Health services utilization and cost of abusive head trauma in Taiwan: A population-based retrospective matched cohort study. (June 2022)

• Record Type: Journal Article
• Authors: Chang, Yi-Ting; Feng, Jui-Ying; Chang, Hsin-Yi; Lu, Tsung-Hsueh; Wu, Joulan; Chang, Yu-Chun
• Is Part Of: Child abuse & neglect. Volume 128(2022)
• Publication Date: 2022-06
• Subjects: Abusive head trauma -- Health services utilization -- Medical cost -- Shaken baby syndrome; Child abuse -- Periodicals; 362.76
• DOI: 10.1016/j.chiabu.2022.105603
• Languages: English
• ISSNs: 0145-2134

Abstract

Abstract: Background: Abusive head trauma (AHT) is a serious health problem that results the highest mortality among children who are maltreated. Many AHT survivors suffer from long-term sequelae and require medical treatment. However, the knowledge of AHT-attributable health services utilization and costs at national level are limited. Objective: To estimate health services utilization and costs attributable to AHT among children aged 0–4 years in Taiwan. Participants and setting: Sixty-three fatal and 664 survival AHT cases were identified using Taiwan national population database between 2003 and 2015. A total of 2656 non-AHT children were exactly 4:1 matched to the survival cases based on their birth year, gender, the calendar year of the index date, insured location, and health insurance premium (social economic status indicator). Methods: Health services utilization and costs were calculated on an annual basis for 3 years after the index date. AHT-attributable health services utilization and costs during 3-year follow-up period was evaluated by regression models. Results: AHT diagnosis was positively associated with inpatient admissions, length of stay, emergency room (ER) visits, and outpatient visits. AHT-attributable medical costs were 1.64–17.27 times, 1.25–5.22 times, and 1.77–2.36 times greater for inpatient, ER, and outpatient during 3-year period than matched controls, respectively. Fatal AHT cases had higher inpatient utilization and greater medical costs than AHT survivors. Conclusions: Children with AHT had greater health services utilization and higher costs for years. Strategies to reduce the burden of AHT on health care system are imperative. Highlights: AHT-attributable medical utilization remains high even after 3-year post-diagnosis. Survivors' inpatient cost was 17 times more than controls within 1 year after AHT. The median survival time of fatal cases after the AHT diagnosis was only 37 days. Inpatient cost for fatal AHT is 5 and 28 times higher than survivors and controls.