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

Pediatr Pulmonol. 2019 Aug;54(8):1267-1276. doi: 10.1002/ppul.24381. Epub 2019 Jun 6.


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.

Keywords: early life; health care use; medical costs; pattern; respiratory; young children.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • Cohort Studies
  • Databases, Factual
  • Emergency Service, Hospital / economics
  • Female
  • Health Care Costs
  • Hospitalization / economics
  • Humans
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Ontario
  • Respiratory Tract Diseases / economics
  • Respiratory Tract Diseases / therapy*

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