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Do rural and urban children have comparable asthma care utilization?
B P Yawn1, A G Mainous, M M Love
1Department of Research, Olmsted Medical Center, 210 Ninth St. S.E., Rochester, MN 55904, USA. yawnx002@tc.umn.edu
Insights
Rural and urban Kentucky children experienced different asthma care patterns in 1995. Urban children accessed specialists and emergency care more frequently, while rural children received different inhaled asthma medications.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Asthma is a significant chronic respiratory disease in childhood.
- Understanding geographic disparities in pediatric asthma care is crucial for public health.
- Kentucky's diverse rural and urban landscape presents unique challenges for healthcare access.
Purpose of the Study:
- To compare asthma-related healthcare utilization and pharmacotherapy between rural and nonrural children in Kentucky.
- To identify potential disparities in asthma management based on geographic location.
- To inform targeted interventions for improving pediatric asthma care in underserved areas.
Main Methods:
- Retrospective analysis of Medicaid-insured children with asthma in Kentucky (1995).
- Comparison of healthcare visit types (office, emergency department, specialist) and medication use (oral steroids, inhaled anti-inflammatories).
- Statistical analysis to determine significant differences between rural and urban populations.
Main Results:
- Urban children were twice as likely to see asthma specialists compared to rural children (5% vs. 2.5%).
- Urban children were 2.7 times more likely to receive asthma care in emergency departments (19% vs. 7%).
- Differences observed in inhaled anti-inflammatory prescribing patterns: rural children favored inhaled steroids, urban children favored cromolynes.
Conclusions:
- Significant geographic variations exist in the patterns of asthma care for Kentucky children.
- Urban children utilized specialist and emergency services more frequently, suggesting potential access or severity differences.
- Tailored strategies may be needed to address rural-urban disparities in pediatric asthma management and medication choices.
Abstract:
This study compares asthma-related health care visits and drug therapy for rural and nonrural Kentucky children with Medicaid health insurance in 1995. The 8,634 children with asthma had a mean age of 5.7 years. Ninety-two percent made at least one asthma office visit, and 13 percent were hospitalized. The urban and rural patterns of care for childhood asthma varied in some potentially important ways. Urban children were twice as likely as rural children to see an asthma specialist (5 percent vs. 2.5 percent, P < 0.05), 2.7 times as likely to receive asthma care in an emergency department (19 percent vs. 7 percent, P < 0.01) and 1.4 times as likely to receive oral steroids (16 percent vs. 12 percent, P = 0.04). If given inhaled anti-inflammatory medication, rural children were more likely to receive inhaled steroids while urban children were more likely to receive cromoglycates.
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