Determinants of health care utilization for respiratory symptoms in the first year of life

Objective: Health care utilization for respiratory symptoms is very common in infancy. Little is known about the determinants of visiting a physician for such complaints in infants. We investigated which factors determine the likelihood of visiting a physician for respiratory symptoms in the first year of life of their offspring. Patients and Methods: Infants were participants of the ongoing Wheezing Illnesses Study Leidsche Rijn (WHISTLER), a prospective birth cohort study on respiratory illnesses. Parental reports on respiratory symptoms and possible risk factors were assessed by daily questionnaires. Physician diagnosed respiratory symptoms were classified in medical records using the International Classification of Primary Care. Outcome was defined as a having a child visit a general practitioner for respiratory symptoms in the first year of life. Logistic regression was used to study the likelihood of outcome (yes/no) as a function of putative predictors. Results: Forty-seven percent of the infants visited a physician for respiratory symptoms in the first year of life. Every extra week of respiratory symptoms was associated with a 4.3% higher chance (odds ratio [OR], 1.043; 95% confidence interval [CI], 1.022-1.065) of visiting a physician. Furthermore, the chance was higher in boys (OR, 1.5; 95% Cl, 1.1-2.1), children attending day care (OR, 1.9; 95% Cl, 1.2-3.0), children with nonwhite mothers (OR, 1.9; 95% Cl, 1.1-3.2), and children whose mother had supplementary health care insurance (OR, 1.7; 95% Cl, 1.1-2.7). Findings were similar within the subgroup of children with serious respiratory symptoms (>median: 46 d/yr), but in that group parental age over 30 also determined physician visits (OR, 3.8; 95% Cl, 1.6-8.9). Conclusions: Child and parent characteristics, besides complaints per se, play an important role in health care utilization for respiratory illnesses in infancy.