IMPORTANCE Over the last 2 decades, bronchiolitis guidelines and improvement efforts focused on supportive care and reducing unnecessary tests, treatments, and hospitalization. There have been limited population-based studies examining hospitalization outcomes over time. OBJECTIVE To describe rates and trends in bronchiolitis hospitalization, intensive care unit (ICU) use, mortality, and costs. DESIGN, SETTING, AND PARTICIPANTS This cohort study used population-based health administrative data from April 1, 2004, to March 31, 2018, to identify bronchiolitis encounters using hospital discharge diagnosis codes in Ontario, Canada. Children younger than 2 years with and without bronchiolitis hospitalization were included. Data were analyzed from January 2020 to July 2021. MAIN OUTCOMES AND MEASURES Bronchiolitis hospitalization per 1000 person-years, ICU use per 1000 hospitalizations, mortality per 100 000 person-years, and costs per 1000 person-years adjusted to 2018 Canadian dollars and reported in 2018 US dollars. RESULTS Among 2 336 446 included children, 1 199 173 (51.3%) were male. During the study period, 43 993 children (1.9%) younger than 2 years had 48 058 bronchiolitis hospitalizations at 141 hospitals. Bronchiolitis accounted for 48 058 of 360 920 all-cause hospitalizations (13.3%) and 215 654 of 2 566 348 all-cause hospital days (8.4%) in children younger than 2 years. Bronchiolitis hospitalization was stable over time, at 14.0 (95% CI, 13.6-14.4) hospitalizations per 1000 person-years in 2004-2005 and 12.7 (95% CI, 12.2-13.1) hospitalizations per 1000 person-years in 2017-2018 (annual percent change [APC], 0%; 95% CI, -1.6 to 1.6; P = .97). ICU admission increased significantly from 38.1 (95% CI, 32.2-44.8) per 1000 hospitalizations in 2004-2005 to 87.8 (95% CI, 78.3-98.0) per 1000 hospitalizations in 2017-2018 (APC, 7.2%; 95% CI, 5.4-8.9; P < .001). Over the study period, bronchiolitis mortality was 2.8 (95% CI, 2.3-3.4) per 100 000 person-years and remained stable (APC, 1.1%; 95% CI, -8.4 to 11.7; P = .85). Hospitalization costs per 1000 person-years increased from $49 640 (95% CI, $49 617-$49 663) in 2004-2005 to $58 632 (95% CI, $58 608-$58 657) in 2017-2018 (APC, 3.0%; 95% CI, 1.3-4.8; P = .002). CONCLUSIONS AND RELEVANCE From 2004 to 2018, bronchiolitis hospitalization and mortality rates remained stable; however, ICU use and costs increased substantially. This represents a major increase in high-intensity hospital care and costs for one of the most common and cumulatively expensive conditions in pediatric hospital care.

中文翻译：

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2004 年至 2018 年毛细支气管炎住院率、重症监护病房使用率、死亡率和费用。

重要性 在过去的 2 年中，细支气管炎指南和改进工作集中在支持性护理和减少不必要的检查、治疗和住院治疗上。随着时间的推移，检查住院结果的基于人群的研究有限。目的 描述毛细支气管炎住院率和趋势、重症监护病房 (ICU) 的使用、死亡率和成本。设计、地点和参与者 本队列研究使用 2004 年 4 月 1 日至 2018 年 3 月 31 日期间基于人群的卫生管理数据，使用加拿大安大略省的出院诊断代码确定毛细支气管炎遭遇。包括 2 岁以下患有和未患有毛细支气管炎住院的儿童。数据分析时间为 2020 年 1 月至 2021 年 7 月。主要结果和措施每1000人年毛细支气管炎住院率、每1000人年ICU使用率、每100 000人年死亡率、每1000人年成本调整为2018年加元，以2018年美元报告。结果 2 336 446名儿童中，男性1 199 173人（51.3%）。在研究期间，43 993 名 2 岁以下儿童（1.9%）在 141 家医院接受了 48 058 次毛细支气管炎住院治疗。在 2 岁以下儿童中，毛细支气管炎占 360 920 例全因住院治疗中的 48 058 天（13.3%）和 2 566 348 天全因住院天数中的 215 654 天（8.4%）。毛细支气管炎住院率随着时间的推移保持稳定，2004-2005 年每 1000 人年住院 14.0 (95% CI, 13.6-14.4) 和 12.7 (95% CI, 12.2-13.0)。1) 2017-2018 年每 1000 人年住院率（年变化百分比 [APC]，0%；95% CI，-1.6 至 1.6；P = .97）。ICU 入院率从 2004-2005 年的每 1000 次住院患者 38.1 (95% CI, 32.2-44.8) 显着增加至 2017-2018 年的每 1000 次住院患者 87.8 (95% CI, 78.3-98.0) (APC, 7.2%; 95% CI, 5.4-8.9；P < .001)。在研究期间，细支气管炎死亡率为每 10 万人年 2.8 人（95% CI，2.3-3.4）并保持稳定（APC，1.1%；95% CI，-8.4 至 11.7；P = .85）。每 1000 人年的住院费用从 2004-2005 年的 49640 美元（95% CI，49617-49663 美元）增加到 2017-2018 年的 58632 美元（95%CI，58608-58657 美元）（APC，3.0%； 95% CI，1.3-4.8；P = .002）。结论和相关性 从 2004 年到 2018 年，毛细支气管炎住院率和死亡率保持稳定；然而，ICU 的使用和成本大幅增加。