title: Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states.
abstract: BACKGROUND
  Despite evidence-based prevention and practice guidelines, asthma prevalence, treatment, and outcomes vary widely at individual and community levels. Asthma disproportionate/ly affects low-income and minority children, who comprise a large segment of the Medicaid population.
  
  
  METHODS
  2007 Medicaid claims data from 14 southern states was mapped for 556 counties to describe the local area variation in 1-year asthma prevalence rates, emergency department (ED) visit rates, and racial disparity rate ratios.
  
  
  RESULTS
  One-year period prevalence of asthma ranged from 2.8% in Florida to 6.4% in Alabama, with a median prevalence rate of 4.1%. At the county level, the prevalence was higher for Black children and ranged from 1.03% in Manatee County, FL, to 21.0% in Hockley County, TX. Black-White rate ratios of prevalence ranged from 0.49 in LeFlore County, MS, to 3.87 in Flagler County, FL. Adjusted asthma ED visit rates ranged from 2.2 per 1000 children in Maryland to 16.5 in Alabama, with a median Black-White ED-visit rate ratio of 2.4. Rates were higher for Black children, ranging from 0.80 per 1000 in Wicomico County, MD, to 70 per 1000 in DeSoto County, FL. Rate ratios of ED visits ranged from 0.25 in Vernon Parish, LA, to 25.28 in Nelson County, KY.
  
  
  CONCLUSIONS
  Low-income children with Medicaid coverage still experience substantial variation in asthma prevalence and outcomes from one community to another. The pattern of worse outcomes for Black children also varies widely across counties. Eliminating this variation could substantially improve overall outcomes and eliminate asthma disparities.
authors.affiliation: National Center for Primary Care, Morehouse School of Medicine , Atlanta, GA , United States .
authors.forename: Khusdeep
authors.initials: K
authors.lastname: Malhotra
authors.forename: Peter
authors.initials: P
authors.lastname: Baltrus
authors.forename: Shun
authors.initials: S
authors.lastname: Zhang
authors.forename: Luceta
authors.initials: L
authors.lastname: McRoy
authors.forename: Lilly Cheng
authors.initials: LC
authors.lastname: Immergluck
authors.forename: George
authors.initials: G
authors.lastname: Rust
mesh_terms: D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D001741:Black or African American
keywords: Asthma; health disparities; local-area variation