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Trends in Neighborhood Opportunity, Hospitalizations, and Costs for Pediatric Asthma
Jonathan M Gabbay1, Benjamin V M Bajaj2, Michael D Fishman3
1Division of Hospital Medicine, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
Insights
Asthma exacerbation hospital admissions and costs are rising across all Child Opportunity Index (COI) levels. While disparities are converging, higher opportunity neighborhoods see faster cost increases, necessitating targeted interventions.
Area of Science:
- Pediatric Health Services Research
- Health Equity and Disparities
- Healthcare Economics
Background:
- Asthma exacerbations in children represent a significant healthcare burden.
- Neighborhood opportunity, as measured by the Child Opportunity Index (COI), is linked to health outcomes.
- Understanding temporal trends in pediatric asthma hospitalizations and associated costs across different socioeconomic contexts is crucial.
Purpose of the Study:
- To evaluate changes in pediatric asthma exacerbation hospitalization admissions over time relative to COI levels.
- To assess trends in hospitalization costs for pediatric asthma exacerbations across different COI levels.
Main Methods:
- Retrospective analysis of the Pediatric Health Information System (PHIS) database (2016-2024).
- Inclusion of pediatric patients (2-18 years) with asthma exacerbations.
- Mixed-effects regression models used to analyze odds of admission and hospitalization costs relative to COI levels over time.
Main Results:
- Over 777,000 pediatric asthma exacerbation encounters were analyzed, with a 26.8% admission rate.
- Admission odds were generally higher across lower COI levels compared to very high COI levels, though converging.
- Inflation-adjusted hospitalization costs increased across all COI levels, with the fastest rise observed in very high COI neighborhoods.
Conclusions:
- Persistent disparities in pediatric asthma hospitalization admissions based on neighborhood opportunity exist but are narrowing.
- Healthcare costs for pediatric asthma hospitalizations are increasing universally, disproportionately affecting higher opportunity areas.
- Further research is essential to address ongoing hospitalization disparities and the drivers of escalating costs for targeted interventions.
Objective:
To evaluate changes in (1) admissions and (2) costs of hospitalization over time relative to Child Opportunity Index (COI) levels for pediatric patients with asthma exacerbations.
Study Design:
We conducted a retrospective study using the PHIS database from 2016 to 2024 for children aged 2 to 18 years who presented to children's hospitals with an asthma exacerbation. Outcomes were odds of admission and costs (per hospitalization) over time relative to COI levels. Mixed-effects regression models with interaction terms were used for analyses.
Results:
We identified 777,370 encounters, of which 208,415 (26.8%) were admitted. In adjusted models, odds of admission were significantly higher across all COI levels relative to encounters from very high COI levels for most years. Only encounters from very low COI neighborhoods showed a decreased average annual odds of admission relative to those from very high neighborhoods (adjusted annual percent change: -0.96% [95% CI: -1.59%, -0.33%], p = 0.003). Inflation-adjusted mean costs per hospitalization increased across all COI levels (p < 0.001 for all). The average annual cost increase for very low, low, moderate, and high COI levels was significantly lower compared to those from very high COI neighborhoods.
Conclusions:
Disparities in admissions by neighborhood opportunity continue to exist but appear to be converging over time. Hospitalization costs among COI levels are increasing, although at a faster rate for those from the highest-opportunity neighborhoods. Future research is needed to understand continued hospitalization disparities and drivers of rising costs to develop community- and individual-level targeted interventions.
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