Peer-reviewed article
Burden of diarrhoeal diseases among hospitalised patients in Thailand: a retrospective national database analysis (2014-2022).
Suppasit Srisaeng, Sakkarin Chirapongsathorn, Ngamphol Soonthornworasiri, Kittiyod Poovorawan, Wirichada Pan-Ngum ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed Thailand's national hospital admission database from 2014 to 2022 to understand the burden of diarrhoeal diseases across the population. Children under 5 years and adults aged 60 and older accounted for over half of all diarrhoeal admissions, with older adults experiencing the highest mortality rates. The research found that improved water and sanitation, rotavirus vaccination, and better hospital preparedness are needed to reduce the diarrhoeal disease burden in Thailand.
Key points
- Among over 3 million diarrhoeal admissions, children younger than 5 years accounted for 31.4% while older adults aged 60+ accounted for 25.7% of admissions but 64.6% of deaths
- Admission rates fell from 686.5 per 100,000 pre-pandemic to 474.5 per 100,000 during the pandemic, while average cost per admission increased from $372 to $539
- Total disease burden was 1,124,618 disability-adjusted life years (DALYs) over the study period, with mean annual DALYs declining from 132,366 to 110,140
- Each 1% increase in rotavirus vaccine coverage was associated with a 2% reduction in rotavirus admissions among children under 5
- Infections with Salmonella and Clostridioides difficile, along with older age and male sex, were associated with higher mortality and high-cost admissions
Limitations
This study is based on hospital admission data and does not capture community cases of diarrhoea that are managed without hospitalization, limiting understanding of the true population burden. The analysis cannot determine causality for identified risk factors or fully assess the impact of interventions beyond rotavirus vaccination.
Abstract
BACKGROUND: Acute diarrhoea remains one of the leading causes of morbidity and mortality worldwide. Most existing research has focused on children younger than 5 years of age, while data from Thailand are limited. In this study we characterised trend of diarrhoeal admissions, associated Disability-adjusted life years (DALYs) and determined predictors of mortality and high-cost admissions in Thailand. METHODS: We analysed Thailand's National Health Security Office inpatient claims database for 2014-2022. We estimated admission rates (ASRs), costs of admission ($PPP), and DALYs for pre-pandemic (2014-2019) and pandemic (2020-2022) periods. Predictors of mortality and high-cost admission were assessed using logistic regression. Rotavirus vaccine impact was evaluated among children younger than 5 years of age. FINDINGS: Among 3,041,699 total admissions, 54·3% were female, median age was 22 years (IQR 3-61). ASR fell from 686·5/100,000 pre-pandemic to 474·5/100,000 pandemic, while mean cost rose from $PPP 372 to 539. The case fatality ratio was 0·6 (18,782 deaths). Total burden was 1,124,618 DALYs; mean annual DALYs fell from 132,366 to 110,140. Children younger than 5 years of age accounted for 31·4% of admissions, whereas adults older than or equal to 60 years of age accounted for 25·7% of admissions and 64·6% of total deaths. Older age, male sex, referral hospitals, central region, stroke, sepsis, respiratory failure, and Salmonella or Clostridioides difficile infection was associated with mortality or high-cost admission. Each 1% increase in rotavirus vaccine coverage was associated with 2·0% reduced rotavirus admissions. INTERPRETATION: Thailand's diarrhoeal admissions were concentrated among young children and older adults, with mortality and high-cost admissions driven by Salmonella and C. difficile infections. Improved water, sanitation, rotavirus vaccination, and hospital preparedness are essential to tackle the diarrhoeal disease burden. FUNDING: This research was funded by Wellcome (grant number 315982/Z/24/1). For the purposes of open access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Rotavirus vaccination coverage expansion
- Population
- Children younger than 5 years in Thailand
Key finding
Each 1% increase in rotavirus vaccine coverage was associated with a 2.0% reduction in rotavirus admissions among children younger than 5 years