Factors Associated with Asthma ED Visit Rates among Medicaid-enrolled Children: A Structural Equation Modeling...

Area of Science:

• Environmental health
• Pediatric health
• Health services research

Background:

• Asthma is a major cause of pediatric emergency department (ED) visits and school absenteeism in the U.S.
• Significant local and racial-ethnic variations exist in asthma-related ED visit rates.
• Understanding factors contributing to these disparities is crucial for targeted interventions.

Purpose of the Study:

• To investigate county-level factors associated with variations in asthma-related ED visits among children.
• To test a conceptual model linking socioeconomic status, healthcare capacity, and air quality to asthma ED visit rates.
• To evaluate the utility of confirmatory factor analysis in studying health disparities.

Main Methods:

• Calculated ED visit rates for children aged 5-12 with asthma enrolled in Medicaid across multiple states.
• Employed exploratory factor analysis with over 226 variables to identify county-level factors.
• Utilized confirmatory factor analysis and structural equation modeling to test the conceptual model.

Main Results:

• County-level variables successfully clustered into predefined factors: socioeconomic status, healthcare capacity, and air quality.
• Structural equation models demonstrated a reasonable fit, connecting ED visit rates to these identified factors.
• The study confirmed the proposed conceptual framework for understanding asthma ED visit variations.

Conclusions:

• Confirmatory factor analysis is a viable quantitative method for examining conceptual models of health disparities.
• The findings highlight the interplay of socioeconomic, environmental, and healthcare system factors in pediatric asthma ED use.
• This approach can inform strategies to reduce local-area variations and racial disparities in asthma care.