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Trends in pediatric asthma hospitalization rates: regional and socioeconomic differences
D C Goodman1, T A Stukel, C H Chang
1Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755, USA.
Insights
Childhood asthma hospitalization rates vary regionally, with New York seeing increases while New Hampshire experienced decreases. These trends highlight the need to tailor asthma management strategies to specific populations and geographic areas.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Health Services Research
Background:
- Childhood asthma hospitalization rates are rising nationally, despite guideline dissemination efforts.
- Understanding regional variations is crucial for effective public health interventions.
Purpose of the Study:
- To analyze childhood asthma hospitalization trends in four northeastern states over a decade.
- To assess the generalizability of national asthma hospitalization trends to regional populations.
Main Methods:
- Longitudinal analysis of state hospital discharge datasets (1985-1994).
- Inclusion criteria: Children (<18 years) residing in Maine, New Hampshire, Vermont, or New York.
- Multivariate analyses controlling for demographic and socioeconomic factors.
Main Results:
- New York saw a 3.8% annual increase in asthma hospitalizations; New Hampshire saw a 5.8% annual decrease.
- Maine and Vermont rates remained stable; no significant changes observed.
- Increased rates were observed in Black and Hispanic children, those in lower-income areas, and metropolitan residents.
- Proportion of hospital days for asthma increased across all groups, despite falling non-asthma hospitalization rates.
Conclusions:
- Regional asthma hospitalization trends do not uniformly mirror national patterns.
- Existing hypotheses for national trends do not solely explain these regional disparities.
- Targeted resource allocation toward identified high-risk populations is recommended for improved asthma outcomes.
Objective:
Asthma hospitalization rates continue to increase nationally for children despite efforts by the National Institutes of Health and specialty organizations to improve outcomes through the dissemination of practice guidelines. To understand the generalizability of national trends to regional populations, we studied childhood hospitalizations over a 10-year period in four northeastern states.
Design:
Longitudinal analysis of hospitalization rates by patient residence and patient characteristics using state hospital discharge datasets.
Population:
Age < 18 years residing in Maine, New Hampshire, Vermont, or New York state during the period 1985 to 1994.
Results:
In multivariate analyses (controlling for age, sex, race/ethnicity, median household income, metropolitan status), we found that New York asthma hospitalization rates increased 3.8% per annum (95% confidence interval: 3.3, 4.2), whereas in New Hampshire, rates decreased 5.8% (95% confidence interval: 7.6, 4.1). Maine and Vermont rates did not change significantly during the study period. Increased asthma hospitalization rates were noted in black and Hispanic populations, in children residing in zip codes with lower median household incomes, and in those living in metropolitan areas. Hospitalization rates for nonasthma causes fell substantially. As a result, the proportion of hospital days attributed to childhood asthma increased in all population groups.
Conclusions:
Asthma discharge rates measured by the state of residence or socioeconomic characteristic do not necessarily parallel national trends. None of the current hypotheses offered to explain national trends in asthma hospitalization rates (changes in disease severity, diagnostic substitution, or differences in the supply and character of medical care) can be the sole explanation of these regional trends. Efforts intended to improve asthma outcomes may benefit a greater number of children by redirecting resources toward specific populations identified through state hospital discharge datasets.