Asthma Hospitalization Rates Research Articles

Childhood asthma along the United States/Mexico border: hospitalizations and air quality in two California counties.

Since the passage of the North American Free Trade Agreement in 1993, there has been an increasing need to monitor environmental health trends that may be related to the rapid industrialization of the United States/Mexico border. We studied two counties on the California/Baja California border to obtain baseline data on trends in childhood asthma hospitalizations and two pollutants that aggravate asthma, ozone and particulate matter (less than 10 microns in diameter), from 1983 to 1994. Hospital discharge records of children 14 years and younger were analyzed, and rates by county, race, and sex were age-adjusted to the 1990 California population. Data on five ozone and particulate matter indices obtained from the California Environmental Protection Agency were used. Imperial County had the highest childhood asthma hospitalization rates in California for non-Hispanic whites and African-Americans, and the second highest for Hispanics. San Diego County had rates below the state average. Over the time period examined, rates in Imperial County increased 59%, while those in San Diego County decreased 9%. Maximum ozone levels increased 64% in Imperial County but decreased 46% in San Diego County. Particulate matter levels were four times higher in Imperial than in San Diego County. High rates of childhood asthma hospitalizations in Imperial County may be partially related to high levels of poverty and worsening air quality conditions produced by increased burdens on the local airshed. Asthma prevalence surveys and binational time-series analyses examining asthma-pollutant relationships are needed.

Race, Income, Urbanicity, and Asthma Hospitalization in California: A Small Area Analysis

To explicate the interrelationship between asthma hospitalization and race/ethnicity and income.Small area ecologic analysis using census and administrative data.All asthma hospitalizations in California were identified using the 1993 California Hospital Discharge file. Small area analyses of Los Angeles (LA) were compared with published rates in New York City (NYC).In 1993, the age-adjusted asthma hospitalization rate in California for nonelderly blacks was 42.5/10,000-approximately four times higher than other populations. Black rates remained fourfold higher after stratification by age, income, and urbanicity. Multivariate analyses suggest that the association between black race and asthma hospitalization is independent of income. Regardless of race, children and persons living in poverty were at increased risk for asthma hospitalization. Urbanicity was not a predictor for asthma hospitalization. Overall, asthma hospitalization rates in NYC were 2.8 times higher compared with rates in LA; while rates were similar among blacks (60 vs 40/10,000, respectively), Puerto Rican Hispanics in NYC had dramatically higher rates compared with Mexican Hispanics in LA (63 vs 14/10,000, respectively).After controlling for socioeconomic status, notable differences in asthma hospitalization by race and ethnicity persist. The reasons for the significantly elevated risk of asthma morbidity among blacks remain unclear.

Variations in hospitalization rates for asthma among Black and minority ethnic communities

In response to the introduction of ethnic monitoring within the U.K. hospital inpatient data set, this study investigates the variations in secondary healthcare utilization by Black and minority ethnic communities whose cause of admission is related to asthma. The study examines all residents of the West Midlands: over 5 million people, of whom 8·5% are from Black and minority ethnic groups. A retrospective study of 15 921 asthma-related hospital admissions, from 1 April 1995 to 31 March 1996, was carried out. Age-standardized admission rates were higher in all Black and minority ethnic groups studied than in the White group. There were elevated rates in Black children aged 5–14 years, and particular differences were observed for Indian and Bangladeshi men and women aged 65 years or over. Emergency admissions to hospital for asthma were strongly associated with patients' socioeconomic background but this was largely observed for Black and minority ethnic groups that also generally experience high levels of deprivation. The findings support previous studies which suggest that hospital utilization rates for asthma among people from Black and minority ethnic groups are high compared with the White group, despite little evidence in measured prevalence. This study suggests that ethnic background is more important in asthma admissions than deprivation, which raises serious concerns on the appropriateness and quality of asthma care for these patient groups within our society. Future studies need to examine pathways to care, that is the health-seeking behaviour of Black and minority ethnic groups, the type of treatment received at the primary care level and referral patterns to secondary care.

Asthmatic Children Treated in School: A Population-Based Survey† 583

Background: Asthma is the leading chronic illness in school-aged children. A community-based initiative to improve the care and school performance of children with chronic health problems was developed in E. Virginia as a partnership of public schools and health care providers. This study is part of a needs assessment to guide policy and programs for school-aged children. Study population: School children residing in Portsmouth and VA Beach, proximal cities in E. VA. Compared to VA Beach, Portsmouth has more child poverty (27% vs. 8%); black pop. (57% vs 16%); and school drop-outs (16% vs. 9%). Objective: To describe the pattern of asthma medication use in public schools compared to asthma hospitalization rates in school-aged children. Methods: School health databases developed for Portsmouth and VA Beach school districts included all students enrolled in 1995. The databases identified students administered asthma medication in school, their age, grade, race and gender. The 1995 Virginia Health Information dataset was used to analyze all hospitalizations for asthma among school-aged children (6-17 yrs) residing in the study cities.Results: In Portsmouth, 7.8% of students (N=15,489) received medication for asthma while in school; increasing slightly between grade school (6-10 yr olds; 7.4%) and middle/high school (11-17 yr olds; 8.2%). Administration of asthma medication in school occurred significantly(P<.05) more often among male (8.8%) than female (6.8%) and black (8.6%) than white (6.6%) students. In VA Beach, 3.5% of students (N=87,947) received medication for asthma while in school; decreasing slightly between grade school (3.8%) and middle /high school students (3.3%). Male gender and black race were significantly associated with increased asthma medication usage in VA Beach schools. The asthma hospitalization rate was 4.8 per 1000 school-aged children in Portsmouth compared to 0.8 per 1000 school-aged children in VA Beach. Risk of hospitalization compared to asthma medication use in schools was significantly higher for male and black students in both school districts.Conclusions: Treatment of asthma in school occurs relatively often in low-income, predominantly black urban areas. Such data are needed to focus local school health resources and to guide development of health care policy aimed toward improving care delivery to pediatric at-risk populations.

Effect of a Pediatric Observation Unit on the Rate of Hospitalization for Asthma

Study objective: To determine the asthma admission rate and the rate of repeat visits to the emergency department for asthma within 72 hours before and after the introduction of an observation unit (OU). When necessary, admission to the ward from the OU is usually made within 12 hours. Methods: We conducted a before-and-after study with retrospective data collection in an urban tertiary care pediatric ED. Our subjects were patients aged 1 to 18 years who presented to the ED with asthma. The pre-OU group comprised patients seen between July 1, 1991, and June 30, 1992, before the opening of the OU. The post-OU group consisted of children seen between July 1, 1993, and June 30, 1994, after the opening of the OU. Results: The pre- and post-OU groups had 1,979 and 2,248 asthma visits, respectively. The admission rate decreased from 31% in the pre-OU group to 24% in the post-OU group ( P<.01). The frequency of inpatient admissions of less than 24 hours decreased from 17% in the pre-OU group to 10% in the post-OU group ( P≤.01). The rate of repeat ED visits within 72 hours was 3% in the pre-OU group and 5% in the post-OU group ( P=.01). Conclusion: The use of an OU in the ED was associated with a reduction in the hospitalization rate for children with acute asthma exacerbation. However, we also noted an increased rate of repeat visits to the ED after the introduction of the OU. [Gouin S, Macarthur C, Parkin PC, Schuh S: Effect of a pediatric observation unit on the rate of hospitalization for asthma. Ann Emerg Med February 1997;29:218-222.]

Seasonal Patterns in Asthma Hospitalization in Saaskatchewan, 1979 to 1989

OBJECTIVES: To determine whether monthly asthma hospitalization rates in Saskatchewan exhibited a seasonal pattern. Rates were studied from January 1979 to December 1989.PATIENTS: The age groups studied were aged birth to four years, aged five to 14 years, 15 to 34 years, 35 to 49 years and 50 to 65 years. Sex differences in seasonal patterns in asthma hospitalization rates were also investigated.METHODS: The hospitalization data for asthma were obtained for the province of Saskatchewan from 1979 to 1989, inclusive. The time series was decomposed into its trend, seasonal and error component, using an additive model. Significance of the components was tested using a two-way ANOVA.RESULTS: Seasonal variations were observed in the monthly asthma hospitalization rates among Saskatchewan residents. Increases in asthma hospitalization rates were observed in the spring and fall months among children, in summer months among young adults aged 15 to 34 years and in winter months among the older age groups. Seasonal patterns in asthma hospitalization rates were similar for males and females in children and in adults aged 50 to 64 years. In young adults aged 15 to 34 years, increased asthma hospitalization rates were observed in spring months among men and in both spring and fall months among women. The 35- to 49-year-old men did not exhibit a statistically significant seasonal pattern, whereas the women did. No sex differences in seasonal patterns of asthma hospitalization rates were statistically significant.CONCLUSIONS: Seasonal patterns were observed in asthma hospitalization rates for residents of Saskatchewan. Asthma hospitalizations were greater in spring and fall seasons for children and in winter for the older adults. More studies are required to examine possible reasons for these seasonal differences in asthma hospitalizations.

Factors associated with pediatric asthma readmissions

Hospitalization rates for childhood asthma have increased steadily over the past 20 years.1 It is unclear whether this increase represents a change in disease prevalence, severity, or health care utilization. Readmissions contribute substantially to this burden, with up to half of all admissions for treatment of asthma representing repeat admissions.2 The objective of this study was to determine the factors associated with pediatric asthma readmission.

New Asthma Efforts in The Bronx

Research ArticleOpen AccessNew asthma efforts in the Bronx. L Claudio L Claudio Search for more papers by this author Published:1 October 1996https://doi.org/10.1289/ehp.961041028Cited by:3AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit "New asthma efforts in the Bronx.." Environmental Health Perspectives, 104(10), pp. 1028–1029FiguresReferencesRelatedDetailsCited by O'Sullivan B, Lafleur J, Fridal K, Hormozdi S, Schwartz S, Belt M and Finkel M (2005) The effect of pesticide spraying on the rate and severity of ED asthma, The American Journal of Emergency Medicine, 10.1016/j.ajem.2004.12.017, 23:4, (463-467), Online publication date: 1-Jul-2005. Claudio L, Tulton L, Doucette J and Landrigan P (2009) Socioeconomic Factors and Asthma Hospitalization Rates in New York City, Journal of Asthma, 10.3109/02770909909068227, 36:4, (343-350), Online publication date: 1-Jan-1999. Claudio L, Torres T, Sanjurjo E, Sherman L and Landrigan P (2018) Environmental health sciences education--a tool for achieving environmental equity and protecting children., Environmental Health Perspectives, 106:suppl 3, (849-855), Online publication date: 1-Jun-1998. Vol. 104, No. 10 October 1996Metrics About Article Metrics Publication History Originally published1 October 1996Published in print1 October 1996 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Does Quality of Care Affect Rates of Hospitalization for Childhood Asthma?

Hospitalization rates for childhood asthma are three times as high in Boston, Massachusetts, as in Rochester, New York; New Haven, Connecticut, rates are intermediate. We undertook this study to determine how care for children admitted for asthma varies across these communities. We performed a community-wide retrospective chart review. We reviewed a random sample of all asthma hospitalizations, from 1988 to 1990, of children 2 to 12 years old living in these communities (n = 614). Abstracted data included demographics, illness severity, and treatment before admission. Compared with Rochester children, Boston children were less likely to have received maintenance preventive therapy (inhaled corticosteroids or cromolyn [odds ratio (OR), 0.4 (0.2, 0.9)]), acute "rescue" therapy (oral corticosteroids [OR, 0.2 (0.1, 0.4)]), or inhaled beta-agonist therapy [OR, 0.5 (0.3, 1.0)]. A larger proportion of admitted asthmatic patients in Boston (34%) were in the least severely ill group-oxygen saturation 95% or above-compared with patients in Rochester (20%). The quality of ambulatory care, including choice of preventive therapies and thresholds for admission, likely plays a key role in determining community hospitalization rates for chronic conditions such as childhood asthma.

Increased asthma hospitalizations among registered Indian children and adults in Saskatchewan, 1970–1989

We investigated asthma morbidity in children and adults among Registered Indians in Saskatchewan using hospitalization data for 1970–1989. In Registered Indians, significant increases were observed in the asthma hospitalization rates from 1979 to 1989 in boys and girls under 4 years, boys aged 5–14 years, and female adults aged 15–34 years respectively. In children under 4 years, the asthma hospitalization rates increased from 12.7 per 1000 in 1979 to 21.7 per 1000 in 1989. Asthma hospitalizations were higher among Indian boys than girls in the age group 0–4 years but this was reversed in the age groups 15–34 and 35–64 years. When compared with other Saskatchewan populations, the Indian population in age groups 0–4 and 35–64 years had significantly increased risk for hospitalization for asthma. Even though asthma was reported to be rare among Indians before 1975, we observed increases in asthma morbidity in recent years among Indian children and young adults.

Poverty, Race, and Medication Use Are Correlates of Asthma Hospitalization Rates: A Small Area Analysis in Boston

Hospitalization rates for asthma in New York City are highest in poor urban neighborhoods, although the reasons for this are unknown. We performed a small area analysis of asthma hospitalization rates in Boston, to determine whether this pattern of asthma hospitalization also obtained in a medium-sized city and to identify characteristics of neighborhoods with high hospitalization rates, including the relative use of inhaled anti-inflammatory medication. Zip codes were used to define 22 small areas within Boston. The number of asthma hospitalizations for residents of each area in 1992 was obtained from the Codman Research Group. Population and demographic characteristics of each area were obtained from the 1990 US Census. Estimates of inhaled asthma medications (beta-agonists, steroids, and cromolyn) dispensed in each area in 1992 were obtained from IMS America. Asthma hospitalization rates for each of the six areas with the highest rates (5.3 to 9.8 per 1,000 persons) were significantly greater than the city-wide average of 4.2 hospitalizations per thousand persons (p < 0.001 for each comparison). Asthma hospitalization rate was positively correlated with poverty rate and with the proportion of nonwhite residents and inversely correlated with income and educational attainment. Asthma hospitalization rate was inversely correlated with the ratio of inhaled anti-inflammatory to beta-agonist medication use (r = -0.55, p = 0.008). We conclude that asthma hospitalization rates in Boston are highest in poor inner city neighborhoods, and that these high rates affect both genders and all age groups. Underuse of inhaled anti-inflammatory medication may be one of the many factors that contributes to this excess hospitalization.

Exposure of children to pollutants in house dust and indoor air.

This review summarizes occurrence and exposure studies for pollutants in house dust and related indoor air exposures. A standard sampling method and control methods to reduce these exposures are discussed, including recommendations for future research. Infants and toddlers receive a broad and significant range of exposures to lead, pesticides, PAHs, allergens, and VOCs in house dust and indoor air. Carpet dust in eight Columbus and nine Seattle homes contained concentrations of potentially carcinogenic PAHs ranging from 3 to 290 micrograms/g, of lead from 250 to 2250 micrograms/g, and of PCBs from 210 to 1900 ng/g. Dust collected from ten used sofas in Seattle averaged 16.3, 37.2, and 229 micrograms/g for dust mite allergen, cat allergen, and lead, respectively; dust samples showed mutagenic activity. Biological and chemical pollutants in indoor dust and air have been associated with lead poisoning, cancer, allergy, asthma, damage to the nervous system, and sick building symptoms. The 11% of toddlers who have pica tend to have the highest exposures and risks. Further, the exposure of toddlers to lead via the dust pathway can be greater than by other routes. Standard method ASTM 5438.94 for sampling house dust has been used to characterize current and chronic exposure of toddlers in epidemiological studies. The accumulation of dust, dust mites, and tracked-in soil in old carpets, sofas, and mattresses appears to be a major source of exposure to lead, pesticides, allergens, PAHs, and VOCs. Remodeling and energy conservation can reduce ventilation and increase relative humidity, dust, dust mites, molds, VOCs, and other indoor air pollutants. The U.S. faces large and increasing costs from asthma and allergy. Asthma incidence in the U.S. has increased from 0.5% in 1930 to 8%-12% in 1991. Asthma hospitalization rates for children are increasing at the rate of 4%/yr in the U.S. and 14%/yr in Seattle. Such hospital visits would be rare with effective diagnosis, patient education, and control of home exposures. Asthma was estimated to cost $6.2 billion in 1990; hospital visits of children in Seattle cost $2,526,000 in 1993. Forty percent of the U.S. population has been sensitized to allergens; one in three homes has high relative humidity, which favors dust mites, molds, allergies, asthma, and other respiratory diseases. Reducing indoor allergens can reduce costs, severity, and the risk of being sensitized and developing allergic disease. Use of volunteer Master Home Environmentalists to do free in-home surveys and education in Seattle may reduce immediate health costs from allergens as well as long-term risks from lead, carcinogens, and home chemicals.(ABSTRACT TRUNCATED AT 400 WORDS)

Characteristics of Hospitalization for Asthma Among Persons Less than 35 Years of Age in Chicago

Mortality from asthma in Chicago is among the highest in the nation for 5-34-year-olds. Data for all hospitalizations among Chicago residents less than 35 years of age were examined to define characteristics that may be contributing to morbidity and mortality from asthma. From 1987 through 1989, the average annual age-adjusted hospitalization rate among persons less than 35 years of age in Chicago was 3.57 per 1000 persons. There were significant associations of community hospitalization rate with median income (r = -0.61, p < 0.001) and with proportion of community asthma hospitalizations using Medicaid, Medicare, or self-payment (r = 0.69, p < 0.001). Among 18-34-year-old men, asthma hospitalization rates for Medicaid recipients were 17.4-34.1-fold higher than among men using other forms of insurance. Asthma admissions using Medicaid, Medicare, or self-payment were more likely than those using other forms of insurance to present through the emergency department (79.3% and 66.4%, respectively, p < 0.001) and be discharged against medical advice (1.8% vs. 0.7%, respectively, p < 0.001). These data suggest that differential access to or utilization of health care may be contributing to asthma morbidity in Chicago.

Trends and Rural-Urban Differences in Asthma Hospitalizations in Saskatchewan 1970-1989

OBJECTIVE: To examine the trends in hospitalization rates for atsthma in Saskatchewan from 1970 to 1989 and to investigate the differences in asthma hospitalization rates between rural and urban dwellers.DESIGN: Asthma hospitalization rates were calculated for the age groups O to 4, 5 to 9. 10 to 14, 15 to 24. 25 to 34. 35 to 49 and 50 to 64 years for the period between 1970 and 1989. Only the first admission in each year for each person was included in the analysis. As the classification of asthma changed in 1978. trends in asthma hospitalization rates were investigated separately for the periods 1970 to 1978 and 1979 to 1989. respectively. Rate ratios were obtained for male/female and rural/urban comparisons by fitting Poisson regression models.SETTING: The hospitalization data for respiratory diseases for the province of Saskatchewan were examined by age group, sex and place or residence.RESULT: No significant increases were observed in asthma hospitalization rates lrorn 1970 to 1978. In the period 1979 to 1989. asthma hospitalization rates increased significantly among children under four years from 4.31/1000 in 1979 to 7.04/1000 in 1989. Among children under 14 years. asthma hospitalization rates were greater in boys than in girls . The converse was true for adults aged 15 and above, with women having a higher hospitalization rate for asthma than men . In adults aged 35 and above. rural dwellers had higher hospitalization rates for asthma than urban dwellers throughout the study period. In other age groups, although rural dwellers had higher asthma hospitalization rates than did urban dwellers during 1970 to 1984. the differences disappered duri ng 1985 to 1989.CONCLUSION: Further studies are required to find reasons for the increase in asthma hospitalizations among young children under four years old and for the differences between rural and urban dwellers in the age group 35 years and above.

Temporal Trends in Hospital-based Episodes of Asthma Care in a Health Maintenance Organization

Studies reporting increased asthma hospitalizations and mortality in the United States and abroad have heightened concern about the changing epidemiology of asthma. We studied 20-yr patterns of acute asthma care occurring at two large community hospitals among members of a large health maintenance organization. The presentation focuses on the conceptualization and operationalization of an "episode" of asthma care, defined as a collection of encounters (emergency room visits, urgency care visits, and hospital admissions) that cluster in time, as well as on changes in episode rates over time. We found a statistically significant increase in asthma episodes among boys younger than 5 yr of age that continued unabated from 1967 to 1987 despite a drop in asthma hospitalization rates starting in 1985. We hypothesize that this difference may reflect a change in emergency room management practices and not a true change in the underlying epidemiology of asthma. The concept of an episode of acute asthma care has not been studied in the literature and represents a potentially useful methodologic innovation. Particularly in the context of managed health care systems, studies of such episodes may be less sensitive than studies of hospital admissions to changes in the organization and delivery of acute asthma care, and thus may be better suited for studying changes in the epidemiology of asthma.

Effect of Racial and Socioeconomic Factors on Asthma Mortality in Chicago

Asthma is a chronic disease affecting nearly 10 million persons1 and leading to 500,000 hospitalizations annually.2 During the 1980s, mortality from asthma in the United States increased by 6% per year.3 Weiss et al3,4 previously noted that Cook County, Illinois has one of the highest mortality rates from asthma in the country, with most of the deaths occurring within the city of Chicago. Several studies have found that asthma mortality and hospitalization rates in general are greater among nonwhites5,6 and persons with low income,7,8 with possible explanations for the racial and socioeconomic differences in asthma rates including differential access to care, exposure to environmental pollutants, and crowded conditions leading to increased exposure to allergens and infections.

Variations in asthma hospitalizations and deaths in New York City.

Recent reports have identified New York City as having asthma mortality rates that are substantially higher than expected based on US rates. This study investigates the problems of asthma morbidity and mortality in New York City. Data on asthma hospitalizations (1982 to 1986) and deaths (1982 to 1987) among persons aged 0 to 34 years were studied. Descriptive and multivariate techniques were used to examine differences in rates among subgroups and across geographic areas. The average annual hospitalization rate was 39.2 per 10,000; the mortality rate was 1.2 per 100,000. Hospitalization and death rates among Blacks and Hispanics were 3 to 5.5 times those of Whites. Large geographic variations in hospitalizations and mortality occurred. Asthma hospitalization and mortality rates were highly correlated (r = .67), with the highest rates concentrated in the city's poorest neighborhoods. Household income, percentage of population Black, and percentage of population Hispanic were significant predictors of area hospitalization rates (adjusted R2 = .75). These findings provide a basis for focusing investigations of the causes of variations in asthma outcomes and targeting interventions to reduce the disproportionate morbidity and mortality borne by poor and minority populations.

National Trends in the Morbidity and Mortality of Asthma in the US: Prevalence, Hospitalization and Death from Asthma Over Two Decades: 1965–1984

National population-based data systems of the National Center for Health Statistics (NCHS) were used to study the epidemiology of asthma in the United States over the last 20 years. Asthma is more prevalent among males, those living below the poverty level, persons living in the South and West, and blacks; however, this difference did not attain statistical significance. Death rates from asthma among the older age groups probably increased between 1968 and 1982, with a substantial increase since 1979. For children, the evidence is less clear, but the death rate has increased for children over five years of age during the period from 1979 to 1982. Between 1964 and 1980, asthma has become more prevalent in children under 17 years of age, but this does not reflect an increase in the severity of asthma over this same time period. Hospitalization rates for asthma between 1965 and 1983 increased by 50 percent in adults and by over 200 percent in children. Rates for black patients are 50 percent higher in adults and 150 percent greater in children. It is concluded that there has been a marked increase in hospitalization rates for asthma, a moderate increase in death rates from asthma and a smaller increase in overall prevalence of the disease in the United States.

Recent observations on increases in morbidity and mortality from asthma.

There are nearly 20 million persons in the United States suffering from asthma. Nearly 5 million of these are children. This represents an increase in the prevalence of the condition in the past twenty years. In the same time period hospitalization rates for asthma have increased dramatically in the pediatric and adult population. Of greater concern, is a significant increase of deaths due to asthma in the past eight years.

Childhood asthma hospitalization rates in Spokane County, Washington: impact of volcanic ash air pollution.

Childhood asthma hospitalization rates in Spokane County, Washington: impact of volcanic ash air pollution.