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Hosp Pediatr. 2017 Jul;7(7):365-372. doi: 10.1542/hpeds.2016-0179. Epub 2017 Jun 20.

Contributions of Children With Multiple Chronic Conditions to Pediatric Hospitalizations in the United States: A Retrospective Cohort Analysis.

Author information

Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts;
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of Graduate Medical Sciences, Boston University School of Public Health, Boston, Massachusetts.
Division of General Pediatrics, PolicyLab, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
Children's Hospital Association, Overland Park, Kansas.



Children with multiple chronic conditions (CMCC) are increasingly using hospital care. We assessed how much of US pediatric inpatient care is used by CMCC and which chronic conditions are the key drivers of hospital use.


A retrospective analysis of all 2.3 million US acute-care hospital discharges in 2012 for children age 0 to 18 years in the Kids' Inpatient Database. The ∼4.5 million US hospitalizations for pregnancy, childbirth, and newborn and neonatal care were not assessed. We adapted the Agency for Healthcare Research and Quality's Chronic Condition Indicators to classify hospitalizations for children with no, 1, or multiple chronic conditions, and to determine which specific chronic conditions of CMCC are associated with high hospital resource use.


Of all pediatric acute-care hospitalizations, 34.3% were of children with no chronic conditions, 36.5% were of those with 1 condition, and 29.3% were of CMCC. Of the $23.6 billion in total hospital costs, 19.7%, 27.4%, and 53.9% were for children with 0, 1, and multiple conditions, respectively, and similar proportions were observed for hospital days. The three populations accounted for the most hospital days were as follows: children with no chronic condition (20.9%), children with a mental health condition and at least 1 additional chronic condition (20.2%), and children with a mental health condition without an additional chronic condition (13.3%). The most common mental health conditions were substance abuse disorders and depression.


CMCC accounted for over one-fourth of acute-care hospitalizations and one-half of all hospital dollars for US pediatric care in 2012. Substantial CMCC hospital resource use involves children with mental health-related conditions.

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