Disparities in pediatric asthma hospitalizations.
OBJECTIVE
The purpose of this project was to determine to what extent rural children are hospitalized for asthma, an ambulatory care sensitive condition defined by the Agency for Healthcare Research and Quality pediatric quality indicators; to analyze differences in hospitalization rates for asthma by state and by rurality; and to examine the relationships between asthma hospitalization rates and poverty, health insurance, and physician supply.


METHODS
The project used 2001 through 2004 hospital inpatient discharge data for children aged 2 to 17 years from six geographically diverse states in the Healthcare Cost and Utilization Project. County-level poverty, uninsurance estimates, and physician data came from the 2004 Area Resource File. Pediatric Quality Indicator software was used to calculate county-level admission rates for asthma. Multivariate regression models were specified to assess how sensitive hospitalization rates were to characteristics of the children's counties of residence.


RESULTS
Pediatric asthma hospitalization rates per 100,000 children aged 2 to 17 years varied by state ranging from 51.1 to 185.9. When comparing all six states, rural children were the most likely to be hospitalized for asthma. However, after controlling for rurality, poverty, uninsurance, and physician supply, uninsurance was the only variable to significantly impact hospitalization rates.


CONCLUSIONS
These findings indicate that there are significant differences in pediatric asthma hospitalizations rates by and within states, which may best be addressed by targeting public health and healthcare interventions. In addition, the findings support efforts to increase health insurance coverage for children, especially rural children who are less likely to be insured.
University of North Dakota Center for Rural Health, Grand Forks, USA. aknudson@medicine.nodak.edu
Alana
A
Knudson
Michelle
M
Casey
Michele
M
Burlew
Gestur
G
Davidson
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019992:Databases as Topic; D005260:Female; D054625:Healthcare Disparities / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D010820:Physicians / Q000600:supply & distribution; D011203:Poverty; D012424:Rural Population; D013224:Status Asthmaticus; D014481:United States