Children readmissions in NSW (2007-2022) and VIC (2017-2018)
Worldwide incidence of asthma readmission is up to 40% (ref 1, intro).
NSW (ref 1,3)
A retrospective longitudinal study looking at 48,217 asthma hospitalisations in children aged 2-17 years reported that over 1 in 5 children hospitalised for asthma in NSW between 2007 and 2022 were readmitted for asthma within a year, costing an average AU$2593 per readmission. (ref 1)
The study included all children born in NSW between 2005 and 2015 who had at least one asthma hospitalisation across NSW between 2007 and 2022.
Findings (ref 1):
- 21.6% of children were readmitted to hospital due to asthma within 12 months
- readmitted children were younger than non-readmitted ones (mean age 3.8 vs 4.37) with 81% of readmitted children being aged 2-4 years (vs 65% of non-readmitted)
- overall incidence rate for the first asthma readmission within the 12 months was 23.8 per 100 person-years (95% CI 22.6 to 25.1)
- the incidence rate of asthma readmission was twice as high in children 2-4 years and went down with age up to the age group (28.7 per 100 person-years for 2-4 yo; 14.7 for 5-9 yo; 11.2 for 10-14 yo) but then increased again in older adolescents (18.0 per 100 person-years in 15-17 yo)
- the readmission incidence rate was highest in the first month following hospitalisation
- readmission incidence rate was higher in the more disadvantaged areas and major cities, implying socioeconomic disparities with higher population density, traffic congestion, and environmental pollution
- First readmission cost on average AU$2593 in direct medical cost per episode, but increased with age up to 10-14yo: lowest cost in children 2-4 yo (AU$2867 per episode) and highest cost in children 10-14 yo (AU$4392 per episode).
- the medical cost of first asthma readmissions within 12 months was AU$ 15.6million.
Possible reasons:
- Hospital discharge without proper disease management, guideline-discordant asthma care, lack of education including reviewing inhaler technique and adequate counselling during discharge have been demonstrated to influence the risk of asthma readmission within the first few months of index hospitalisation
- Causal factors for higher readmission rate in younger children may include the high incidence of respiratory infections, particularly viral infections, environmental triggers such as environmental tobacco smoke, secondary smoking at home, traffic-related air pollution, moulds at home, dust-mite allergens, food allergens and inhalant allergens are causal risk factors for asthma readmissions among young children.
The same study/data was used to identify risk factors for these asthma readmissions (ref 3).
This second publication reported: (ref 3)
- 22% were readmitted within a year: 18% of these readmitted within 30 days (early readmission) and 82% readmitted after 30 days (late readmission)
- Most readmitted children were aged between 2 and 4 (77% of early readmissions, 81.5% of late readmissions)
Risk factors for early readmissions:(ref 3)
- children’s age 2–4 years (adjusted Relative Risk (adjusted risk ratio 1.71)
- No older siblings (1.26)
- Length of stay ≥ 2 days (1.42)
- Intensive care unit admission (2.27)
- Underlying chronic comorbidities and/or congenital anomalies (1.27)
- Admissions related to allergies or eczema (1.54)
Risk factors for late readmissions:(ref 3)
- Children’s age 2–4 years (1.93) – nearly twice as likely!
- No older siblings (1.09)
- Residence in the most socio‐economically disadvantaged areas (1.16)
- Residence in major cities (1.20)
- Index admission during spring (1.16) or summer (1.10)
- Length of stay ≥ 2 days (1.21)
- Admissions related to allergies or eczema (1.40)
VIC (ref 2)
A smaller study was conducted in VIC across 3 hospitals for 767 children 3-18 years hospitalised for asthma between 2017 and 2018. The study found that 34.3% of children were radmitted within 12 months, 69% of them being aged 3-5 yo.(ref 2)
note: the NSW data is stronger evidence as it is a population-based large study in NSW and included longer follow-up.