title: Trends in pediatric asthma hospitalization rates: regional and socioeconomic differences.
abstract: 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.
  
  
  METHODS
  Longitudinal analysis of hospitalization rates by patient residence and patient characteristics using state hospital discharge datasets.
  
  
  METHODS
  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.
authors.affiliation: Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Goodman
authors.forename: T A
authors.initials: TA
authors.lastname: Stukel
authors.forename: C H
authors.initials: CH
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009511:New England / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology