Insurance Status and Hospital Outcomes for RSV and Asthma Exacerbation Requiring Ventilation

Introduction: Recent federal changes in Medicaid eligibility are expected to decrease health insurance rates among US children. We sought to evaluate the impact of insurance status on mortality and length-of-stay for hospitalized children who required ventilation for respiratory syncytial virus (RSV) or asthma exacerbation.


Methods: A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) 2022 Kids’ Inpatient Database (KID) was performed. We identified patients with ICD-10 codes indicating RSV infection (B974, J20.5, J12.1, or J21.0) or asthma exacerbation (J45) and a procedural code for ventilation (5A1935Z, 5A1955Z, 5A1955Z, 0BH17EZ, 0BH18EZ; 5A0935x, 5A0945x, 5A0955x, 5A19054). We performed hierarchical, survey-weighted multiple logistic regression and multiple linear regression to determine associations between insurance status and in-hospital mortality and length of stay, respectively. We adjusted for age, race, sex, disease severity, income quartile, and hospital characteristics (region, teaching status, ownership, size); we used sample weighting to produce national estimates.


Results: Among 5,660,863 pediatric hospitalizations, 69,490 were for RSV infection or asthma exacerbation requiring ventilation. Mean patient age was 3.32 years old (± standard error [SE]: 0.069) and 29,461 were female (42.40%). 573 (0.83%) reported patient death; average length of stay was 5.97 days (± 0.14 SE). Medicaid insurance plans paid for 39,724 (57.16%) hospitalizations, private insurance for 25,818 (37.15%), self-pay for 1,355 (1.95%), and other for 2,562 (3.69%).

In the multivariate analysis, compared to private insurance, self-pay was associated with a statistically significant increase in death (adjusted odds ratio [aOR]: 2.37, p=0.002); this was not seen for patients with Medicaid (aOR 0.94, p=0.641) nor other insurance (aOR 1.22, p=0.450). Medicaid was associated with decreased length of stay (aOR: 0.48, p< 0.001) and self-pay status was not associated with changes (aOR: -0.36, p=0.386).


Conclusions: Compared to patients with public or private insurance, uninsured self-pay pediatric patients admitted for RSV infections or asthma exacerbations requiring ventilation have significantly higher mortality rates, even after adjustment. Self-pay status does not appear to affect length of stay.