Trends in Intussusception-Associated Hospitalizations and Deaths Among US Infants

Abstract

Context. The newly licensed tetravalent rhesus-human reassortant rotavirus vaccine has been withdrawn following reports of intussusception among vaccinated infants. Objective. To describe the epidemiology of intussusception-associated hospitalizations and deaths among US infants. Design. This retrospective cohort study examined hospital discharge data from the National Hospital Discharge Survey for 1988–1997, Indian Health Service (IHS) for 1980–1997, California for 1990–1997, Indiana for 1994–1998, Georgia for 1997–1998, and MarketScan for 1993–1996, and mortality data from the national multiple cause-of-death data for 1979–1997 and linked birth/infant death data for 1995–1997. Patients. Infants (<1 year old) with anInternational Classification of Diseases, Ninth Revision, Clinical Modification code for intussusception (560.0) listed on their hospital discharge or mortality record, respectively. Results. During 1994–1996, annual rates for intussusception-associated infant hospitalization varied among the data sets, being lowest for the IHS (18 per 100 000; 95% confidence interval [CI] = 9–35 per 100 000) and greatest for the National Hospital Discharge Survey (56 per 100 000; 95% CI = 33–79 per 100 000) data sets. Rates among IHS infants declined from 87 per 100 000 during 1980–1982 to 12 per 100 000 during 1995–1997 (relative risk =7.6, 95% CI = 3.2–18.2). Intussusception-associated hospitalizations were uncommon in the first 2 months of life, peaked from 5 to 7 months old, and showed no consistent seasonality. Intussusception-associated infant mortality rates declined from 6.4 per 1 000 000 live births during 1979–1981 to 2.3 per 1 000 000 live births during 1995–1997 (relative risk = 2.8, 95% CI = 1.8–4.3). Infants whose mothers were <20 years old, nonwhite, unmarried, and had an education level below grade 12 years were at an increased risk for intussusception-associated death. Conclusions. Intussusception-associated hospitalization rates varied among the data sets and decreased substantially over time in the IHS data. Although intussusception-associated infant deaths in the United States have declined substantially over the past 2 decades, some deaths seem to be related to reduced access to, or delays in seeking, health care and are potentially preventable.intussusception, hospitalizations, deaths, risk factors, infants.