Health Disparities among Children with Asthma in the U.S. by Place of Residence

Publication date: Available online 18 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Patrick W. Sullivan, Vahram Ghushchyan, Abhishek Kavati, Prakash Navaratnam, Howard S. Friedman, B. Ortiz
BackgroundChildren residing in poor-urban areas may have greater asthma morbidity. It is unclear if this is due to individual characteristics like race and ethnicity or place of residence.ObjectiveAssess indicators of control and treatment by residence.MethodsThis was a cross-sectional analysis of children (aged 1-17) in the 2000-2014 Medical Expenditure Panel Survey (MEPS). Indicators of poor control included use of > 3 canisters of short-acting beta agonist (SABA) in 3 months, asthma attack, and Emergency Department (ED) or inpatient (IP) visit during the year. Treatment measures included use of controller medications and a ratio of controller-to-total prescriptions ≥ 0.7.ResultsThere were 15,052 children with asthma in the MEPS 2000-14 data, reflecting 8.4 million children in 2014. After controlling for covariates, children with asthma residing in poor-urban areas had lower odds of using controller medications (OR = 0.77), having a controller-to-total ratio ≥ 0.7 (OR = 0.75) and reporting an asthma attack (OR = 0.75); and higher odds of having an ED/IP visit (OR = 1.3) compared to those living elsewhere. Black race and Hispanic ethnicity were associated with greater odds of excessive SABA use (OR = 2.11) and ED/IP visits (OR=2.03); and lower odds of controller-to-total ratio≥0.07 (OR=0.50).ConclusionPoor-urban residence may be independently associated with asthma control and treatment even after controlling for individual characteristics like race and ethnicity. Future research is needed to understand the sources of these geographic health disparities in order to more successfully target public health interventions.