Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states

Abstract

Background Despite evidence-based prevention and practice guidelines, asthma prevalence, treatment, and outcomes vary widely at individual and community levels. Asthma disproportionate/ly affects low-income and minority children, who comprise a large segment of the Medicaid population. Methods 2007 Medicaid claims data from 14 southern states was mapped for 556 counties to describe the local area variation in 1-year asthma prevalence rates, emergency department (ED) visit rates, and racial disparity rate ratios. Results One-year period prevalence of asthma ranged from 2.8% in Florida to 6.4% in Alabama, with a median prevalence rate of 4.1%. At the county level, the prevalence was higher for Black children and ranged from 1.03% in Manatee County, FL, to 21.0% in Hockley County, TX. Black–White rate ratios of prevalence ranged from 0.49 in LeFlore County, MS, to 3.87 in Flagler County, FL. Adjusted asthma ED visit rates ranged from 2.2 per 1000 children in Maryland to 16.5 in Alabama, with a median Black–White ED-visit rate ratio of 2.4. Rates were higher for Black children, ranging from 0.80 per 1000 in Wicomico County, MD, to 70 per 1000 in DeSoto County, FL. Rate ratios of ED visits ranged from 0.25 in Vernon Parish, LA, to 25.28 in Nelson County, KY. Conclusions and relevance Low-income children with Medicaid coverage still experience substantial variation in asthma prevalence and outcomes from one community to another. The pattern of worse outcomes for Black children also varies widely across counties. Eliminating this variation could substantially improve overall outcomes and eliminate asthma disparities.

Individual and county level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach

“…One analysis found substantial regional variation in asthma ED visits among Medicaid-enrolled children in Michigan [15]. A previous analysis by our group found variation in asthma prevalence and asthma ED utilization based on county of residence for both White and Black pediatric Medicaid enrollees in 14 Southern states [16]. In their comprehensive review of the individual and ecologic causes of asthma health disparities, Gold and Wright detail the complexities related to ecologic drivers of the geographic disparities, and the residential segregation that have been observed [17].…”

Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia

“…9, 17, 18 In one study of asthma hospitalizations and deaths in New York City, the rate of hospital admission was nearly 5 times higher in Blacks than Whites and was further associated with striking differences in neighborhood features. In that study, nearly 75% of the geographic variation in the asthma hospitalization rate was associated with median household income and the percentage of the population that was Black.…”

Using Geospatial Analysis and Emergency Claims Data to Improve Minority Health Surveillance

“…[17, 18] Understanding the underlying epidemiology of each chronic disease is a critical first step in reducing health disparities, and it is important to identify the geographic variation in disease burden that exists within each racial and ethnic group. [19] …”