Combined Effect of Race/Ethnicity and Type of Insurance on Reuse of Urgent Hospital-Based Services in Children Discharged with Asthma

Abstract

Asthma is a leading cause of health disparity in children. This study explores the joint effect of race/ethnicity and insurance type on risk for reuse of urgent services within a year of hospitalization. Data were collected from 604 children hospitalized with asthma between 2012 and 2015 and stratified with respect to combination of patients’ insurance status (public vs. private) and race/ethnicity (white vs. nonwhite). Highest rates for at least one emergency department (ED) revisit (49.5%, 95% CI 42.5, 56.5) and for average revisits (1.03, 95% CI 0.83, 1.22) were recorded in nonwhite children with public insurance. Adjusted models revealed higher chance for ED reuse in white as well as nonwhite children covered by public insurance. Hospitalization rate was not dependent on the combination of social determinants, but on the number of post-discharge ED revisits. The combined effect of race/ethnicity and health insurance are associated with post-discharge utilization of ED services, but not with hospital readmission.

Health insurance, pediatric asthma, and emergency department usage

“…Following Medicaid expansion with ACA enactment, states demonstrated significant increases in ED use (Chang et al., 2014; Dresden et al., 2017; Pinto et al., 2020). This trend continued after the ACA enactment at the state level (Pinto et al., 2020) and regionally (Eum et al., 2019). Nikpay et al.…”

“…In addition to public health insurance status, ethnic minority status is a determinant of increased ED use (Alpern et al., 2014; Giannouchos et al., 2020; Pinto et al., 2020). African American and Black asthmatic children are most commonly noted as likely to utilize an ED (Eum et al., 2019; Herndon et al., 2012; Malhotra et al., 2014).…”

“…Low adherence raises the likelihood that asthma severity will require an ED visit (Herndon et al., 2012; Hsu et al., 2016), especially for adolescents in Ohio whose developmental stage causes noncompliant behaviors (McGovern et al., 2017). Noncompliant behaviors are observed across cultures and populations (Herndon et al., 2012; Pinto et al., 2020). Gold et al.…”

“…(2019) focused on one region of New York State. Some articles studied one state's data in their ecological analyses (Alcala et al., 2017; Dresden et al., 2017; Fung et al., 2014; McGovern et al., 2017; Pinto et al., 2020) while others collected data from multiple states (Chang et al., 2014; Hernandez‐Boussard et al., 2014; Herndon et al., 2012; Taubman et al., 2014). Nikpay et al.…”

“…(2017) utilized the databases from their healthcare system while Pinto et al. (2020) investigated within one hospital's admission data cohort in New Jersey.…”