583 - Prevalence and Costs of US Pediatric Hospitalizations, 2022

Publication Number: 2568.583

Anna J. Lytchakov, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Nathan M. Money, University of Utah School of Medicine, Salt Lake City, UT, United States; Jennifer A.. Hoffmann, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Todd A. Florin, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Kenneth Michelson, Lurie Children's Hospital, Chicago, IL, United States; Sriram Ramgopal, Ann & Robert H. Lurie Children's Hospital of Chicago, CHICAGO, IL, United States

Background: Pediatric hospitalizations represent a substantial component of U.S. healthcare utilization. The COVID-19 pandemic accelerated mental health admissions and declines in rural hospital capacity. Understanding how these trends have affected hospitalization patterns, costs, and hospital types informs pediatric health policy and resource planning.

Objective: To describe the most common and costly diagnoses among U.S. pediatric hospitalizations and assess trends in hospitalization volume, costs, and hospital type from 2016-2022.

Design/Methods: We conducted a cross-sectional analysis using the 2016, 2019, and 2022 Kids' Inpatient Database, a nationally representative all-payer dataset of inpatient discharges for children < 18 years, excluding live births. Diagnoses were categorized using the Pediatric Clinical Classification System, and costs were adjusted for inflation to 2022 U.S. dollars. We identified the most prevalent and costly diagnoses in 2022 and described longitudinal trends in volumes and costs across hospital types.

Results: An estimated 1.78 million (95% confidence interval [CI] 1.63-1.93 million) pediatric hospitalizations occurred in 2016, 1.69 million (95% CI 1.55-1.84 million) in 2019, and 1.59 million (95% CI 1.45-1.74 million) in 2022; a 10.5% decline over 7 years (Table 1). In 2022, bronchiolitis (7.0%, 111,000 admissions), major depressive disorder (5.2%, 82,300 admissions), and respiratory failure (5.1%, 79,900 admissions) were the most frequent diagnoses (Figure 1). Mental health conditions comprised three of the twenty most common diagnoses. Inflation-adjusted hospitalization costs increased from $32.1 billion in 2016 to $35.9 billion in 2022, with respiratory failure ($2.0B), septicemia ($1.2B), and chemotherapy ($1.1B) accounting for the greatest expenditures. Rural hospitals represented only 2.8% of admissions in 2022, down from 4.4% in 2016, with urban teaching hospitals (58%) and freestanding children's hospitals (36%) accounting for most admissions in 2022 (Figure 2).

Conclusion(s): Between 2016 and 2022, pediatric hospitalizations declined nationally. During this time, costs continued to rise, and care shifted from rural to urban centers. Although respiratory illnesses remain major cost drivers, mental health admissions have risen in rank, reflecting shifting inpatient needs. Sustaining equitable access will require strengthened pediatric mental health infrastructure, regional coordination, and partnerships to support rural and community hospitals.

Table 1. Characteristics of US Pediatric Hospitalizations in 2022; overall and stratified by urbanicity/teaching status. Numbers represent N (%).
*Omitted due to too few encounters, in accordance with the disclosure policies from the Healthcare Cost and Utilization Project.

Figure 1. (A) Most common and (B) most costly diagnoses (in millions of dollars) for pediatric hospitalizations, overall and by hospital type.
*Omitted due to too few encounters, in accordance with the disclosure policies from the Healthcare Cost and Utilization Project.

Figure 2. National trends in (A) hospitalization volume and (B) inpatient costs for the most common pediatric diagnoses across 2016, 2019, and 2022.