Paediatric asthma hospital utilization varies by demographic factors and area socio-economic status

J Largent,B Nickerson,D Cooper,R.J Delfino

doi:10.1016/j.puhe.2012.04.011

Abstract

Associations of emergency department (ED) visits and hospital admissions for asthma in children with demographics and area socio-economic status (SES) were examined to evaluate long-term trends and identify vulnerable populations. Retrospective population-based trend and cross-sectional analyses. Asthma hospital admissions (2000-2007) and ED visits (2005-2007) for children aged 0-14 years living in Orange County, California were linked with zip-code-level SES data (2000 US Census). Annual population estimates were obtained to calculate age-specific admissions and ED visit rates. Average annual percentage changes (AAPC) were calculated with joinpoint analyses. The risks of ED visits and hospital admissions were estimated from SES indicators with negative binomial regression. Rates of asthma hospital admissions and ED visits were highest among children aged 0-4 years, males and African Americans, and lowest among Asian/Pacific Islanders. African Americans and Hispanics/Latinos were more likely to be uninsured. Asthma admissions decreased significantly for all age groups over the study period. The greatest declines per 100,000 were among children aged 0-4 years (AAPC: -15.3%, 95% confidence interval -17.0% to -13.4%). Rates of hospital admissions and ED visits were significantly higher in low-SES groups. Hospital admission rates were 30-60% higher and ED visits were 80-90% higher in zip codes in the lowest tertile of median household income compared with the highest tertile of median household income. Paediatric asthma hospitalizations and ED visit rates are declining in Orange County. However, certain groups are disproportionately affected, including those living in areas with low SES. This information will help in targeting intervention strategies to children at highest risk for severe asthma episodes.

Highlights

Asthma was estimated to affect 6.5 million children in the USA in 20051 and to account for 12.8 million missed school days in 2003, according to a national survey.[2]
The highest admission rate per 100,000 people was found among African Americans, and the smallest admission rate per 100,000 people was found among Asians and Pacific Islanders, who were at least as well insured as non-Hispanic Whites
An analysis of the National Health Interview Survey suggested that the higher risk among African Americans is due to socioeconomic influences rather than genetic variation, because the risk differences in prevalence of childhood asthma were only seen among poorer African American families.[12]

Summary

Introduction

Asthma was estimated to affect 6.5 million children in the USA in 20051 and to account for 12.8 million missed school days in 2003, according to a national survey.[2].

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Methods

Results

Conclusion