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Childhood asthma and poverty: differential impacts and utilization of health services
1Department of Community Health Sciences, UCLA School of Public Health 90024-1772.
Insights
Asthma prevalence is higher in poor children, who also experience more severe symptoms and utilize healthcare differently. This highlights disparities in access to care for pediatric asthma patients.
Area of Science:
- Pediatric Health
- Health Services Research
- Socioeconomic Disparities in Health
Background:
- Asthma affects a significant percentage of children, with notable differences observed between socioeconomic groups.
- Previous research indicated potential disparities in health outcomes and service utilization based on income.
Purpose of the Study:
- To examine the prevalence of asthma and associated healthcare utilization patterns among poor versus non-poor children.
- To identify the relationship between socioeconomic status, asthma morbidity, and access to routine and emergency healthcare services.
Main Methods:
- Analysis of data from the 1988 National Health Interview Survey on Child Health.
- Comparison of asthma prevalence, bed days, doctor visits, hospitalizations, and usual sources of care between poor and non-poor children.
Main Results:
- Poor children had a higher prevalence of asthma, particularly those under 6 years old.
- Poor children experienced more asthma-related bed days and higher hospitalization rates but fewer doctor visits.
- Poor children were more likely to use clinics or emergency departments for care compared to private doctor's offices.
Conclusions:
- Diminished access to appropriate outpatient services for poor children with asthma is linked to increased morbidity.
- Findings underscore the need for comprehensive care models and suggest a potential role for community clinics, especially with policy changes like Medicaid expansions.
Abstract:
Data from the 1988 National Health Interview Survey on Child Health showed that 4.3% of all children younger than 17 years of age had asthma, with poor children demonstrating a slightly greater prevalence than nonpoor (4.8 poor vs 4.2 nonpoor). This poor/nonpoor differential was even greater for children younger than 6 years old (4.2 vs 3.1). Poor children were also more likely to have had more than 7 bed days in the past year because of their asthma. Measures of health service utilization showed that poor children had 40% fewer doctor visits (3.2 vs 5.4) and had 40% more hospitalizations in the previous year (10.6% vs 7.4%). Although more than 90% of all children had a usual source of routine and/or sick care, poor children were more likely to receive routine care in a neighborhood health center (15.1% vs 1.6%) or hospital-based clinic (11.1% vs 2.8%) than in a doctor's office (67.2% vs 91.1%) and, when sick, then were more than four times more likely to report an emergency department as a usual source of care (8.1% vs 1.7%). Diminished accessibility to appropriate outpatient health services for poor children with asthma was associated with increased morbidity, measured by hospitalization, and bed days. These findings have significant implications for the development of comprehensive models of care and the potential role that community clinics could play with increased funding as a result of Medicaid changes that were instituted as part of the 1989 Omnibus Budget Reconciliation Act.