Background: HUS is a severe syndrome that imposes a substantial burden on patients and their families, furthermore, it's the leading cause of acute kidney failure in children. However, data on the epidemiology and disease burden of HUS are limited in Asia, including in China. We aimed to estimate the incidence and cost of HUS in China.Methods: Data on HUS from 2012 to 2016 were extracted from the databases of the Urban Employee Basic Medical Insurance (UEBMI) and the Urban Resident Basic

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... Insurance (URBMI). All cases were identified by the ICD code and Chinese diagnostic terms. The national incidence rates in 2016 were estimated and stratified by sex, age and season; the associated medical costs were also calculated. Results: The crude incidence was 0.66 per 100,000 person-years (95% CI: 0.57 to 1.06), and the standardized incidence was 0.57 (0.19 to 1.18). The highest incidence was observed in patients younger than 1 year old (5.08,95% CI: 0.23 to24.87). Meanwhile, the incidence was 0.38 per 100,000 person-years (95% CI: 0.13 to 0.75) in patients younger than 5 years old, and 0.29 per 100,000 person-years (95% CI: 0.09 to 0.57) in patients younger than 18 years old. The season with the highest incidence was autumn, followed by winter. The average cost was 1.75 thousand US dollars per patient, which was higher than the national average cost for all inpatients in the same period. Conclusions: The incidence of HUS in our study was lower than those in the most developed countries, and with different age and season distribution in incidence, which may suggest that the cause of HUS in China may be different from that elsewhere. Due to insufficient knowledge of physicians and lacking laboratory facilities required for an accurate diagnosis, the incidence rate of HUS may be underestimated. In view of the healthcare economic burden of HUS, further analyses and supports are needed in the future.