title: Spatiotemporal patterns of childhood asthma hospitalization and utilization in Memphis Metropolitan Area from 2005 to 2015.
abstract: OBJECTIVE
  To identify the key risk factors and explain the spatiotemporal patterns of childhood asthma in the Memphis metropolitan area (MMA) over an 11-year period (2005-2015). We hypothesize that in the MMA region this burden is more prevalent among urban children living south, downtown, and north of Memphis than in other areas.
  
  
  METHODS
  We used a large-scale longitudinal electronic health record database from an integrated healthcare system, Geographic information systems (GIS), and statistical and space-time models to study the spatiotemporal distributions of childhood asthma at census tract level.
  
  
  RESULTS
  We found statistically significant spatiotemporal clusters of childhood asthma in the south, west, and north of Memphis city after adjusting for key covariates. The results further show a significant increase in temporal gradient in frequency of emergency department (ED) visits and inpatient hospitalizations from 2009 to 2013, and an upward trajectory from 4 per 1,000 children in 2005 to 16 per 1,000 children in 2015. The multivariate logistic regression identified age, race, insurance, admit source, encounter type, and frequency of visits as significant risk factors for childhood asthma (p < 0.05). We observed a greater asthma burden and healthcare utilization for African American (AA) patients living in a high-risk area than those living in a low-risk area in comparison to the white patients: AA vs. white [odds ratio (OR) = 3.03, 95% confidence interval (CI): 2.75-3.34]; and Hispanic vs. white (OR = 1.62, 95% CI: 1.21-2.17).
  
  
  CONCLUSIONS
  These findings provide a strong basis for developing geographically tailored population health strategies at the neighborhood level for young children with chronic respiratory conditions.
authors.affiliation: a Department of Preventive Medicine , College of Medicine, The University of Tennessee Health Science Center , Memphis , TN , USA.|d Department of Environmental Sciences , Louisiana State University , Baton Rouge , LA , USA.
authors.forename: Tonny J
authors.initials: TJ
authors.lastname: Oyana
authors.affiliation: b Methodist Le Bonheur Healthcare , Memphis , TN , USA.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Podila
authors.affiliation: c Le Bonheur Children's Medical Center, The University of Tennessee Health Science Center , Memphis , TN , USA.
authors.forename: Jagila Minso
authors.initials: JM
authors.lastname: Wesley
authors.affiliation: d Department of Environmental Sciences , Louisiana State University , Baton Rouge , LA , USA.
authors.forename: Slawo
authors.initials: S
authors.lastname: Lomnicki
authors.affiliation: c Le Bonheur Children's Medical Center, The University of Tennessee Health Science Center , Memphis , TN , USA.
authors.forename: Stephania
authors.initials: S
authors.lastname: Cormier
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D001249:Asthma / Q000208:ethnology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D040362:Geographic Information Systems; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D062211:Spatio-Temporal Analysis; D013714:Tennessee / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data
keywords: Childhood asthma; healthcare utilization; race; risk factors; spatiotemporal patterns