The vast majority of children who die while hospitalized are newborns, according to a new nationwide study. Additionally, death rates are higher for hospitalized children without insurance compared to those with insurance, the researchers found.
Children who were transferred between hospitals also had significantly higher mortality rates, according to the study, which was co-authored by Matthew M. Davis, M.D., M.A.P.P., associate professor of general pediatrics and internal medicine at the Child Health Evaluation and Research (CHEAR) Unit of the U-M Medical School; and Rachel N. Caskey, M.D., M.A.P.P., of the University of Chicago Pritzker School of Medicine.
"As health care providers and institutions expand their efforts to meet the needs of severely ill children and their families, they need to be aware of the higher mortality rates among the youngest children, those without insurance coverage and those who are transferred from one hospital to another," notes Davis, who also is the director of the C.S. Mott Children's Hospital National Poll on Children's Health and associate professor of public policy at the Gerald R. Ford School of Public Policy at U-M.
"These children and families may require support services and end-of-life care beyond what is typically available in many hospitals," Davis says.
The researchers studied data from the Nationwide Inpatient Sample between the years 1992 and 2002, representing more than 35 million patient discharges. Nationally, more than 40 percent of deaths among children occur while they are hospitalized. The study is the first to examine end-of-life hospitalization patterns for children in a national sample.
Specific findings include:
- A majority of the deaths were among newborns; in 2002, for example, nearly 69 percent were newborns. This reflects the fact that a majority of child hospitalizations are for newborns, the authors note.
- While the highest number of deaths was among newborns, the highest rate of mortality was among infants who were not newborns but were younger than 1 year old. In 2002, the death rate in that age group was 0.52 percent of hospitalized children, compared with an overall rate of 0.4 percent among all children.
- Among children without insurance, the mortality rate was 0.58 percent in 2002, compared with 0.45 percent of children on Medicaid, and 0.33 percent of children with private insurance.
- Children in all age groups had a higher mortality rate when they were transferred from another hospital, than if they died in the hospital that originally admitted them. For instance, in 2002, the rate among 1-5-year-olds was 1.33 percent for transferred children, compared with 0.27 percent of children who weren't transferred. The gap was much greater among newborns: 4.75 percent compared with 0.36 percent.
- Insured children who died had significantly longer hospital stays compared with uninsured children who died. It was not clear from the data if this reflected differences in how long insurers allow patients to remain hospitalized, or the severity of the patients' illnesses.
The study was funded by the University of Michigan.
- Caskey et al. Differences associated with age, transfer status, and insurance coverage in end-of-life hospital care for children. Journal of Hospital Medicine, 2008; 3 (5): 376 DOI: 10.1002/jhm.360
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