title: Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid.
abstract: BACKGROUND
  Although poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner cities do not have higher prevalent pediatric asthma. Whether asthma morbidity is higher in inner-city areas across the United States is not known.
  
  
  OBJECTIVE
  This study sought to examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma who are enrolled in Medicaid.
  
  
  METHODS
  Children aged 5 to 19 enrolled in Medicaid in 2009 to 2010 were included. Asthma was defined by at least 1 outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2-year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty, and race/ethnicity on rates of asthma outpatient visits, ED visits, and hospitalizations.
  
  
  RESULTS
  This study included 16,860,716 children (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but it was associated with significantly more asthma-related ED visits and hospitalizations among those with asthma in crude analyses (risk ratio, 1.48; 95% CI, 1.24-1.36; and 1.97; 95% CI, 1.50-1.72, respectively) and when adjusted for race/ethnicity, age, and sex (adjusted risk ratio, 1.23; 95% CI, 1.08-1.15; and 1.62; 95% CI, 1.26-1.43). Residence in urban or poor areas and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma-related ED visits and hospitalizations.
  
  
  CONCLUSIONS
  Residence in poor and urban areas is an important risk factor for asthma morbidity, but not for prevalence, among low-income US children.
authors.affiliation: Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: ckeet1@jhmi.edu.
authors.forename: Corinne A
authors.initials: CA
authors.lastname: Keet
authors.affiliation: Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Matsui
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Meredith C
authors.initials: MC
authors.lastname: McCormack
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Peng
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D009017:Morbidity; D011203:Poverty; D015995:Prevalence; D044469:Racial Groups; D012111:Residence Characteristics; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Asthma; inner city; poverty; urbanization