More Hemorrhagic and Severe Events Cause Higher Hospitalization Care Cost for Childhood Stroke in Taiwan

Received 31 January 2007; received in revised form 19 June 2007; accepted 3 August 2007. published online 05 November 2007.

Objective

Rarely has childhood stroke been compared with adult stroke for incidence or cost. This population study compared the stroke incidence and the associated hospitalization care costs between children and adults in Taiwan.

Study design

We used reimbursement claims data from the National Health Insurance program to identify stroke diagnoses in 1997 to 2003. The inpatient costs of both the first admission and recurrent stroke from 1979 childhood cases and 365,169 adult cases were compared by age and stroke subtype, excluding those less than 1 month of age.

Results

The mean inpatient costs were higher for patients <10 and 10 to 19 years of age ($3565 per case) compared with adult cases ($1933), including both first and recurrent hospitalizations, and they were higher for the recurrent cases. Patients <10 years old had the highest proportional incidence of hemorrhage events (71.4%), followed by patients in the 10- to 19-year-old group (61.4%), and the lowest for adults (21.3%). Hemorrhagic events incurred 2 to 12 times higher cost than other types of stroke.

Conclusions

The hospitalization care costs for stroke are higher for children than for adults because of a greater proportion of hemorrhagic cases among children.

Abbreviations: HS, Hemorrhage stroke, ICD-9-CM, International classification of disease-9-clinical modification, ICH, Intracerebral hemorrhage, IS, Ischemic stroke, LOS, Length of stay, NHI, National health insurance, OIH, Other intracranial hemorrhage, SAH, Subarachnoid hemorrhage, TIA, Transient cerebral ischemia

a Institution of Environmental Health, National Taiwan University Hospital, Taipei

b Institution of Preventive Medicine, National Taiwan University Hospital, Taipei

c Department of Internal Medicine, National Taiwan University Hospital, Taipei

d Department of Neurology, National Taiwan University Hospital, Taipei

e Institution of Environmental Health, China Medical University College of Public Health, Taichung, Taiwan.

Reprint requests: Fung-Chang Sung, PhD, MPH, Institute of Environmental Health, China Medical University College of Public Health, 91 Hsueh-Shih Rd, Taichung 404, Taiwan.

Supported by the National Science Council, Executive Yuan, Taiwan, Grant NSC94-2314-B-039-006, 2005-2006.

PII: S0022-3476(07)00755-X

doi:10.1016/j.jpeds.2007.08.003

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