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Maternal and Child Health Journal

, Volume 2, Issue 4, pp 223–229 | Cite as

Characteristics of Children Having Multiple Medicaid-Paid Asthma Hospitalizations

  • Anand ChabraEmail author
  • Gilberto F. Chávez
  • Elizabeth J. Adams
  • Don Taylor
Article

Abstract

Objectives: We undertook this population-based study to describe the characteristics of poor children with multiple asthma hospitalizations and to discern if poor minority children have a greater risk for these events than poor white children. Methods: We conducted a retrospective analysis of 1994 California hospital discharge data for asthma hospitalizations among 1 to 12-year-old Medicaid patients (N = 6844 discharges). Risk factors for multiple Medicaid asthma hospitalizations were calculated by using logistic regression procedures. Results: In 1994, asthma hospitalizations accounted for 11.6% of Medicaid-funded hospitalizations for 1 to 12-year-olds in California. These hospitalizations had a mean length of 2.7 days and a mean hospital charge of $6532. After we controlled for source of admission and length of stay, African American children (OR, 1.93; 95% CI 1.49–2.49) and Latino children (OR, 1.34; 95% CI 1.04–1.72) had a higher risk of multiple Medicaid-paid hospitalizations for asthma than did white children. Adjusted odds ratios for multiple asthma hospitalizations were 1.35 (CI, 1.05–1.74) for children with emergency room admissions, and 1.16 (CI, 0.97–1.39) for children having hospital stays of at least 5 days duration. Conclusions: Among children with Medicaid-paid hospitalizations for asthma, the risk for multiple asthma hospitalizations within a year was greater among African Americans and Latinos than among whites. Programs attempting to decrease repeat hospitalizations for asthma may benefit by focusing on these populations.

asthma readmission hospitalization children pediatric 

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REFERENCES

  1. 1.
    Gergen PJ, Mullally DI, Evans R. National survey of prevalence of asthma among children in the United States, 1976 to 1980. Pediatrics 1988;81:1–7.Google Scholar
  2. 2.
    Halfon N, Newacheck PW. Childhood asthma and poverty: differential impacts and utilization of health services. Pediatrics 1993;91:56–61.Google Scholar
  3. 3.
    Mak H, Johnston P, Abbey H, Talamo RC. Prevalence of asthma and health service utilization of asthmatic children in an inner city. J Allergy Clin Immunol 1982;70:367–72.Google Scholar
  4. 4.
    Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med 1992;326:862–6.Google Scholar
  5. 5.
    Evans R, Mullally DI, Wilson RW, Gergen PJ, Rosenberg HM, Grauman JS, Chevarley FM, Feinleib M. National trends in the morbidity and mortality of asthma in the US. Chest 1987;91:65S–74S.Google Scholar
  6. 6.
    Halfon N, Newacheck PW. Trends in the hospitalization for acute childhood asthma, 1970–84. Am J Public Health 1986;76:1308–11.Google Scholar
  7. 7.
    Gergen PJ, Weiss KB. Changing patterns of asthma hospitalization among children: 1979 to 1987. JAMA 1990;264:1688–92.Google Scholar
  8. 8.
    Mitchell EA, Burr D. Comparison of the characteristics of children with multiple admissions to hospital for asthma with those with a single admission. NZ Med J 1987;100:736–8.Google Scholar
  9. 9.
    Mitchell EA, Bland JM, Thompson JMD. Risk factors for readmission to hospital for asthma in childhood. Thorax 1994;49:33–6.Google Scholar
  10. 10.
    Spencer NJ, Lewis MA, Logan S. Diagnostic and socio-demographic changes in multiple hospital admission in children under two over a five-year period. J Public Health Med 1993;15:332–6.Google Scholar
  11. 11.
    To T, Dick P, Feldman W, Hernandez R. A cohort study on childhood asthma admissions and readmissions. Pediatrics 1996;98:191–5.Google Scholar
  12. 12.
    Centers for Disease Control and Prevention. Asthma hospitalizations and readmissions among children and young adults—Wisconsin, 1991–1995. MMWR 1997;46:726–9.Google Scholar
  13. 13.
    Wissow LS, Gittelsohn AM, Szklo M, Starfield B, Mussman M. Poverty, race, and hospitalization for childhood asthma. Am J Public Health 1988;78:777–82.Google Scholar
  14. 14.
    Lozano P, Connell FA, Koepsell TD. Use of health services by African-American children with asthma on Medicaid. JAMA 1995;274:469–73.Google Scholar
  15. 15.
    Chabra A, Chavez GF, Taylor D. Hospital use by pediatric patients: implications for change. Am J Prev Med 1997;13(Suppl 2):30–7.Google Scholar
  16. 16.
    SPSS. SPSS for Windows: Base System User's Guide, Release 7.0. Chicago, IL: SPSS, Inc., 1996.Google Scholar
  17. 17.
    SAS Institute. SAS User's Guide: Basics, Release 6.03. Cary, NC: SAS Institute, Inc., 1988.Google Scholar
  18. 18.
    Centers for Disease Control and Prevention. Epi Info, Version 6: A Word-Processing, Database, and Statistics Program for Public Health on IBM-Compatible Microcomputers. Atlanta, GA: CDC, 1994.Google Scholar
  19. 19.
    Greineder DK, Loane KC, Parks P. Reduction in resource utilization by an asthma outreach program. Arch Pediatr Adolesc Med 1995;149:415–20.Google Scholar
  20. 20.
    Zeiger RS, Heller S, Mellon MH, Wald J, Falkoff R, Schatz M. Facilitated referral to asthma specialist reduces relapses in asthma emergency room visits. J Allergy Clin Immunol 1981;87:1160–8.Google Scholar
  21. 21.
    Mitchell EA, Ferguson V, Norwood M. Asthma education by community child health nurse. Arch Dis Child 1986;61:1184–9.Google Scholar
  22. 22.
    Anderson HR. Increase in hospital admissions for childhood asthma: trends in referral, severity, and readmissions from 1970 to 1985 in a health region of the United Kingdom. Thorax 1989;44:614–9.Google Scholar
  23. 23.
    Storr J, Barrell E, Lenney W. Rising asthma admissions and self referral. Arch Dis Child 1988;63:774–9.Google Scholar
  24. 24.
    Meux EF, Stith SA, Zach A. Report of results from the OSHPD reabstracting project: An evaluation of the reliability of selected patient discharge data July through December 1988. Sacramento, CA: Office of Statewide Health Planning and Development, State of California, 1990.Google Scholar
  25. 25.
    Halfon N, Wood DL, Valdez RB, Pereyra M, Duan N. Medicaid enrollment and health services access by Latino children in inner-city Los Angeles. JAMA 1997;277:636–41.Google Scholar
  26. 26.
    Newacheck PW, Hughes DC, Stoddard JJ. Children's access to primary care: Differences by race, income, and insurance status. Pediatrics 1996;97:26–32.Google Scholar
  27. 27.
    St. Peter RF, Newacheck PW, Halfon N. Access to care for poor children: Separate and unequal? JAMA 1992;267:2760–4.Google Scholar
  28. 28.
    Peters JM, Avol E, Navidi W, London SJ, Gauderman WJ, Lurmann F, Linn WS, Margolis H, Rappaport E, Gong H, Jr., Thomas DC. A study of twelve southern California communities with differing levels and types of air pollution. I. Prevalence of respiratory morbidity. Am J Respir Crit Care Med 1999;159:760–7.Google Scholar
  29. 29.
    Von Behren J, Kreutzer R, Smith D, McLaughlin B. California county asthma hospitalization chart book. Sacramento, CA: Department of Health Services, State of California, 1997.Google Scholar
  30. 30.
    Eggleston PA, Malveaux FJ, Butz AM, Huss K, Thompson L, Kolodner K, Rand CS. Medications used by children with asthma living in the inner city. Pediatrics 1998;101:349–54.Google Scholar
  31. 31.
    Finkelstein JA, Brown RW, Schneider LC, Weiss ST, Quintana JM, Goldmann DA, Homer CJ. Quality of care for preschool children with asthma: the role of social factors and practice setting. Pediatrics 1995;95:389–94.Google Scholar
  32. 32.
    Celano M, Geller RJ, Phillips KM, Ziman R. Treatment adherence among low-income children with asthma. J Pediatr Psychol 1998;23:345–9.Google Scholar
  33. 33.
    Sperber K, Ibrahim H, Hoffman B, Eisenmesser B, Hsu H, Corn B. Effectiveness of a specialized asthma clinic in reducing asthma morbidity in an inner-city minority population. J Asthma 1995;32:335–43.Google Scholar
  34. 34.
    Lieu TA, Quesenberry CP Jr, Capra AM, Sorel ME, Martin KE, Mendoza GR. Outpatient management practices associated with reduced risk of pediatric asthma hospitalization and emergency department visits. Pediatrics 1997;100:334–41.Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • Anand Chabra
    • 1
    Email author
  • Gilberto F. Chávez
    • 1
    • 2
  • Elizabeth J. Adams
    • 1
    • 3
  • Don Taylor
    • 1
  1. 1.Maternal and Child Health BranchCalifornia Department of Health ServicesSacramento
  2. 2.California Department of Health Services, Maternal and Child Health BranchBerkeley
  3. 3.Pregnancy and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlanta

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