title: Cartography of emergency department visits for asthma - targeting high-morbidity populations.
abstract: BACKGROUND
  Asthma education should be offered with priority to populations with the highest asthma-related morbidity. In the present study, the aim was to identify populations with high-morbidity for asthma from the Quebec Health Insurance Board Registry, a large administrative database, to help the Quebec Asthma and Chronic Obstructive Pulmonary Disease Network target its interventions.
  
  
  METHODS
  All emergency department (ED) visits for asthma were analyzed over a one-year period, considering individual and medical variables. Age- and sex-adjusted rates, as well as standardized rate ratios related to the overall Quebec rate, among persons zero to four years of age and five to 44 years of age were determined for 15 regions and 163 areas served by Centres Locaux de Services Communautaires (CLSC). The areas with rates 50% to 300% higher (P<0.01) than the provincial rate were defined as high-morbidity areas. Maps of all CLSC areas were generated for the above parameters.
  
  
  RESULTS
  There were 102,551 ED visits recorded for asthma, of which more than 40% were revisits. Twenty-one CLSCs and 32 CLSCs were high-morbidity areas for the zero to four years age group and five to 44 years age group, respectively. For the most part, the high-morbidity areas were located in the south-central region of Quebec. Only 47% of asthmatic patients seen in ED had also seen a physician in ambulatory care.
  
  
  CONCLUSIONS
  The data suggest that a significant portion of the population seeking care at the ED is undiagnosed and undertreated. A map of high-morbidity areas that could help target interventions to improve asthma care and outcomes is proposed.
authors.affiliation: Unité de recherche en santé publique, Centre hospitalier universitaire de Québec, Hôpital Laval. pierre.lajoie@inspq.qc.ca
authors.forename: Pierre
authors.initials: P
authors.lastname: Lajoie
authors.forename: Andrée
authors.initials: A
authors.lastname: Laberge
authors.forename: Germain
authors.initials: G
authors.lastname: Lebel
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Boulet
authors.forename: Marie
authors.initials: M
authors.lastname: Demers
authors.forename: Pierre
authors.initials: P
authors.lastname: Mercier
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Gagnon
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011792:Quebec; D012959:Socioeconomic Factors