Original ResearchPaediatric asthma hospital utilization varies by demographic factors and area socio-economic status
Introduction
Asthma was estimated to affect 6.5 million children in the USA in 20051 and to account for 12.8 million missed school days in 2003, according to a national survey.2 Rates of emergency department (ED) visits and hospital admissions for asthma have been reported to be highest among children, with those aged 0–4 years having the highest rates overall.2 In addition, disproportionately higher rates of asthma have been reported for children who are male, non-Hispanic, African American or poor.1, 3, 4 Compounding this burden of asthma is that for racial/ethnic minorities (including African Americans and Hispanics or Latinos) and poorer families, access to high-quality health care is limited in the USA due to lack of private insurance.3, 4, 5
Efforts to reduce severe asthma episodes requiring treatment in an ED or inpatient hospital setting include use of controller medications, and healthcare provider and patient education.6 These approaches may be out of reach for children of low-income families in the USA who do not have private health insurance.5 Stafford et al. reported that asthma-related office visits in the USA increased throughout the 1980s, then levelled off during the next decade, corresponding with an increase in controller-medication use including inhaled corticosteroids.7 A recent meta-analysis reported that paediatric asthma education reduced mean numbers of hospitalizations and ED visits.8 However, this requires adequate access to health care.
The present population-based study evaluated asthma hospital data for Orange County, California. Therefore, results cannot be generalized beyond this region but are likely to be similar for other US counties. Orange County (total population in 2000: 2,846,297, with 25% under 18 years of age) has a fairly diverse population, with 30.8% being of Hispanic or Latino ethnicity and 9.2% being below the poverty level, according to the 2000 US Census Bureau (http://factfinder.census.gov/home/saff/main.html%3f_lang%3den). The Asthma and Chronic Lung Disease (ACLD) Institute, supported by the Children and Families Commission of Orange County, launched a variety of clinical and educational initiatives in 2002 to reduce the burden of asthma in Orange County children aged 0–5 years, when most asthma symptom phenotypes first emerge. As part of this effort, data were collected on asthma ED visits and hospital admissions for children of all ages in Orange County to examine trends in recent years and to investigate whether area-level socio-economic status (SES) indicators may be associated with episodes of paediatric asthma that are treated in the hospital setting. The aim of this study was to evaluate annual trends in asthma hospital encounters, and to identify groups that may benefit from targeted prevention or intervention programmes.
Section snippets
Hospital admissions and emergency-department visits
Two separate population-based datasets were obtained from the California Office of Statewide Health Planning and Development (OSHPD), one for asthma hospital admissions and another for asthma ED visits for children who live in Orange County. The hospital admissions data were available for 2000–2007. ED data collection began on 1 January 2005 and were available for 2005–2007. Reporting on ED visits and hospital admissions is required of all non-federal hospitals (excluding veterans
Patient characteristics for hospital admissions and ED visits
Table 1 displays patient characteristics including sex, race/ethnicity and age group for asthma hospital admissions for 2000–2007 and ED visits for 2005–2007 in Orange County. The youngest age group (0–4 years) had the highest rates of asthma admissions and ED visits, and males had higher rates of asthma admissions and ED visits than females for all age groups. Of the racial/ethnic groups, African Americans had the highest rates of asthma admissions and ED visits, followed by non-Hispanic
Discussion
The highest admission rate per 100,000 people was found among African Americans, and the smallest admission rate per 100,000 people was found among Asians and Pacific Islanders, who were at least as well insured as non-Hispanic Whites. The higher rates among African Americans are consistent with US national data,10, 11, 12 and suggest that targeted interventions and risk factor identification are needed. An analysis of the National Health Interview Survey suggested that the higher risk among
Acknowledgements
Ethical approval
This study was approved by the University of California Irvine Institutional Review Board and the Committee for the Protection of Human Subjects, California Health and Human Services Agency.
Funding
The Asthma and Chronic Lung Disease Institute, for the Children and Families Commission of Orange County, Grant no. FCI-CU3-13.
Competing interests
None declared.
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