Advertisement

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

  • Alexander F. Glick
    Correspondence
    Address correspondence to Alexander F. Glick, MD, Department of Pediatrics, Bellevue Hospital Center, Administration Building, Room A314A, New York, NY 10016.
    Affiliations
    Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
    Search for articles by this author
  • Suzy Tomopoulos
    Affiliations
    Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
    Search for articles by this author
  • Arthur H. Fierman
    Affiliations
    Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
    Search for articles by this author
  • Leonardo Trasande
    Affiliations
    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
    Search for articles by this author
Published:January 05, 2016DOI:https://doi.org/10.1016/j.acap.2015.12.014

      Abstract

      Objective

      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.

      Methods

      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.

      Results

      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).

      Conclusions

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Akinbami L.J.
        • Moorman J.E.
        • Liu X.
        Asthma prevalence, health care use, and mortality: United States, 2005-2009.
        Natl Health Stat Report. 2011; 32: 1-14
        • Akinbami L.J.
        • Moorman J.E.
        • Garbe P.L.
        • et al.
        Status of childhood asthma in the United States, 1980-2007.
        Pediatrics. 2009; 123: S131-S145
        • Moorman J.E.
        • Zahran H.
        • Truman B.I.
        • et al.
        Current asthma prevalence - United States, 2006-2008.
        MMWR Surveill Summ. 2011; 60: 84-86
        • Beck A.F.
        • Huang B.
        • Simmons J.M.
        • et al.
        Role of financial and social hardships in asthma racial disparities.
        Pediatrics. 2014; 133: 431-439
        • Boudreaux E.D.
        • Emond S.D.
        • Clark S.
        • et al.
        Race/ethnicity and asthma among children presenting to the emergency department: differences in disease severity and management.
        Pediatrics. 2003; 111: e615-e621
        • Crocker D.
        • Brown C.
        • Moolenaar R.
        • et al.
        Racial and ethnic disparities in asthma medication usage and health-care utilization: data from the National Asthma Survey.
        Chest. 2009; 136: 1063-1071
        • Jones R.
        • Lin S.
        • Munsie J.P.
        • et al.
        Racial/ethnic differences in asthma-related emergency department visits and hospitalizations among children with wheeze in Buffalo, New York.
        J Asthma. 2008; 45: 916-922
        • Joseph C.
        • Havstad S.
        • Ownby D.
        • et al.
        Racial differences in emergency department use persist despite allergist visits and prescriptions filled for antiinflammatory medications.
        J Allergy Clin Immunol. 1998; 101: 484-490
        • Flores G.
        • Snowden-Bridon C.
        • Torres S.
        • et al.
        Urban minority children with asthma: substantial morbidity, compromised quality and access to specialists, and the importance of poverty and specialty care.
        J Asthma. 2009; 46: 392-398
        • Lieu T.
        • Lozano P.
        • Finkelstein J.
        Racial/ethnic variation in asthma status and management practices among children in managed Medicaid.
        Pediatrics. 2002; 109: 857-865
        • Piper C.N.
        • Glover S.
        • Elder K.
        • et al.
        Disparities in access to care among asthmatic children in relation to race and socioeconomic status.
        J Child Health Care. 2010; 14: 271-279
        • Ortega A.
        • Gergen P.
        • Paltiel A.
        Impact of site of care, race, and Hispanic ethnicity on medication use for childhood asthma.
        Pediatrics. 2002; 109: E1
        • Krishnan V.
        • Diette G.B.
        • Rand C.S.
        • et al.
        Mortality in patients hospitalized for asthma exacerbations in the United States.
        Am J Respir Crit Care Med. 2006; 174: 633-638
        • Sumino K.
        • O'Brian K.
        • Bartle B.
        • et al.
        Coexisting chronic conditions associated with mortality and morbidity in adult patients with asthma.
        J Asthma. 2014; 51: 306-314
        • Cazzola M.
        • Calzetta L.
        • Bettoncelli G.
        • et al.
        Asthma and comorbid medical illness.
        Eur Respir J. 2011; 38: 42-49
        • Boulet L.
        • Boulay M.
        Asthma-related comorbidities.
        Expert Rev Respir Med. 2011; 5: 377-393
        • Fisher-Owens S.A.
        • Turenne W.M.
        • Chavanu K.
        • et al.
        Racial disparities in children hospitalized with asthma at academic childrens' hospitals.
        Pediatr Asthma Allergy Immunol. 2006; 19: 162-171
      1. HCUP. Overview of the National (Nationwide) Inpatient Sample (NIS). Available at: https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed March 2, 2015.

      2. HCUP. Cost-to-Charge Ratio Files. Available at: https://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp. Accessed March 2, 2015.

        • Duan N.
        Smearing estimate: a nonparametric retransformation method.
        J Am Stat Assoc. 1983; 78: 605-610
      3. United States Census Bureau. State & County QuickFacts. Available at: http://quickfacts.census.gov/qfd/states/00000.html. Accessed March 2, 2015.

        • Singleton R.J.
        • Holman R.C.
        • Cobb N.
        • et al.
        Asthma hospitalizations among American Indian and Alaska Native people and for the general US population.
        Chest. 2006; 130: 1554-1562
        • Mehal J.M.
        • Holman R.C.
        • Steiner C.A.
        • et al.
        Epidemiology of asthma hospitalizations among American Indian and Alaska Native people and the general United States population.
        Chest. 2015; 146: 624-632
        • Brim S.N.
        • Rudd R.A.
        • Funk R.H.
        • et al.
        Asthma prevalence among US children in underrepresented minority populations: American Indian/Alaska Native, Chinese, Filipino, and Asian Indian.
        Pediatrics. 2008; 122: e217-e222
        • Rose D.
        • Garwick A.
        Urban American Indian family caregivers’ perceptions of barriers to management of childhood asthma.
        J Pediatr Nurs. 2003; 18: 2-11
        • Van Sickle D.
        • Wright A.L.
        Navajo perceptions of asthma and asthma medications: clinical implications.
        Pediatrics. 2001; 108: E11
        • Lee A.C.
        • Brugge D.
        • Phan L.
        • et al.
        A comparison of knowledge about asthma between Asians and non-Asians at two pediatric clinics.
        J Immigr Minor Health. 2007; 9: 245-254
        • Greenfield R.O.
        • Lee A.C.
        • Tang R.
        • et al.
        Screening for asthma in Cantonese-speaking immigrant children.
        BMC Public Health. 2005; 5: 48
        • Calmes D.
        • Leake B.D.
        • Carlisle D.M.
        Adverse asthma outcomes among children hospitalized with asthma in California.
        Pediatrics. 1998; 101: 845-850
        • Davis A.M.
        • Kreutzer R.
        • Lipsett M.
        • et al.
        Asthma prevalence in Hispanic and Asian American ethnic subgroups: results from the California Healthy Kids Survey.
        Pediatrics. 2006; 118: e363-e370
        • Wilhelm M.
        • Qian L.
        • Ritz B.
        Outdoor air pollution, family and neighborhood environment, and asthma in LA FANS children.
        Health Place. 2009; 15: 25-36
        • Lee J.T.
        • Son J.Y.
        • Kim H.
        • et al.
        Effect of air pollution on asthma-related hospital admissions for children by socioeconomic status associated with area of residence.
        Arch Environ Occup Health. 2007; 61: 123-130
        • Self T.H.
        • Chrisman C.R.
        • Mason D.L.
        • et al.
        Reducing emergency department visits and hospitalizations in African American and Hispanic patients with asthma: a 15-year review.
        J Asthma. 2005; 42: 807-812
        • Coffman J.M.
        • Cabana M.D.
        • Halpin H.A.
        • et al.
        Effects of asthma education on children's use of acute care services: a meta-analysis.
        Pediatrics. 2008; 121: 575-586