Background
Methods
Study design and participants
Characteristic | Patients (n) | Patients with viral gastroenteritis (n, %) | χ2 | P value |
---|---|---|---|---|
Total | 5,711,724 | 28,189(0.49) | ||
Sex | 16.863 | < 0.001 | ||
Male | 3,532,336 | 17,099 (0.48) | ||
Female | 2,179,388 | 11,090 (0.51) | ||
Age group | 23,590.088 | < 0.001 | ||
≤ 28 days | 571,879 | 733 (0.13) | ||
28 days < ~ ≤ 1 years old | 1,632,150 | 17,563 (1.08) | ||
1 < ~ ≤ 3 years old | 1,207,254 | 8803 (0.73) | ||
3 < ~ ≤ 6 years old | 1,099,157 | 959 (0.09) | ||
6 < ~ ≤ 12 years old | 1,030,936 | 124 (0.01) | ||
> 12 years old | 170,348 | 7 (0.00) | ||
Years | 331.482 | < 0.001 | ||
2016 | 1,015,850 | 5102 (0.50)a | ||
2017 | 1,123,239 | 6618 (0.59) | ||
2018 | 1,205,364 | 5919 (0.49)a | ||
2019 | 1,337,314 | 6129 (0.46) | ||
2020 | 1,029,957 | 4421 (0.43) | ||
Seasons | 11,117.324 | < 0.001 | ||
Spring | 1,362,478 | 6090(0.45) | ||
Summer | 1,525,852 | 2731(0.18) | ||
Autumn | 1,412,944 | 5188(0.37) | ||
Winter | 1,410,450 | 14,180(1.01) | ||
Regions | 9,236.243 | < 0.001 | ||
Northeast China | 249,244 | 2023(0.81) | ||
North China | 828,006 | 3020(0.36)a | ||
East China | 1,896,173 | 6960(0.37)a | ||
South China | 422,268 | 1689(0.40) | ||
Central China | 1,098,999 | 2671(0.24) | ||
Northwest China | 775,561 | 8505(1.10) | ||
Southwest China | 441,473 | 3321(0.75) | ||
Hospital discharge-dollars | - | |||
Discharge against medical advice | 1640 (5.82) | |||
Other | 174 (0.62) | |||
Discharge with medical advice | 26,363 (93.52) | |||
Transferred to other hospital with medical advice | 12 (0.04) | |||
Death | 0(0.00) | |||
Hospitalization | - | |||
Length of stay- days | ||||
Median | 5 | |||
Interquartile range | 3–6 | |||
Cost-US dollars | ||||
Median | 587 | |||
Interquartile range | 541–642 |
Inclusion and exclusion criteria
Statistical analysis
Results
Prevalence of viral gastroenteritis in children
Viral gastroenteritis characterized by different viral pathogens
Characteristic | CV | RV | NV | ADV | Not clear |
---|---|---|---|---|---|
Total (n = 28,189) | 83(0.29) | 25,274(89.66) | 441(1.56) | 1047(3.71) | 1344(4.77) |
P value | <0.001 | ||||
Sex | |||||
Male(n = 17,099) | 51(61.45) | 15,395(60.91) | 262(59.41) | 615(58.74) | 776(57.74) |
Female(n = 11,090) | 32(38.55) | 9879(30.09) | 179(40.59) | 432(41.26) | 568(42.26) |
χ2 | 0.022 | 6.607 | 0.292 | 1.678 | 5.044 |
P value | 0.883 | 0.010 | 0.589 | 0.195 | 0.025 |
Age group | |||||
≤ 28 days(n = 733) | 9(10.84)a | 677(2.68)a | 8(1.81)a | 13(1.24)a | 26 (1.93)a,b |
28 days < ~ ≤ 1 years old(n = 17,563) | 47(56.63)b | 15,635(61.86) | 249(56.46)a | 764 (72.97)b,c | 868(64.58)b |
1 < ~ ≤ 3 years old(n = 8803) | 26(31.33)b | 8034(31.79)a | 142 (32.20)a | 234(22.35)a,d,e | 367(27.31)a |
3 < ~ ≤ 6 years old(n = 959) | 1 (1.20)b | 831(3.29) | 32(7.26)b | 33(3.15)b,c,d,e | 62(4.61)c |
6 < ~ ≤ 12 years old(n = 124) | 0(0.00) a,b | 93(0.37)b | 9(2.04)c | 2(0.19)a,c,e | 20(1.49)d |
> 12 years old(n = 7) | 0(0.00) a,b | 4(0.02)b | 1(0.23)b,c | 1(0.10)b,d | 1(0.07)a,b,c,d |
χ2 | 23.752 | 83.984 | 56.675 | 58.943 | 53.265 |
P value | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Years | |||||
2016(n = 5102) | 23(27.71)a | 4754 (18.81) | 3(0.68)a | 120(11.46)a | 202 (15.03) |
2017(n = 6618) | 45(54.22)a | 6267(24.80) | 12(2.72)a | 143(13.66)a | 151(11.24) |
2018(n = 5919) | 11(13.25) | 5319(21.05) | 33(7.48) | 252(24.07)b | 304(22.62)a |
2019(n = 6129) | 3(3.61)b | 5292(20.94) | 117(26.53) | 271(25.88)b | 446(33.18) |
2020(n = 4421) | 1(1.20)b | 3642(14.41) | 276(62.59) | 261(24.93) | 241 (17.93)a |
χ2 | 63.841 | 574.912 | 829.389 | 143.848 | 188.731 |
P value | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Seasons | |||||
Spring(n = 6090) | 19(22.89) | 5508(21.79) | 56(12.70) | 189(18.05) | 318(23.66)a |
Summer(n = 2731) | 10(12.05) | 2028(8.02) | 54(12.24) | 356(34.00) | 283(21.06) |
Autumn(n = 5188) | 18(21.69) | 4380(17.33) | 152(34.47) | 346(33.05) | 292(21.73)a |
Winter(n = 14,180) | 36(43.37) | 13,358(52.85) | 179(40.59) | 156(14.90) | 451(33.56) |
χ2 | 1.824 | 1171.716 | 90.68 | 1067.481 | 278.173 |
P value | 0.610 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Regions | |||||
Northeast China(n = 2023) | 0(0.00)a,b,c,d,e | 1939(7.67)a | 47(10.66)a | 0(0.00) | 37(2.75)a |
North China(n = 3020) | 0(0.001)d,e | 2418(9.57) | 207(46.94) | 122(11.65) | 273(20.31)b |
East China(n = 6960) | 78(93.98) | 6428(25.43)c | 40(9.07) | 182(17.38)a | 232(17.26) |
South China(n = 1689) | 1(1.20)b,c,e | 1560(6.17)c | 68(15.42) | 25(2.39)b | 35(2.60)a |
Central China(n = 2671) | 4(4.82)c | 2583(10.22)a | 4(0.91)b | 53(5.06)a,b | 27 (2.01) |
Northwest China(n = 8505) | 0(0.00)a,d | 7156(28.31) | 19(4.31)b | 644(61.51) | 686(51.04)b |
Southwest China(n = 3321) | 0(0.00)a,b,d,e | 3190(12.62)a | 56(12.70)a | 21(2.01) | 54(4.02)a |
χ2 | 216.754 | 1020.363 | 801.414 | 590.509 | 577.404 |
P value | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Hospital discharge, n (proportion, %) | |||||
Against medical advice(n = 1640) | 4(4.82) | 1461(5.78) | 44(9.98) | 52(4.97) | 79(5.88) |
Other(n = 174) | 2(2.41) | 165(0.65) | 0(0.00) | 3(0.29) | 4(0.30) |
With medical advice(n = 26,363) | 77(92.77) | 23,637(93.52) | 397(90.02) | 992(94.75) | 1260(93.75) |
Transferred to other hospital(n = 12) | 0(0.00) | 11(0.04) | 0(0.00) | 0(0.00) | 1(0.07) |
Viral gastroenteritis combined with other diseases
Diseases | CV (n = 83) | RV (n = 25,274) | NV (n = 441) | ADV (n = 1047) |
---|---|---|---|---|
Respiratory diseases | ||||
Upper respiratory tract diseases | 1 (1.20) | 3641 (14.41) | 86 (19.50) | 211 (20.15) |
Bronchitis | 3 (3.61) | 2991 (11.83) | 48 (10.88) | 100 (9.55) |
Bronchopneumonia | 0 (0) | 1748 (6.92) | 28 (6.35) | 40 (3.82) |
Pneumonia | 2 (2.41) | 1102 (4.36) | 17 (3.85) | 29 (2.77) |
Asthma | 0 (0) | 26 (0.10) | 0 (0) | 0 (0) |
Respiratory failure | 0 (0) | 28 (0.11) | 0 (0) | 3 (0.29) |
Pulmonary vascular diseasea | 0 (0) | 24 (0.09) | 0 (0) | 3 (0.29) |
Urogenital diseases | ||||
Hematuria and/or Proteinuria | 0 (0) | 5 (0.02) | 0 (0) | 0 (0) |
Nephritis | 0 (0) | 5 (0.02) | 0 (0) | 0 (0) |
Renal failure | 0 (0) | 93 (0.37) | 0 (0) | 1 (0.10) |
Renal insufficiency | 0 (0) | 162 (0.64) | 2 (0.45) | 3 (0.29) |
Nephrotic syndrome | 0 (0) | 12 (0.05) | 0 (0) | 0 (0) |
Urethral diseasesa | 0 (0) | 14 (0.06) | 0 (0) | 0 (0) |
Urethral stone, obstruction and hydroureter | 0 (0) | 44 (0.17) | 0 (0) | 5 (0.48) |
Endocrine system diseases | ||||
Abnormal glucose metabolism | 0 (0) | 291 (1.15) | 11 (2.49) | 26 (2.48) |
Diabetes | 0 (0) | 10 (0.04) | 0 (0) | 0 (0) |
Obesity | 0 (0) | 1 (0.004) | 0 (0) | 0 (0) |
Hyperinsulinemia | 0 (0) | 1 (0.004) | 0 (0) | 0 (0) |
Pancreatitis | 0 (0) | 5 (0.02) | 0 (0) | 0 (0) |
Thyroid function abnormalities | 0 (0) | 206 (0.82) | 9 (2.04) | 2 (0.19) |
Rickets | 0 (0) | 9 (0.04) | 0 (0) | 0 (0) |
Immune system diseases | ||||
Kawasaki disease | 0 (0) | 22 (0.09) | 2 (0.45) | 1 (0.10) |
Hypogammaglobulinemia | 0 (0) | 21 (0.08) | 0 (0) | 0 (0) |
Antibody deficiency disorders | 0 (0) | 1 (0.004) | 0 (0) | 0 (0) |
Immunoglobulin deficiency syndromes | 0 (0) | 49 (0.19) | 1 (0.23) | 0 (0) |
Skin and subcutaneous tissue diseasesa | 2 (2.41) | 739 (2.92) | 13 (2.95) | 25 (2.39) |
Nervous system diseases | ||||
Epilepsy | 0 (0) | 327 (1.29) | 5 (1.13) | 12 (1.15) |
Seizureb | 2 (2.41) | 1415 (5.60) | 64 (14.51) | 63 (6.02) |
Febrile seizures | 0 (0) | 14 (0.99) | 2 (6.25) | 0 (0) |
Benign convulsions with gastroenteritis | 0 (0) | 31 (2.19) | 7 (21.88) | 3 (7.14) |
Benign infantile convulsions | 0 (0) | 218 (15.41) | 23 (71.88) | 18 (42.86) |
Congenital diseasea | 4 (4.82) | 426 (1.69) | 9 (2.04) | 8 (0.76) |
Digestive system diseases | ||||
Digestive tract stenosis and obstruction | 0 (0) | 444 (1.76) | 8 (1.81) | 13 (1.24) |
Gastrointestinal hemorrhage | 0 (0) | 140 (0.55) | 1 (0.23) | 5 (0.48) |
Biliary tract or bile duct diseases | 0 (0) | 25 (0.10) | 1 (0.23) | 4 (0.38) |
cholestasis | 0 (0) | 19 (0.08) | 1 (0.23) | 4 (0.38) |
Hepatic failure | 0 (0) | 16 (0.06) | 0 (0) | 1 (0.10) |
Hepatic dysfunction | 5 (6.02) | 1556 (6.16) | 17 (3.85) | 25 (2.39) |
Other liver-related diseasesa | 0 (0) | 240 (0.95) | 6 (1.36) | 10 (0.96) |
Peptic ulcer | 0 (0) | 51 (0.20) | 1 (0.23) | 0 (0) |
Neonatal diseasesa | 1 (1.20) | 578 (2.29) | 9 (2.04) | 24 (2.29) |
Hematologic diseases | ||||
Leukocyte-related disorders | 0 (0) | 141 (0.56) | 4 (0.91) | 2 (0.19) |
Neutrophilic diseases | 4 (4.82) | 1220 (4.83) | 23 (5.22) | 32 (3.06) |
Platelet disorders | 0 (0) | 104 (0.41) | 4 (0.91) | 6 (0.57) |
Hemolytic anemia | 0 (0) | 1 (0.004) | 1 (0.23) | 0 (0) |
Nutritional anemia | 1 (1.20) | 448 (1.77) | 5 (1.13) | 36 (3.44) |
Aplastic anemia | 0 (0) | 3 (0.01) | 1 (0.23) | 1 (0.10) |
Thalassemia | 0 (0) | 19 (0.08) | 0 (0) | 0 (0) |
Coagulation disorders | 0 (0) | 34 (0.13) | 2 (0.45) | 3 (0.29) |
Favism | 0 (0) | 20 (0.08) | 1 (0.23) | 0 (0) |
Langerhans cell histiocytosis | 0 (0) | 3 (0.01) | 0 (0) | 0 (0) |
Hemophagocytic syndrome | 0 (0) | 4 (0.02) | 1 (0.23) | 0 (0) |
Lymphadenoma | 0 (0) | 5 (0.02) | 0 (0) | 0 (0) |
Leukemia | 0 (0) | 12 (0.05) | 0 (0) | 0 (0) |
Circulatory system diseases | ||||
Congenital heart disease | 0 (0) | 1186 (4.69) | 13 (2.95) | 65 (6.21) |
Cardiac insufficiency | 0 (0) | 13 (0.05) | 1 (0.23) | 1 (0.10) |
Myocardial diseasesb | 23 (27.71) | 7845 (31.04) | 75 (17.01) | 115 (10.98) |
Abnormal cardiac enzymes | 0 (0) | 261 (3.33) | 2 (2.67) | 0 (0) |
Myocardial impairment | 23 (100) | 6188 (78.88) | 72 (96.00) | 84 (73.04) |
Myocarditis | 0 (0) | 22 (0.28) | 0 (0) | 2 (1.74) |
Cardiomyopathy | 0 (0) | 11(0.14) | 0 (0) | 1 (0.87) |
Heart failure | 0 (0) | 8 (0.03) | 0 (0) | 2 (0.19) |
Arrhythmia | 2 (2.41) | 95 (0.38) | 0 (0) | 3 (0.29) |
Valvar heart diseases | 0 (0) | 20 (0.08) | 0 (0) | 0 (0) |
Primary structural cardiac anomalies | 0 (0) | 7 (0.03) | 0 (0) | 1 (0.10) |
Cardio vascular diseases | 0 (0) | 19 (0.08) | 1 (0.23) | 0 (0) |
Hereditary diseases | 0 (0) | 31 (0.12) | 2 (0.45) | 0 (0) |
Nutritional diseases | ||||
Growth retardation | 1 (1.20) | 114 (0.45) | 3 (0.68) | 4 (0.38) |
Vitamin deficiency | 0 (0) | 102 (0.40) | 5 (1.13) | 3 (0.29) |
Malnutrition | 7 (8.43) | 522 (2.07) | 16 (3.63) | 29 (2.77) |
Coinfection with other pathogens
Pathogens | CV (n = 83) | RV (n = 25,274) | NV (n = 441) | ADV (n = 1047) | Total (n = 26,845) |
---|---|---|---|---|---|
Virus | |||||
EBV | 0 (0) | 253 (1.00) | 4 (0.91) | 5 (0.48) | 262 (0.98) |
HIV | 0 (0) | 2 (0.01) | 0 (0) | 0 (0) | 2 (0.01) |
HSV | 0 (0) | 29 (0.11) | 0 (0) | 1 (0.10) | 30 (0.11) |
RuV | 0 (0) | 1 (0.004) | 0 (0) | 0 (0) | 1 (0.004) |
PIV | 0 (0) | 41 (0.16) | 4 (0.91) | 0 (0) | 45 (0.17) |
HV | 0 (0) | 6 (0.02) | 0 (0) | 0 (0) | 6 (0.02) |
CMV | 1 (1.20) | 135 (0.53) | 3 (0.68) | 2 (0.19) | 141 (0.53) |
FLU | 0 (0) | 176 (0.70) | 4 (0.91) | 1 (0.10) | 181 (0.67) |
MV | 0 (0) | 3 (0.01) | 0 (0) | 0 (0) | 3 (0.01) |
VZV | 0 (0) | 6 (0.02) | 0 (0) | 0 (0) | 6 (0.02) |
RhV | 0 (0) | 2 (0.01) | 1 (0.23) | 0 (0) | 3 (0.01) |
RSV | 0 (0) | 107 (0.42) | 1 (0.23) | 2 (0.19) | 110 (0) |
SARS-CoV-2 | 0 (0) | 2 (0.01) | 0 (0) | 0 (0) | 2 (0.01) |
Bacteria | |||||
A. baumannii | 0 (0) | 1 (0.004) | 0 (0) | 0 (0) | 1 (0.004) |
E. coli | 0 (0) | 3 (0.01) | 0 (0) | 0 (0) | 3 (0.01) |
S. flexneri | 0 (0) | 1 (0.004) | 0 (0) | 0 (0) | 1 (0.004) |
S. aureus | 0 (0) | 2 (0.01) | 0 (0) | 0 (0) | 2 (0.01) |
M. tuberculosis | 0 (0) | 4 (0.02) | 0 (0) | 0 (0) | 4 (0.01) |
Legionella | 0 (0) | 26 (0.10) | 0 (0) | 1 (0.10) | 27 (0.10) |
S. pneumoniae | 0 (0) | 15 (0.06) | 1 (0.23) | 0 (0) | 16 (0.06) |
S. aureus | 0 (0) | 9 (0.04) | 0 (0) | 1 (0.10) | 10 (0.04) |
Salmonellaa | 0 (0) | 38 (0.15) | 2 (0.45) | 6 (0.57) | 46 (0.17) |
H. influenzae | 0 (0) | 15 (0.06) | 0 (0) | 0 (0) | 15 (0.06) |
B. pertussis | 0 (0) | 6 (0.02) | 0 (0) | 1 (0.10) | 7 (0.03) |
H. pylori | 0 (0) | 11 (0.04) | 0 (0) | 0 (0) | 11 (0.04) |
Unknown bacteria | 0 (0) | 32 (0.13) | 1 (0.23) | 0 (0) | 33 (0.12) |
Fungi and other pathogens | |||||
C. albicans | 0 (0) | 119 (0.47) | 8 (1.81) | 2 (0.19) | 129 (0.48) |
Unknown fungi | 0 (0) | 5 (0.02) | 0 (0) | 1 (0.10) | 6 (0.02) |
A. lumbricoides | 0 (0) | 7 (0.03) | 0 (0) | 1 (0.10) | 8 (0.03) |
M. pneumoniae | 0 (0) | 507 (2.01) | 10 (2.27) | 6 (0.57) | 523 (1.95) |
C. pneumoniae | 0 (0) | 51 (0.20) | 0 (0) | 0 (0) | 51 (0.19) |
TP | 0 (0) | 1 (0.004) | 0 (0) | 0 (0) | 1 (0.004) |
Complications
Characteristic | Dehydration (n, %) | Electrolyte disorders (n, %) | Acidosis (n, %) | Shock (n, %) | Total (n, %) |
---|---|---|---|---|---|
Age group | |||||
≤ 28 days | 101(13.78)a | 22(3.00)a | 113 (15.42)a | 2(0.27) | 733 |
28 days < ~ ≤ 1 years old | 7491(42.65)b | 1944(11.07)b | 5726(32.60)b | 34(0.19) | 17,563 |
1 < ~ ≤ 3 years old | 3481 (39.54)c | 1191(13.53)c | 2388(27.13)c | 15(0.17) | 8803 |
3 < ~ ≤ 6 years old | 326(33.99)d | 119(12.41)b,c | 226(23.57)d | 1 (0.10) | 959 |
6 < ~ ≤ 12 years old | 26(20.97)e | 20(16.13)b,c | 13(10.48)a | 0(0.00) | 124 |
> 12 years old | 1(14.29)a,b,c,d,e | 0(0.00)a,b,c | 2(28.57)a,b,c,d | 0(0.00) | 7 |
χ2 | 292.674 | 92.778 | 206.708 | 1.062 | |
P value | < 0.001 | < 0.001 | < 0.001 | 0.975 | |
Etiology | |||||
CV | 11(13.25) | 6(7.23)a,b | 3 (3.61) | 1(1.20) | 83 |
RV | 10,455(41.37) | 3040(12.03)b | 7670(30.35)a | 43(0.17) | 25,274 |
NV | 226 (51.25) | 45(10.20)b | 134(30.39)a,b | 1 (0.23) | 441 |
ADV | 327(31.23)a | 112(10.70)b | 359(34.29)b | 4(0.38) | 1047 |
Not clear | 407(30.28)a | 93(6.92)a | 302 (22.47) | 3(0.22) | 1344 |
χ2 | 150.075 | 35.962 | 74.377 | 7.347 | |
P value | < 0.001 | < 0.001 | < 0.001 | 0.119 |
LOS, hospitalization expense, discharge and outcome
Characteristic | Length of stay (days) | Cost (US dollars) | χ2 | P value |
---|---|---|---|---|
Total | 5(3–6) | 587(541–642) | ||
Age group | 242.05/505.92 | < 0.0001 | ||
≤ 28 days | 5(4–7)a | 758(555–1035)a | ||
28 days < ~ ≤ 1 years old | 5(4–6)a,b | 561(390–778)b | ||
1 < ~ ≤ 3 years old | 5(4–6)c | 515(371–703)c | ||
3 < ~ ≤ 6 years old | 4(3–6)d | 515(353–695)c | ||
6 < ~ ≤ 12 years old | 4(3–6)c,d | 548(365–740)b,c | ||
> 12 years old | 6(5–8)a,b,c,d | 810(366–1226)a,b,c | ||
Regions | 688.09/2,436.03 | < 0.0001 | ||
Northeast | 5(4–6)a | 566(448–733)a | ||
North China | 5(4–6)a | 643(477–876) | ||
East China | 5(4–6) | 473(347–641) | ||
South China | 4(3–5) | 379(279–536) | ||
Central China | 5(4–7)a | 442(324–632) | ||
Northwest | 5(3–6) | 659(450–844) | ||
Southwest | 5(4–6) | 562(426–736)a | ||
Etiology | 76.76/170.92 | < 0.0001 | ||
CV | 5(3–6)a,b,c,d,e | 541(435–691)a,b,c,d,e | ||
RV | 5(4–6)b,d | 541(379–751)b | ||
NV | 5(4–6)c | 627(468–835)a,c,d,e | ||
ADV | 5(3–6)d | 642(453–835)a,c,d,e | ||
Not clear | 4(3–6)e | 586(435–811)a,c,d,e |