Rural-Urban Differences in Pediatric Asthma Presentation and Outcomes, 2016-2021

Asthma remains one of the public health challenges in children and is usually managed outpatient, but hospitalization, when needed, is a costly, prolonged, and disruptive event for families. This study examined the presentation and clinical outcomes of hospitalization for pediatric acute asthma among rural children compared with urban.

We used the 2016-2021 National Inpatient Sample to identify hospital discharge records for children aged 2 to 17 years with a primary diagnosis of acute asthma (n = 64 686). We used descriptive statistics to examine geographic variations in the clinical presentation. We performed multivariable regression analyses to determine whether rurality was associated with the outcomes of ventilation, length of stay, and total costs.

From 2016 to 2021, the proportion of acute asthma was 1.2% among urban hospitalized children and 0.8% among rural hospitalized children. The percentage of rural children hospitalized in urban areas compared with rural hospitals was higher in 2019 (18.5% vs 16.2%), 2020 (9.4% vs 6.3%), and 2021 (14.4% vs 9.7%). Rural pediatric asthma encounters were more likely to involve ventilation than urban encounters (odds ratio, 1.63; 95% CI, 1.34-1.98) and more likely to involve longer days of hospitalization than urban ones (incidence risk ratio, 1.08; 95% CI, 1.05-1.11), but they generated significantly lesser costs (-$262.09; 95% CI, -$332.46 to -$191.73).

Given the higher risk of morbidity associated with acute asthma hospitalizations, it is critical to implement tailored primary care, asthma management education, and policies that address the unique factors contributing to higher asthma morbidity in rural areas.