Burden of diarrhoeal diseases among hospitalised patients in Thailand: a retrospective national database analysis (2014-2022).

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.