Distribution by age

Figure 1 shows the age distribution for children admitted to the hospital. About 4.6 million discharges (72 percent) were for newborns and infants younger than one year of age. Children ages 1–4 years made up nearly 9 percent of all pediatric discharges, 5–9 and 10–14 year olds comprised 5–6 percent each, and 15–17 year olds accounted for 8 percent of pediatric discharges.

Figure 1

Frequency and distribution of hospital stays for children by age, 2009. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Kids’ Inpatient Database (KID), 2009. Rates calculated using resident (more...)

Figure 2 shows the rate of hospitalizations by age. Since nearly all infants are born in the hospital, the rate for newborns and infants was the highest. Adolescents 15–17 years old had the next highest rate of hospitalization at 382 per 10,000 population. Children 5–9 and 10–14 years old had the lowest rate of hospitalization at 177 and 183 per 10,000 population, respectively.

Figure 2

Rate of hospital stays for children by age, 2009. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Kids’ Inpatient Database (KID), 2009. Rates calculated using resident population for July (more...)

Distribution by payer

Figure 3 shows the distribution of children’s stays in hospitals by primary expected payer, comparing 2009 to 2000 and 2006. Approximately 55 percent of all hospital stays for children 17 years and younger were covered by private insurance in 2000, but by 2006 this decreased to 48 percent and in 2009 only 45 percent of children were covered by private insurance. Medicaid was the expected payer for 37 percent of all stays in 2000, but this increased to 47 percent in 2009. There were no differences between 2000, 2006, and 2009 in the percentage of hospitalized children who were uninsured or covered by “other” payers such as other State government programs.

Figure 3

Distribution of hospital stays for children by payer, percentage, 2000–2009. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Kids’ Inpatient Database (KID), 2000, 2006, and 2009. Costs (more...)

Figure 3 also shows the percentage of total hospital costs by primary expected payer. In 2009, hospital stays covered by Medicaid cost $16.4 billion (nearly half of aggregate costs for children), a significant increase since 2000 when Medicaid incurred $10.5 billion in costs (40 percent of aggregate hospital costs for children). Between 2000 and 2009, aggregate costs paid by private insurers fell from over half (52 percent) to 44 percent.

Most common major diagnostic categories for children’s admissions

The most common pediatric hospital stays were for newborns. In 2009 there were 4,164,000 newborn hospital stays, down from 4,279,000 in 2006. In 2000, there were 4,033,000 newborn stays (data not shown).

Figure 4 depicts reasons for hospital stays based on the most frequent major diagnostic categories (MDCs) for the 2.2 million non-newborn pediatric stays. In 2009, respiratory conditions were the most frequent reason for admission to the hospital among non-newborns, accounting for 510,000 hospitalizations, or nearly 1 in 4 non-newborn stays (23 percent). Digestive conditions made up about 266,000 cases, or 1 in 8 non-newborn stays (12 percent). Disorders of the nervous system accounted for 172,000 hospital stays—8 percent of non-newborn stays.

Figure 4

Top 15 major diagnostic categories for hospital stays in children, in thousands, 2009. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Kids’ Inpatient Database (KID), 2009

In 2009, there were 155,000 hospital stays involving adolescent pregnancy, which accounted for 7 percent of all non-newborn pediatric stays.

There were 144,000 pediatric stays for mental health disorders, making this the fifth most common major reason for hospitalization. Mental health; endocrine/metabolic; ear, nose, mouth, and throat; and musculoskeletal disorders each accounted for about 6 percent of non-newborn stays.

Skin disorders, infectious and parasitic disease, and kidney disorders each made up about 4 percent of non-newborn hospitalizations. Blood and circulatory disorders each accounted for nearly 3 percent of non-newborn stays. Injuries (including poisonings, multiple trauma, and burns) and neoplasms each accounted for about 2 percent of non-newborn stays.

Figure 5 compares discharge rates by body system for non-newborns for 2000, 2006, and 2009 for the 15 most common MDCs. The hospitalization rate for respiratory conditions was consistently ranked as #1 for each of the three years, and there were no significant changes over this time frame.

Figure 5

Rate of discharges per 10,000 population for the most frequent conditions by body system, 2000–2009. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Kids’ Inpatient Database (KID), (more...)

There were significant declines in hospital discharge rates for five MDCs during the decade. Diseases of the digestive system had the second highest hospital discharge rate in each of the three years with a rate of 37.7 per 10,000 children in 2009, a significant decrease from 44.5 per 10,000 children in 2006.

The hospital discharge rate for teen pregnancy decreased by nearly one-quarter over the nine-year period, from a high of 28.7 per 10,000 children in 2000 to 24.9 in 2006 to 22.0 in 2009.

Conditions of the musculoskeletal system declined from 2000 (22.1 per 10,000) to 2006 (19.8 per 10,000) and 2009 (18.2 per 10,000), but the change from 2006 to 2009 was not significant.

Similarly, injuries and poisonings declined from 2000 (8.7 per 10,000) to 2006 (7.5 per 10,000) and 2009 (7.1 per 10,000) but the change from 2006 to 2009 was not significant.

The hospital discharge rate for infectious and parasitic diseases declined from 2000 (14.1 per 10,000) to 2009 (12.6 per 10,000), but the changes from 2000 to 2006 and 2006 to 2009 were not significant.

Among the top 15 hospital discharge rates, there were two significant increases. The rate of hospital discharges for ear, nose, mouth, and throat conditions increased from 16.6 per 10,000 children in 2006 to 19.6 per 10,000 in 2009. The hospital discharge rate for skin and subcutaneous tissue also significantly increased from 2000 to 2006 and 2009, but not between 2006 and 2009.

Most common specific conditions for children’s admissions

Table 2 shows the most common reasons for admission to the hospital based on more specific diagnosis information and again excludes conditions related to newborns. The top three conditions were related to the respiratory system—pneumonia, asthma, and acute bronchitis. The fourth most common reason for admission to the hospital among children was a mental health condition—mood disorders, which include depression and bipolar disorder. The fifth most common condition is a surgical diagnosis—appendicitis. The sixth ranked condition—dehydration—is often a complication of gastroenteritis. Epilepsy is also among the top 10 conditions, ranking eighth. Five of the top 10 conditions are infections—pneumonia, bronchitis, skin infections, urinary tract infections, and influenza.

Table 2

Most common specific reasons for admission to the hospital, 2009.

The major changes in the ranking of diagnoses over the last nine years were for (1) skin and subcutaneous tissue infections, which increased from 13^th in 2000 to 7^th in 2009, and (2) influenza, which ranked 65^th in 2000 and 56^th in 2006, but was ranked 10^th in 2009.

Most common hospital procedures received by children

Table 3 presents the most common all-listed procedures received by children in U.S. hospitals, including principal and secondary non-diagnostic, therapeutic, or operative procedures. The most common procedure received by children and infants in the hospital was prophylactic vaccination, which consisted primarily of hepatitis B vaccine, given to over 1.3 million infants. The second most common procedure was circumcision, which was performed on over 1.1 million male infants. Ranking third, but with far fewer cases, was respiratory intubation and mechanical ventilation, which was received by about 226,700 cases.

Table 3

Most common all-listed procedures received by children in U.S. hospitals, 2009.

Enteral and parenteral nutrition (tube feeding) and blood transfusion were the fourth and fifth most common procedures, respectively. Appendectomy was ranked sixth, and was the only non-obstetric major operating room procedure that fell into the top 10. Repair of obstetric laceration—a procedure received by adolescents giving birth, was ranked seventh. Cancer chemotherapy and artificial rupture of membranes to assist in delivery were ranked eighth and ninth, respectively. Incision and drainage of skin and subcutaneous tissue—conducted primarily for infections—ranked 10^th. Overall, the rankings of procedures in 2009 were very similar to those in 2000 (data not shown).

Diagnoses, ICD-9-CM, Clinical Classifications Software (CCS), and Major Diagnostic Categories (MDC)

The principal diagnosis is that condition established after study to be chiefly responsible for the patient’s admission to the hospital. Secondary diagnoses are concomitant conditions that coexist at the time of admission or that develop during the stay.

ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification, which assigns numeric codes to diagnoses. There are about 13,600 ICD-9-CM diagnosis codes.

CCS categorizes ICD-9-CM diagnoses into a manageable number of clinically meaningful categories.⁴ This “clinical grouper” makes it easier to quickly understand patterns of diagnoses and procedures.

Procedures and Clinical Classifications Software (CCS)

The principal procedure is the procedure that was performed for definitive treatment rather than performed for diagnostic or exploratory purposes (i.e., the procedure that was necessary to take care of a complication). If two procedures appear to meet this definition, the procedure most related to the principal diagnosis was selected as the principal procedure.

CCS categorizes procedure codes into clinically meaningful categories.⁴ This “clinical grouper” makes it easier to quickly understand patterns of procedure use.

Major Diagnostic Categories (MDCs)

MDCs are derived from the Diagnosis Related Groups reimbursement system. A patient’s hospital record is assigned a single MDC that designates the body system (e.g., respiratory system) or etiology (e.g., trauma) of the principal diagnosis for that hospital stay.

Types of hospitals included in HCUP

HCUP is based on data from community hospitals, defined as short-term, non-Federal, general, and other hospitals, excluding hospital units of other institutions (e.g., prisons). HCUP data include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals. Excluded are long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals. Please note that a discharge of this nature will be included in the NIS if it occurred in a community hospital.

Unit of analysis

The unit of analysis is the hospital discharge (i.e., the hospital stay), not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate “discharge” from the hospital.

Costs and charges

Total hospital charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare and Medicaid Services (CMS).⁵ Costs will tend to reflect the actual costs of production, while charges represent what the hospital billed for the case. For each hospital, a hospital-wide cost-to-charge ratio is used because detailed charges are not available across all HCUP States. Hospital charges reflect the amount the hospital charged for the entire hospital stay and does not include professional (physician) fees. For the purposes of this Statistical Brief, costs are reported to the nearest hundreds.

Payer

Payer is the expected primary payer for the hospital stay. To make coding uniform across all HCUP data sources, payer combines detailed categories into more general groups:

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Medicare includes fee-for-service and managed care Medicare patients.

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Medicaid includes fee-for-service and managed care Medicaid patients. Patients covered by the State Children’s Health Insurance Program (SCHIP) may be included here. Because most state data do not identify SCHIP patients specifically, it is not possible to present this information separately.

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Private insurance includes Blue Cross, commercial carriers, and private HMOs and PPOs.

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Other includes Workers’ Compensation, TRICARE/CHAMPUS, CHAMPVA, Title V, and other government programs.

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Uninsured includes an insurance status of “self-pay” and “no charge.”

When more than one payer is listed for a hospital discharge, the first-listed payer is used.

Discharge status

Discharge status indicates the disposition of the patient at discharge from the hospital, and includes the following six categories: routine (to home), transfer to another short-term hospital, other transfers (including skilled nursing facility, intermediate care, and another type of facility such as a nursing home), home health care, against medical advice, or died in the hospital.