Role of financial and social hardships in asthma racial disparities.
OBJECTIVE
Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models.


METHODS
We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards.


RESULTS
The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%.


CONCLUSIONS
African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.
Divisions of General and Community Pediatrics.
Andrew F
AF
Beck
Bin
B
Huang
Jeffrey M
JM
Simmons
Terri
T
Moncrief
Hadley S
HS
Sauers
Chen
C
Chen
Patrick H
PH
Ryan
Nicholas C
NC
Newman
Robert S
RS
Kahn
D000293:Adolescent; D001741:Black or African American / Q000208:ethnology*; D001249:Asthma / Q000191:economics* / Q000208:ethnology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000191:economics* / Q000639:trends; D006801:Humans; D007223:Infant; D008297:Male; D010359:Patient Readmission / Q000191:economics* / Q000639:trends; D011159:Population Surveillance; D011203:Poverty / Q000191:economics / Q000639:trends; D011446:Prospective Studies; D012923:Social Class; D044465:White People / Q000208:ethnology*
childhood asthma; pediatrics; racial disparities; readmissions