Age-based health and economic burden of skin and soft tissue infections in the United States, 2000 and 2012.

Khine Tun,James F Shurko,Grace C Lee,Laurajo Ryan,Gabriel A Picone

doi:10.1371/journal.pone.0206893

Abstract

ObjectiveThe aim of this study was to compare the incidence of skin and soft tissue infections (SSTIs) across healthcare settings and analyze direct healthcare expenditures related to SSTIs in 2000 and 2012 in the United States.MethodsWe performed a retrospective, cross-sectional analysis of nationally representative data from the Medical Expenditure Panel Surveys. Population-based incidence rates were examined for all healthcare settings that include inpatient visits, emergency department visits and ambulatory visits for SSTIs. The direct costs of healthcare services utilization were reported. Population-based prescribing rates for each antimicrobial class during ambulatory visits were compared.ResultsA total of 2.4 million patients experienced an SSTI in 2000 compared to 3.3 million in 2012 (40% increase). From 2000 to 2012, the incidence of patients with at least one hospital visit for SSTIs increased 22%, ambulatory care visits increased 30%, and emergency department visits increased 40%. The incidence of SSTIs in children and adolescents declined 50% (from 150 to 76 per 10,000 person; RR = 0.51, 95% CI: 0.38–0.67; p<0.001) whereas SSTIs in older adults (> 65 years of age) increased almost 2-fold (from 67 to 130 per 10,000 person; RR = 1.94, 95% CI: 1.44–2.61; p<0.001). The annual incidence of SSTI in adults did not change significantly from 2000 to 2012 (from 84 to 81 per 10,000 person; RR = 0.96, 95% CI: 0.71–1.31; p = 0.41). The total estimated direct healthcare costs of SSTIs increased 3-fold from $4.8 billion in 2000 to $15.0 billion in 2012, largely driven by an 8-fold increase in ambulatory expenditures for SSTIs. Total population-based antimicrobial prescription rates for SSTIs increased 4-fold from 2000 to 2012 (from 59.5 to 250.4 per 10,000 person).ConclusionsThe highest healthcare utilization for SSTI treatment occurred in the ambulatory care setting and also accounted for the largest increase in overall direct expenditures from 2000 to 2012.

Highlights

In the United States, skin and soft tissue infections (SSTIs) are some of the most common infectious diseases encountered across healthcare settings [1]
Population-based incidence rates were examined for all healthcare settings that include inpatient visits, emergency department visits and ambulatory visits for SSTIs
The incidence of SSTIs in children and adolescents declined 50% whereas SSTIs in older adults (> 65 years of age) increased almost 2-fold

Summary

Introduction

In the United States, skin and soft tissue infections (SSTIs) are some of the most common infectious diseases encountered across healthcare settings [1]. Published reports have suggested that the incidence of SSTIs has increased substantially over the past two decades. An investigation evaluating data from the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP) identified a 30% increase in hospital admissions due to SSTIs from 2000 to 2004. HCUP data identified SSTIs as the most rapidly increasing indication for hospitalizations between 1997 and 2007 [4]. A study of ambulatory and inpatient data found that the steady increase in SSTI incidence was sustained from 2005–2010 in persons younger than 65 years [5]. Recent studies evaluating the trends of SSTIs across all healthcare settings and age-groups are limited

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