Abstract
BackgroundAsthma is one of the leading causes of emergency department visits and school absenteeism among school-aged children in the United States, but there is significant local-area variation in emergency department visit rates, as well as significant differences across racial-ethnic groups.AnalysisWe first calculated emergency department (ED) visit rates among Medicaid-enrolled children age 5–12 with asthma using a multi-state dataset. We then performed exploratory factor analysis using over 226 variables to assess whether they clustered around three county-level conceptual factors (socioeconomic status, healthcare capacity, and air quality) thought to be associated with variation in asthma ED visit rates. Measured variables (including ED visit rate as the outcome of interest) were then standardized and tested in a simple conceptual model through confirmatory factor analysis.ResultsCounty-level (contextual) variables did cluster around factors declared a priori in the conceptual model. Structural equation models connecting the ED visit rates to socioeconomic status, air quality, and healthcare system professional capacity factors (consistent with our conceptual framework) converged on a solution and achieved a reasonable goodness of fit on confirmatory factor analysis.ConclusionConfirmatory factor analysis offers an approach for quantitatively testing conceptual models of local-area variation and racial disparities in asthma-related emergency department use.
Highlights
Asthma is one of the most common chronic childhood diseases in the United States, affecting approximately 7 million children [1]
The rate of children age 5–17 in family poverty and unemployment rate, significantly contributed to the latent variable, socioeconomic status (SES); pediatric physicians per 100 thousand children and total physicians per 100,000 population significantly contributed to the latent variable, health systems and median air quality index significantly contributed to the latent variable, air quality
Our findings confirm that asthma emergency department (ED) visit rates are associated with a complex mix of variables, and that our conceptual models of local-area variation in asthma ED visit rates can be quantitatively measured for goodness of fit against real-world data
Summary
Asthma is one of the most common chronic childhood diseases in the United States, affecting approximately 7 million children [1]. It is one of the leading causes of emergency department (ED) visits and school absenteeism among school-age children [2,3], and is a significant cause of preventable hospitalizations and even death when poorly managed [4]. Asthma is one of the leading causes of emergency department visits and school absenteeism among school-aged children in the United States, but there is significant local-area variation in emergency department visit rates, as well as significant differences across racial-ethnic groups. Measured variables (including ED visit rate as the outcome of interest) were standardized and tested in a simple conceptual model through confirmatory factor analysis
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