Objective: Lower respiratory tract illness (LRI) is the most common serious illness in childhood and the most common reason for hospitalization of infants beyond the neonatal period. This study assessed the potential for cost savings from reduction in hospitalization for LRI.
Setting and sample: LRI hospitalization rates for children in the first 2 years of life (infants) were studied for the 62 counties of New York State and six socioeconomic areas within Monroe County (Rochester) for the years 1985 through 1991.
Design: Analysis of small area variations.
Results: LRI accounted for 51.2% of infant hospitalizations in New York State. The overall LRI hospitalization rate for New York's 62 counties was 27.0 per 1000 child-years and ranged, among the 18 most populous counties, from 10.7 for Monroe County to 39.3 for the Bronx. Unemployment rate was the strongest predictor of LRI hospitalization rates for counties, explaining 29% of the variance in multiple regression analysis. Within Monroe County, LRI hospitalization rates followed a geographic gradient from the inner city (22.5) to the rest of the city (12.2), and to the suburbs (7.3). Deaths from LRI were uncommon (0.36% of state LRI hospitalizations) and varied little between inner city (0.42%) and suburbs (0.51%). If LRI hospitalization rates for Monroe County suburban children prevailed for the entire state, 10,439 hospitalizations and $32,916,000 would be saved annually.
Conclusions: A large portion of the increased cost of health care for children living in poverty is attributable to hospitalization for LRI in infants. Physician discretion in decision making and factors associated with socioeconomic status are probably major determinants of variation. Well-coordinated follow-up of acute illness visits, home monitoring by visiting nurses, and empirically based clinical guidelines for management of LRI might yield both substantial cost savings and better service to families.