs 1012/10 000 person-years; P < .05; incidence rate ratio [IRR] = 0.71; 95% CI = 0.51 to 0.99), whereas ED visits were more frequent in African Americans than Caucasians (520/10 000 person-years vs 286/10 000 person-years; P < .05; IRR = 1.83; 95% CI = 1.58 to 2.11). Approximately 29% of outpatient diarrhea-associated outpatient visits (273/10 000 person-years; 95% CI = 145 to 401) and 25% of diarrhea-associated ED visits (78/10 000 person-years; 95% CI = 64 to 83) were due to rotavirus. Conclusions Diarrhea- and rotavirus-associated illness is associated with significant healthcare utilization. Future studies are needed to investigate factors causing differences in healthcare use by race and to explore the impact of the rotavirus vaccine.