BOSTON – Asthma admissions, like politics, are local.
So suggests the wide variability within a single Ohio county in hospitalization rates for children with acute asthma, Dr. Andrew F. Beck, a fellow in general and community pediatrics at Cincinnati Children’s Hospital Medical Center, said at the annual meeting of the Pediatric Academic Societies.
A neighborhood-by-neighborhood analysis of pediatric asthma admissions in Hamilton County (Cincinnati and environs), showed that some neighborhoods had admission rates as high as 27 per 1,000 children aged 1-16 years while others recorded no pediatric asthma hospitalizations at all, Dr. Beck reported.
"Hamilton County had an admission rate double the national average, with profound in-county variation in admission distribution," he noted. "Given this variation, we expect that neighborhood would be a powerful unit of measure that would be easily translatable to members of the community."
Armed with highly localized data, public health authorities could develop more effective interventions targeted at reducing disparities in asthma care, theoretically reducing admissions and saving millions of health care dollars, he explained.
To characterize variations in asthma admission rates among Hamilton County neighborhoods and assess differences in patient- and neighborhood-level characteristics, the investigators drew data from the population-based, prospective, observational Greater Cincinnati Asthma Risks Study.
Dr. Andrew F. Beck: "Given this variation [of admission rate], we expect that neighborhood would be a powerful unit of measure that would be easily translatable to members of the community."
They looked at 862 sequential admissions of 757 patients for asthma or wheezing from September 2010 through August 2011 of all children aged 1-16 years with addresses within the county.
All of the admissions were at Cincinnati Children’s Hospital Medical Center, which accounts for about 95% of all county admissions, according to Ohio public health data. To reduce the likelihood of confounding variables, the researchers excluded children with respiratory or cardiovascular comorbidities.
The mean overall admission rate for the county was 5.1 per 1,000 children; that compares with a national average of about 2.5 per 1,000, Dr. Beck noted. Neighborhoods whose residents had the highest third of admission rates averaged 17.0 per 1,000, compared with 7.5 per 1,000 for the middle third and 2.6 per 1,000 for the bottom third.
"If the county rate were reduced to that of the lowest tertile, annual admissions would decrease by more than 50% and $2.1 million could be saved," Dr. Beck said.
The researchers used factors chosen from U.S. Census data to determine differences among the three admission-rate groups. They found that lower household incomes, lower levels of education, greater population density, and lower percentage of home ownership within neighborhoods were all significantly predictive of higher asthma admission rates (P less than .0001 for all factors).
The authors also looked at available survey data for 447 patients, grouped into tertiles with respect to patient factors that are known to affect asthma morbidity. Factors significantly associated with a greater chance of admission included patient-reported "difficulty making ends meet," lack of transportation, cockroach infestation, depressive symptoms, and running out of medications (P less than .01 for all comparisons).
The investigators plan to create multilevel models for assessing the degree to which specific factors may affect asthma morbidity, and they hope to better delineate "geographic hot spots" of potentially modifiable risks, Dr. Beck said.
The study was supported by a National Institutes of Health grant and a National Research Service Award grant. The investigators reported having no relevant financial disclosures.