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Published on: November 4, 2010
Paediatric asthma hospital utilization varies by demographic factors and area socio-economic status
J Largent1, B Nickerson, D Cooper
1Department of Epidemiology, School of Medicine, University of California, Irvine, 224 Irvine Hall, Irvine, CA 92697-7555, USA.
Insights
Pediatric asthma hospitalizations and emergency department (ED) visits are decreasing, but remain higher in low socioeconomic status (SES) areas. This highlights the need for targeted interventions for high-risk children with severe asthma episodes.
Area of Science:
- Pediatric pulmonology
- Public health
- Health disparities research
Background:
- Asthma remains a significant pediatric health concern, necessitating an understanding of trends and risk factors.
- Socioeconomic status (SES) is a known determinant of health outcomes, but its specific impact on pediatric asthma ED visits and hospital admissions requires ongoing investigation.
Purpose of the Study:
- To examine long-term trends in pediatric asthma emergency department (ED) visits and hospital admissions.
- To identify demographic and area socioeconomic status (SES) factors associated with these asthma-related healthcare encounters.
- To pinpoint vulnerable populations disproportionately affected by pediatric asthma.
Main Methods:
- Retrospective population-based trend and cross-sectional analyses of pediatric asthma hospital admissions (2000-2007) and ED visits (2005-2007) in Orange County, California.
- Linking healthcare utilization data with zip-code-level SES data from the 2000 US Census.
- Calculating age-specific admission and ED visit rates and analyzing trends using joinpoint analyses and negative binomial regression to estimate risks associated with SES indicators.
Main Results:
- Asthma hospital admissions and ED visits were highest among young children (0-4 years), males, and African Americans.
- Significant declines in asthma hospital admissions were observed across all age groups, with the greatest decrease in children aged 0-4 years.
- Children residing in low-SES areas, particularly those in the lowest tertile of median household income, experienced significantly higher rates of both hospital admissions (30-60% higher) and ED visits (80-90% higher) compared to those in high-SES areas.
Conclusions:
- While pediatric asthma hospitalizations and ED visits are declining in Orange County, significant disparities persist.
- Children in low-SES areas are disproportionately affected by severe asthma episodes, indicating ongoing health inequities.
- Findings underscore the importance of targeted public health interventions to address the needs of high-risk pediatric populations and mitigate asthma-related healthcare burdens.
Objectives:
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.
Study Design:
Retrospective population-based trend and cross-sectional analyses.
Methods:
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.
Results:
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.
Conclusions:
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.
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