Disparities in Mortality and Morbidity in Pediatric Asthma Hospitalizations, 2007 to 2011

  • Alexander F. Glick
    Address correspondence to Alexander F. Glick, MD, Department of Pediatrics, Bellevue Hospital Center, Administration Building, Room A314A, New York, NY 10016.
    Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
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  • Suzy Tomopoulos
    Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
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  • Arthur H. Fierman
    Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
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  • Leonardo Trasande
    Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York

    Departments of Environmental Medicine and Population Health, New York University School of Medicine, New York

    New York University Wagner School of Public Service, New York

    Department of Nutrition, Food & Public Health, New York University Steinhardt School of Culture, Education, and Human Development, New York

    New York University Global Institute of Public Health, New York
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Published:January 05, 2016DOI:



      Asthma is a leading cause of pediatric admissions. Although several factors including race have been linked to increased overall asthma morbidity and mortality, few studies have explored factors associated with inpatient asthma outcomes. We examined factors associated with mortality and morbidity in children admitted for asthma.


      Data were obtained from the US Nationwide Inpatient Sample for 2007 to 2011. Patients 2 to 18 years old with a primary diagnosis of asthma were included. Predictor variables were sociodemographic and hospital factors and acute/chronic secondary diagnoses. Outcomes were mortality, intubation, length of stay (LOS), and costs. Weighted national estimates were calculated. Multivariable analyses were performed.


      There were 97,379 (478,546 weighted) asthma admissions. Most patients were male (60.6%); 30% were white, 28% black, and 18% Hispanic. Mortality rate was 0.03%, and 0.3% were intubated. Median LOS was 2 (interquartile range, 1–3) days. Median costs were $2,950 (interquartile range, $1990–$4610). Native American race, older age (13–18 years), and West region were significant independent predictors of mortality. Intubation rate was lower in Hispanic compared with white children (P = .028). LOS was shorter in Asian compared with white children (P = .022) but longer in children with public insurance and from low income areas (P < .001). Average costs were higher in black, Hispanic, and Asian compared with white children (P < .05).


      With the exception of Native Americans, race/ethnicity is not associated with inpatient asthma mortality and has varied effects on morbidity. Recognition of factors associated with increased asthma mortality and morbidity might allow for earlier, more effective treatment and avoidance of complications.


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