Association of Clinical Severity With Family Affluence-Based Socioeconomic Status Among Hospitalized Pediatric Hand, Foot, and Mouth Disease Patients in Henan, China: A Single Hospital-Based Case Series Study

Kai Wang; Fang Wang; Yu Li; Lu Liang; Peng Cui; Shujuan Han; Yonghong Zhou; Qi Qiu; Yibing Cheng; Chun Guo; Mengyao Zeng; Lu Long; Tianchen Zhang; Hongjie Yu

doi:10.1093/ofid/ofab150

Association of Clinical Severity With Family Affluence-Based Socioeconomic Status Among Hospitalized Pediatric Hand, Foot, and Mouth Disease Patients in Henan, China: A Single Hospital-Based Case Series Study

Open Forum Infect Dis. 2021 Mar 26;8(7):ofab150. doi: 10.1093/ofid/ofab150. eCollection 2021 Jul.

Authors

Kai Wang¹, Fang Wang², Yu Li^{3

4}, Lu Liang⁵, Peng Cui¹, Shujuan Han², Yonghong Zhou¹, Qi Qiu¹, Yibing Cheng², Chun Guo⁶, Mengyao Zeng^{1

7}, Lu Long⁵, Tianchen Zhang³, Hongjie Yu¹

Affiliations

¹ School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
² Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China.
³ Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
⁴ WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
⁵ West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
⁶ School of Public Health, Huazhong University of Science and Technology, Wuhan, China.
⁷ NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Medical School, Fudan University, Shanghai, China.

Abstract

Background: The association between the clinical severity of hand, foot, and mouth disease (HFMD) inpatients and socioeconomic status (SES) is important for quantifying SES inequality in HFMD disease burden and informing decision-makers regarding medical subsidy and reimbursement policies. Here, this association was investigated using a quantitative SES measurement.

Methods: Laboratory-confirmed HFMD cases hospitalized at Henan Children's Hospital from February 15, 2017, to February 15, 2018, were invited. We utilized the revised Family Affluence Scale for family affluence-based SES measurement. Clinical severity was diagnosed based on central nervous system (CNS) complications, treatments, and length of stay. We applied logistic regression for association analyses and multiple imputation for missing data.

Results: A total of 1229 laboratory-confirmed HFMD inpatients responded. Adjusted by age, sex, rural residence, EV-A71 infection, and health-seeking behavior, CNS complications (odds ratio [OR], 2.72; 95% CI, 1.41-5.31), intensive care unit (ICU) admission (OR, 7.30; 95% CI, 2.21-25.97), and prolonged hospitalization (OR, 4.28; 95% CI, 2.44-7.58) were significantly associated with lower family affluence-based SES. These associations increased as the SES category descended. For EV-A71-infected inpatients, severe HFMD was significantly associated with low and intermediate SES. For non-EV-A71-infected inpatients, only the association of prolonged hospitalization with low SES increased significantly. Also, severe HFMD inpatients, especially those admitted to the ICU, incurred high hospitalization costs.

Conclusions: The clinical severity of HMFD inpatients was significantly associated with family affluence-based SES. Severe HFMD inpatients were more likely to have lower SES than nonsevere inpatients and suffered a heavy economic burden. Therefore, medical subsidy and reimbursement policies should offer sufficient monetary support to severe HFMD inpatients to alleviate economic burden in low-SES populations and reduce potential SES inequality.

Keywords: clinical severity; family affluence scale; hand, foot, and mouth disease; hospitalization cost; socioeconomic status.