Health consequences of breast-feeding - Doctors' visits and hospitalizations during the first 18 months of life in Hong Kong Chinese infants

Background: The evidence on whether breast-feeding reduces health services use in nonwhite infants is scant. We examined the effects of breast-feeding on health services utilization in Hong Kong Chinese infants. Methods: We followed a population-based cohort of 8327 infants born in 1997 for 18 months. The main outcome measures were higher (above the sample mean) utilization of outpatient visits and hospitalizations for jaundice, gastrointestinal or respiratory/febrile illnesses, and all illnesses. Results: Breast-fed infants had fewer illness-related doctor visits overall through the first 18 months of life. Results were strongest for infants breast fed exclusively for 2 to 3 months (odds ratio [OR] for higher utilization = 0.78; 95% confidence interval [CI] = 0.62-0.99) and for 4 or more months (0.65; 0.53-0.81). However, breast-fed infants were more likely to receive outpatient care for jaundice, particularly in the first 3 months of life (ORs ranging from 2.5 to 8.4). Any breast-feeding was also associated with more jaundice-related hospital admissions, the effects of which were most acute in the first 3 months of life. Compared with exclusively formula-fed infants, the OR (CI) for mixed breast- and formula-fed was 2.4 (1.7-3.5); for exclusive breast-feeding up to 1 month, 4.5 (2.7-7.6); for exclusive breast-feeding 2 to 3 months, 3.2 (1.8-5.7); and for exclusive breast-feeding 4 or more months, 3.4 (2.0-5.7). Conclusions: Breast-feeding in Hong Kong Chinese infants reduces doctor visits overall, but increases both outpatient visits and hospitalizations for jaundice.