Pediatric asthma hospitalization: individual and environmental characteristics of high utilizers in South Texas

Abstract

Objective: Few studies have examined factors affecting the high frequency of hospitalization for pediatric asthma. This study identifies individual and environmental characteristics of children with asthma from a low-income community with a high number of hospitalizations. Methods: The study population included 902 children admitted at least once to a children's hospital in South Texas because of asthma from 2010 to 2016. The population was divided into three groups by utilization frequency (high: !4 times, medium: 2-3 times, or low: 1 time). Individual-level factors at index admission and environmental factors were included for the analysis. Unadjusted and adjusted multivariate ordered logistic regression models were applied to identify significant characteristics of high hospital utilizers. Results: The high utilization group comprised 2.4% of total patients and accounted for substantial hospital resource utilization: 10.8% of all admissions and 13.5% of days stayed in the hospital. Patients in the high utilization group showed longer length of stay (LOS) and shorter time between admissions on average than the other two groups. The multivariate ordered logistic regression models revealed that age of 5-11 years (OR ¼ 0.57, 95%CI ¼ 0.35-0.93), longer LOS (2 days: OR ¼ 1.80, 95%CI ¼ 1.15-2.84; !3 days: OR ¼ 3.38, 95%CI ¼ 2.10-5.46), warm season at index admission (OR ¼ 1.49, 95%CI ¼ 1.01-2.20), and higher average ozone level in children's residential neighborhoods (OR ¼ 1.78, 95%CI ¼ 1.01-3.14) were significantly associated with a higher number of asthma hospitalizations. Conclusions: The findings suggest the importance of monitoring high hospital utilizers and establishing strategies for such patients based on their characteristics to reduce repeated hospitalizations and to increase optimal use of hospital resources.

The Effect of Outdoor Environmental Exposure on Readmission Rates for Children and Adolescents with Asthma—A Systematic Review

“…There were six studies [ 9 , 10 , 11 , 12 , 13 , 22 ] using the odds ratio (OR) to assess the likelihood of readmission rate due to outdoor exposure. Findings for these can be found in Table 2 .…”

“…The air pollutant models were also adjusted for temperature. As Baek et al (2020) [ 13 ] was a substudy of Baek et al (2020) [ 12 ], the exposure is essentially the same; however, the air pollutants were both measured using the daily average prediction from the reliable United States of America environmental protection agency (U.S. EPA) Downscaler model [ 25 ], which were then divided into four categories (quartile 1 (the lowest) to quartile 4 (the highest)). In contrast, Beck et al (2017) [ 17 ] utilised the Health and Environmental Opportunity Index (HEOI) [ 26 ] as the exposure variable.…”

“…The results from Baek et al (2020) [ 13 ] indicated that most of the readmissions occurred after 90 days. In the multivariate analysis, when only individual characteristics were considered, the warm season (OR 1.51 (95% CI 1.03–2.20) p = 0.034) was associated with a higher number of readmissions.…”

“…Many studies have been undertaken to understand factors that trigger asthma exacerbations requiring admissions; however, to a lesser extent only a handful of studies have explored risk factors of asthma readmission rates. Furthermore, very few studies [ 9 , 10 , 11 , 12 , 13 ] have investigated the impact of outdoor environmental risk factors associated with asthma readmission rates. No study has been undertaken to synthesise the outdoor environmental risk factors on readmission rates.…”

Ozone Exposure and Asthma Attack in Children

“…Pulmonary function tests were used to evaluate the prevalence of asthma in children in areas with high and low ozone concentrations, and it was found that ozone pollution would increase the prevalence of asthma ( 12 ). Moreover, high levels of ozone may increase the number of hospitalizations in children with asthma ( 13 ). A study from South Texas that included 902 children who were hospitalized for asthma at least twice found that a higher level of ozone was significantly associated with an increased number of children hospitalized for asthma.…”