HOSPITALIZATION FOR LOWER RESPIRATORY-TRACT ILLNESS IN INFANTS - VARIATION IN RATES AMONG COUNTIES IN NEW-YORK-STATE AND AREAS WITHIN MONROE COUNTY

Objective: Lower respiratory tract illness (LRI) is the most common se rious illness in childhood and the most Common reason for hospitalizat ion of infants beyond the neonatal period. This study assessed the pot ential for cost savings from reduction in hospitalization for LRI. Set ting and Sample: LRI hospitalization rates for children in the first 2 years of life (infants) were studied for the 62 counties of New York State and six socioeconomic areas within Monroe County (Rochester) for the years 1985 through 1991. Design: Analysis of small area variation s. Results: LRI accounted for 51.2% of infant hospitalizations in New York State. The overall LRI hospitalization rate for New York's 62 cou nties was 27.0 per 1000 child-years and ranged; among the 18 most popu lous counties, from 10.7 for Monroe County to 39.3 for the Bronx. Unem ployment rate was the strongest predictor of LRI hospitalization rates for counties, explaining 29% of the variance in multiple regression a nalysis. Within Monroe County, LRI hospitalization rates followed a ge ographic gradient from the inner city (22.5) to the rest of the city ( 12.2), and to the suburbs (7.3). Deaths from LRI were uncommon (0.36% of state LRI hospitalizations) and varied little between inner city (0 .42%) and suburbs (0.51%). If; LRI hospitalization rates for Monroe Co unty suburban children prevailed for the entire state, 10,439 hospital izations and $32,916,000 would be saved annually. Conclusions: 9 large portion of the increased cost of health care for children living in p overty is attributable to hospitalization for LRI in infants. Physicia n discretion in decision making and factors associated with socioecono mic status are probably major determinants of variation. Well-coordina ted follow-up of acute illness visits, home monitoring by visiting nur ses, and empirically based clinical guidelines for management of LRI m ight yield both substantial cost savings and better service to familie s.