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Association between birth order and emergency room visits and acute hospital admissions following pediatric vaccination: a self-controlled study


Objective — The authors investigated the association between a child’s birth order and emergency room (ER) visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations.

Methods — The authors included all children born in Ontario between April 1st, 2006 and March 31st, 2009 who received a qualifying vaccination. The authors identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. The authors used the self-controlled case series design to compare the relative incidence (RI) of events among 1st-born and later-born children using relative incidence ratios (RIR).

Results — For the 2-month vaccination, the RIR for 1st-borns versus later-born children was 1.37 (95% CI: 1.19-1.57), which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1st-borns vs. later-borns was 1.70 (95% CI: 1.45-1.99), representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1st vs. later-borns was 1.27 (95% CI: 1.09-1.48), or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02-1.21), or 249 excess events/100,000 vaccinated.

Conclusions — Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1st-born children had significantly higher relative incidence of events compared to later-born children.



Hawken S, Kwong JC, Deeks SL, Crowcroft NS, Ducharme R, Manuel DG, Wilson K. PLoS One. 2013; 8(12):e81070. Epub 2013 Dec 4.

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