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Patterns of health care use related to respiratory conditions in early life: a birth cohort study with linked administrative data

Chen W, Subbarao P, McGihon RE, Feldman LY, Zhu J, Lou W, Gershon A, Abdullah K, Moraes TJ, Dubeau A, Sears MR, Lefebvre DL, Turvey SE, Mandhane PJ, Azad MB, To T. Pediatr Pulmonol. 2019; 54(8):1267-76. Epub 2019 Jun 6. DOI: https://doi.org/10.1002/ppul.24381


Objectives — To identify distinctive patterns of respiratory-related health services use (HSU) between birth and 3 years of age, and to examine associated symptom and risk profiles.

Methods — This study included 729 mother and child pairs enrolled in the Toronto site of the Canadian Healthy Infant Longitudinal Development study in 2009-2012; they were linked to Ontario health administrative databases (2009-2016). A model-based cluster analysis was performed to identify distinct groups of children who followed a similar pattern of respiratory-related HSU between birth and 3 years of age, regarding hospitalization, emergency department (ED) and physician office visits for respiratory conditions and total health care costs (2016 Canadian dollars).

Results — The majority (estimated cluster weight = 0.905) showed a pattern of low and stable respiratory care use (low HSU) while the remainder (weight = 0.095) showed a pattern of high use (high HSU). From 0 to 3 years of age, the low- and high-HSU groups differed in mean trajectories of total health care costs ($783 per 6 months decreased to $114, vs $1796 to $177, respectively). Compared to low-HSU, the high-HSU group was associated with a constant risk of hospitalizations, early high ED utilization and physician visits for respiratory problems. The two groups differed significantly in the timing of wheezing (late onset in low-HSU vs early in high-HSU) and future total costs (stable vs increased).

Conclusions — One in ten children had high respiratory care use in early life. Such information can help identify high-risk young children in a large population, monitor their long-term health, and inform resource allocation.

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