Impact of economic downturn on pediatric hospitalizations

The economic fallout of the COVID-19 pandemic has caused many to wonder what the effect will be on children’s health, as the connection between economics and child health can be complex. A recent analysis in Health Affairs that looked at county-level unemployment and pediatric hospitalizations for several years could offer some guidance.¹

The researchers at the National Institutes of Health ran a population-level repeated cross-sectional study of all pediatric hospitalizations, which included 14 states, in 2002, 2005, 2008, 2011, and 2014. The years were chosen to encompass any employment growth following the 2001 mini-recession, the Great Recession of 2007 to 2009 , and the recovery following. The 14 states included in the research were Colorado, Florida, Iowa, Kentucky, Michigan, Nebraska, New Jersey, New York, North Carolina, Oregon, Rhode Island, Utah, Vermont, and Washington, and they were selected because they record the zip code of every hospitalized patient to Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project State Inpatient Databases. The county unemployment data were acquired from the Department of Labor’s Bureau of Labor Statistics.

Following an adjustment for any state-specific effects on unemployment for all counties and year, the investigators found that increased unemployment was linked with increased hospitalizations for 4 conditions that could be economy sensitive. With diabetes mellitus, a 1 percent increase in unemployment was tied to a 4 percent increase in hospitalizations. Medical complexity as well as poisoning and burns saw a 2 percent increase in hospitalizations for each percent increase in unemployment. Hospitalizations for substance abuse saw a 5 percent increase for each 1 percent increase in unemployment. However, hospitalizations for mental health programs did not appear to be linked with unemployment. Overall the average all-cause pediatric hospitalizations increased by 2% for every 1 percent increase in unemployment.

The investigators concluded that there were some hospitalizations for certain conditions that appeared to be sensitive to the economy such as substance abuse and diabetes mellitus. They believe that further research is needed to look at programs and policies that could help moderate the effect of economic downturns on children’s health.

Reference

1. Colvin J, Richardson T, Ginther D, Hall M, Chung P. Economy-sensitive conditions: are some pediatric hospitalizations triggered by economic recessions?. Health Affairs. 2020;39(10):1783-1791. doi:10.1377/hlthaff.2020.00732