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Poverty, race, and hospitalization for childhood asthma
L S Wissow1, A M Gittelsohn, M Szklo
1Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Insights
Black children face higher asthma hospitalization rates, but this disparity largely disappears when poverty is considered. The study suggests poverty, not race, is a key factor in asthma hospitalizations.
Area of Science:
- Pediatric Health
- Epidemiology
- Health Disparities
Background:
- Asthma is a significant pediatric health concern.
- Racial disparities in asthma hospitalization rates have been observed.
- The role of socioeconomic factors in these disparities requires further investigation.
Purpose of the Study:
- To investigate racial differences in asthma hospitalization rates among children in Maryland.
- To determine if socioeconomic factors, specifically poverty, explain these racial disparities.
- To examine the association between asthma hospitalizations and healthcare resource availability.
Main Methods:
- Analysis of Maryland hospital discharge data from 1979-1982 for children aged 1-19.
- Comparison of asthma discharge rates between Black and White children.
- Ecologic analysis adjusting for poverty levels within populations.
- Assessment of correlations between discharge rates and hospital bed supply or physician ratios.
Main Results:
- Black children had higher crude asthma discharge rates (3.75/1000) compared to White children (1.25/1000).
- Medicaid enrollment was associated with increased asthma discharge rates for both racial groups.
- After adjusting for poverty, asthma discharge rates between Black and White children became nearly equal.
- No significant association was found between asthma discharge rates and hospital bed supply or primary care physician ratios.
Conclusions:
- Black children experience a higher risk of asthma hospitalization.
- Poverty appears to be a significant confounding factor, explaining a substantial portion of the observed racial disparity.
- Race itself may not be an independent risk factor for asthma hospitalization when socioeconomic status is accounted for.
Abstract:
This study uses Maryland hospital discharge data for the period 1979-82 to determine whether Black children are more likely to be hospitalized for asthma and whether this difference persists after adjustment for poverty. The average annual asthma discharge rate was 1.95/1000 children aged 1-19; 3.75/1000 for Black children, and 1.25/1000 for White. Medicaid-enrolled children of both races had increased discharge rates for asthma compared to those whose care was paid for by other sources: 5.68/1000 vs 2.99/1000 for Blacks, and 3.10/1000 vs 1.11/1000 for Whites. When ecologic analyses were performed, populations of Black and White children had nearly equal asthma discharge rates after adjustment for poverty. The statewide adjusted rate was 2.70/1000 (95% CL = 1.93, 3.78) for Black children and 2.10/1000 (1.66, 2.66) for White children. Among Maryland counties and health planning districts, variation in asthma discharge rates was not associated with the supply of hospital beds or the population to primary-care physician ratio. We conclude that Black children are at increased risk of hospitalization for asthma, but that some or all of this increase is related to poverty rather than to race.