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Disparities in Mortality and Morbidity in Pediatric Asthma Hospitalizations, 2007 to 2011
Alexander F Glick1, Suzy Tomopoulos1, Arthur H Fierman1
1Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York.
Insights
Pediatric asthma admissions show varied outcomes. Native American race, older age, and region predicted mortality, while race/ethnicity had varied effects on morbidity in children with asthma.
Area of Science:
- Pediatric pulmonology
- Health services research
- Epidemiology
Background:
- Asthma is a significant cause of pediatric hospitalizations.
- Factors influencing pediatric asthma inpatient outcomes, including race, require further investigation.
- Understanding these factors is crucial for improving care and reducing complications.
Purpose of the Study:
- To examine factors associated with mortality and morbidity in children admitted for asthma.
- To identify predictors of adverse inpatient asthma outcomes in pediatric populations.
Main Methods:
- Utilized data from the US Nationwide Inpatient Sample (2007-2011).
- Included patients aged 2-18 with a primary asthma diagnosis.
- Analyzed sociodemographic, hospital factors, and secondary diagnoses predicting mortality, intubation, length of stay, and costs.
Main Results:
- Native American race, older age (13-18 years), and Western region predicted higher mortality.
- Hispanic children had lower intubation rates than white children.
- Length of stay varied by race/ethnicity and insurance status; costs were higher for Black, Hispanic, and Asian children compared to white children.
Conclusions:
- Race/ethnicity, except for Native Americans, did not significantly predict inpatient asthma mortality.
- Race/ethnicity demonstrated varied associations with asthma morbidity.
- Identifying risk factors can guide targeted interventions for better pediatric asthma management.
Objective:
Asthma is a leading cause of pediatric admissions. Although several factors including race have been linked to increased overall asthma morbidity and mortality, few studies have explored factors associated with inpatient asthma outcomes. We examined factors associated with mortality and morbidity in children admitted for asthma.
Methods:
Data were obtained from the US Nationwide Inpatient Sample for 2007 to 2011. Patients 2 to 18 years old with a primary diagnosis of asthma were included. Predictor variables were sociodemographic and hospital factors and acute/chronic secondary diagnoses. Outcomes were mortality, intubation, length of stay (LOS), and costs. Weighted national estimates were calculated. Multivariable analyses were performed.
Results:
There were 97,379 (478,546 weighted) asthma admissions. Most patients were male (60.6%); 30% were white, 28% black, and 18% Hispanic. Mortality rate was 0.03%, and 0.3% were intubated. Median LOS was 2 (interquartile range, 1-3) days. Median costs were $2,950 (interquartile range, $1990-$4610). Native American race, older age (13-18 years), and West region were significant independent predictors of mortality. Intubation rate was lower in Hispanic compared with white children (P = .028). LOS was shorter in Asian compared with white children (P = .022) but longer in children with public insurance and from low income areas (P < .001). Average costs were higher in black, Hispanic, and Asian compared with white children (P < .05).
Conclusions:
With the exception of Native Americans, race/ethnicity is not associated with inpatient asthma mortality and has varied effects on morbidity. Recognition of factors associated with increased asthma mortality and morbidity might allow for earlier, more effective treatment and avoidance of complications.
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