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The Impact of Socioeconomic Factors on Asthma Hospitalization Rates by Rural Classification

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Abstract

Asthma hospitalization rates have increased in the past decade. Research has shown that there are multiple correlates for this increase but that driving causal factors may differ for asthma hospitalization rates in rural and non-rural settings. Here we examine the socioeconomic correlates to asthma hospitalization rates in Maine for both rural and non-rural populations to examine the similarity and differences in causal factors. Findings indicate a clear SES gradient relative to asthma hospitalization rates; as population measured SES decreased, asthma hospitalization rates increased. The associated causal factors were found to differ in rural and non-rural areas. In non-rural areas, the presence of insurance was associated with increases in the asthma hospitalization rates while in rural areas, income, occupation and the percentage of non-English language speaking persons were associated with lower asthma hospitalization rates. Public policy should focus on targeted prevention strategies at the community level, especially in rural areas where cultural competency and socioeconomic factors are increasingly important.

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References

  1. Canino, G., McQuaid, E. L., & Rand, C. S. (2009). Addressing asthma health disparities: A multilevel challenge. Journal of Allergy and Clinical Immunology, 123(6), 1209–1219.

    Article  PubMed  Google Scholar 

  2. Wright, R. J., & Subramanian, S. V. (2007). Advancing a multilevel framework for epidemiologic research on asthma disparities. Chest, 132(5), 757S–769S.

    Article  PubMed  Google Scholar 

  3. Akinbami, L. J., & Schoendorf, K. C. (2002). Trends in childhood asthma: Prevalence, health care utilization, and mortality. Pediatrics, 110(2), 315–322.

    Article  PubMed  Google Scholar 

  4. Akinbami, L. (2006). The state of childhood asthma, United States, 1980–2005. Advance Data, 381, 1–24.

    PubMed  Google Scholar 

  5. Rachelefsky, G. S., Shapiro, G. G., Bergman, D., & Blessing-Moore, J. (1999). Pediatric asthma: Promoting best practice. Guide for managing asthma in children. Rochester, NY: American Academy of Allergy, Asthma, and Immunology.

    Google Scholar 

  6. Department of Health and, Human Services. (2000). Healthy people 2010: Conference edition, volume I [and] volume II. http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=ED443795&site=ehost-live.

  7. Chrischilles, E., Ahrens, R., Kuehl, A., et al. (2004). Asthma prevalence and morbidity among rural Iowa schoolchildren. Journal of Allergy and Clinical Immunology, 113(1), 66–71.

    Article  PubMed  Google Scholar 

  8. Mccallister, J. W., & Mastronarde, J. G. (2008). Sex differences in asthma. Journal of Asthma, 45(10), 853–861.

    Article  PubMed  Google Scholar 

  9. Getahun, D., Demissie, K., & Rhoads, G. (2005). Recent trends in asthma hospitalization and mortality in the United States. Journal of Asthma, 42(5), 373–378.

    Article  PubMed  Google Scholar 

  10. Temprano, J., & Mannino, D. M. (2009). The effect of sex on asthma control from the national asthma survey. Journal of Allergy and Clinical Immunology, 123(4), 854–860.

    Article  PubMed  Google Scholar 

  11. Lin, R. Y., & Lee, G. B. (2008). The gender disparity in adult asthma hospitalizations dynamically relates to age. Journal of Asthma, 45(10), 931–935.

    Article  PubMed  Google Scholar 

  12. Bai, Y., Hillemeier, M. M., & Lengerich, E. J. (2007). Racial/ethnic disparities in symptom severity among children hospitalized with asthma. Journal of Health Care for the Poor and Underserved, 18(1), 54–61.

    Article  PubMed  Google Scholar 

  13. Lin, S., Fitzgerald, E., Hwang, S. A., Munsie, J. P., & Stark, A. (1999). Asthma hospitalization rates and socioeconomic status in New York State (1987–1993). Journal of Asthma, 36(3), 239–251.

    Article  PubMed  CAS  Google Scholar 

  14. Jones, V. F., Lawson, P., Robson, G., Buchanan, B., & Aldrich, T. (2004). The use of spatial statistics to identify asthma risk factors in an urban community. Pediatric Asthma, Allergy and Immunology, 17(1), 3–13.

    Article  Google Scholar 

  15. Claudio, L., Tulton, L., Doucette, J., & Landrigan, P. J. (1999). Socioeconomic factors and asthma hospitalization rates in New York City. Journal of Asthma, 36(4), 343–350.

    Article  PubMed  CAS  Google Scholar 

  16. Babin, S. M., Burkom, H. S., Holtry, R. S., et al. (2007). Pediatric patient asthma-related emergency department visits and admissions in Washington, DC, from 2001–2004, and associations with air quality, socio-economic status and age group. Environ Health, 6, 9–11.

    Article  PubMed  Google Scholar 

  17. Shankardass, K., McConnell, R. S., Milam, J., et al. (2007). The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children. Social Science and Medicine, 65(8), 1792–1806.

    Article  PubMed  Google Scholar 

  18. McConnochie, K. M., Russo, M. J., McBride, J. T., Szilagyi, P. G., Brooks, A. M., & Roghmann, K. J. (1999). Socioeconomic variation in asthma hospitalization: excess utilization or greater need? Pediatrics, 103(6), e75.

    Article  PubMed  CAS  Google Scholar 

  19. Liu, S. Y., & Pearlman, D. N. (2009). Hospital readmissions for childhood asthma: The role of individual and neighborhood factors. Public Health Reports, 124(1), 65–78.

    PubMed  Google Scholar 

  20. Saha, C., Riner, M. E., & Liu, G. (2005). Individual and neighborhood-level factors in predicting asthma. Archives of Pediatrics and Adolescent Medicine, 159(8), 759–763.

    Article  PubMed  Google Scholar 

  21. Grineski, S. E. (2009). Predicting children’s asthma hospitalizations: Rural and urban differences in Texas. Rural Sociology, 74(2), 201–219.

    Article  Google Scholar 

  22. Lara, M., Duan, N., Sherbourne, C., Halfon, N., Leibowitz, A., & Brook, R. H. (2003). Children’s use of emergency departments for asthma: Persistent barriers or acute need? Journal of Asthma, 40(3), 289–299.

    Article  PubMed  Google Scholar 

  23. Valet, R. S., Perry, T. T., & Hartert, T. V. (2009). Rural health disparities in asthma care and outcomes. Journal of Allergy and Clinical Immunology, 123(6), 1220–1225.

    Article  PubMed  Google Scholar 

  24. Ownby, D. R. (2005). Asthma in rural America. Annals of Allergy, Asthma & Immunology, 95(5), S17–S22.

    Article  Google Scholar 

  25. Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18(0163–7525), 341–378.

    Article  PubMed  CAS  Google Scholar 

  26. Mechanic, D. (2007). Population health: Challenges for science and society. Milbank Quarterly, 85(0887-378; 3), 533–559.

    Article  PubMed  Google Scholar 

  27. Oakes, J. M., & Rossi, P. H. (2003). The measurement of SES in health research: Current practice and steps toward a new approach. Social Science and Medicine, 56(0277-9536; 4), 769–784.

    PubMed  Google Scholar 

  28. Krieger, N., Chen, J. T., Waterman, P. D., Rehkopf, D. H., & Subramanian, S. V. (2005). Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: The Public Health Disparities Geocoding Project. American Journal of Public Health, 95(0090-0036; 2), 312–323.

    Article  PubMed  Google Scholar 

  29. Krieger, N. (1992). Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology. American Journal of Public Health, 82(0090-0036; 5), 703–710.

    Article  PubMed  CAS  Google Scholar 

  30. Robert, S. A. (1999). Socioeconomic position and health: The independent contribution of community socioeconomic context. Annual Review of Sociology, 25, 489–516.

    Article  Google Scholar 

  31. Krieger, N., Chen, J. T., Waterman, P. D., Soobader, M. J., Subramanian, S. V., & Carson, R. (2002). Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: Does the choice of area-based measure and geographic level matter? The public health disparities geocoding project. American Journal of Epidemiology, 156(0002-9262; 5), 471–482.

    Article  PubMed  Google Scholar 

  32. Krieger, N., Chen, J. T., Waterman, P. D., Soobader, M. J., Subramanian, S. V., & Carson, R. (2003). Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The public health disparities geocoding project (US). Journal of Epidemiology and Community Health, 57(0143-005; 3), 186–199.

    Article  PubMed  CAS  Google Scholar 

  33. Maine Center for Disease Control and Prevention, Division of Chronic Disease, Maine Department of Health and Human Services. (2008). The Burden of Asthma in Maine. http://www.maine.gov/dhhs/bohdcfh/mat/Information%20and%20Publications/2008%20Asthma%20Burden%20Report.pdf.

  34. Goodman, D., Stukel, T. A., & Chang, C.-H. (1998). Trends in pediatric asthma hospitalization rates: Regional and socioeconomic differences. Pediatrics, 101(2), 208–213.

    Article  PubMed  CAS  Google Scholar 

  35. Hirshon, J. M., Weiss, S. R., LoCasale, R., Levine, E., & Blaisdell, C. J. (2006). Looking beyond urban/rural differences: Emergency department utilization by asthmatic children. Journal of Asthma, 43(4), 301–306.

    Article  PubMed  Google Scholar 

  36. Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th ed.). Needham Heights, MA: Allyn and Bacon.

    Google Scholar 

  37. Mertler, C., & Vannatta, R. (2002). Advanced and multivariate statistical methods. Los Angeles: Pryscak Publishers.

    Google Scholar 

  38. WWAMI Rural Health Research Center. (2009). University of Washington Rural-Urban Continuum Codes. http://depts.washington.edu/uwruca/download.html. Updated 2009. Accessed 14 Apr 2009.

  39. Shavers, V. L. (2007). Measurement of socioeconomic status in health disparities research. Journal of the National Medical Association, 99(9), 1013–1023.

    PubMed  Google Scholar 

  40. Marmot, M. G., Kogevinas, M., & Elston, M. A. (1991). Socioeconomic status and disease. WHO Regional Publications. European Series, 37(0378–2255), 113–146.

    PubMed  CAS  Google Scholar 

  41. Krieger, N. (1994). Epidemiology and the web of causation: Has anyone seen the spider. Social Science and Medicine, 39(7), 887–903.

    Article  PubMed  CAS  Google Scholar 

  42. Frenzen, P. D. (1993). Health insurance coverage in U.S. urban and rural areas. Journal of Rural Health, 9(3), 204–214.

    Article  PubMed  CAS  Google Scholar 

  43. Ziller, E. C., Coburn, A. F., Anderson, N. J., & Loux, S. L. (2008). Uninsured rural families. Journal of Rural Health, 24(1), 1–11.

    Article  PubMed  Google Scholar 

  44. Maine Department of Health and Human Services. (2009). Maine Asthma Prevention and Control Programs. http://maine.gov/dhhs/bohdcfh/mat/index.html. Updated 2007. Accessed 14 Apr 2009.

  45. Zhang, W., Mueller, K. J., Chen, L., & Conway, K. (2006). The role of rural health clinics in hospitalization due to ambulatory care sensitive conditions: A study in Nebraska. Journal of Rural Health, 22(3), 220–223.

    Article  PubMed  CAS  Google Scholar 

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Conflict of Interest

The authors have no research support or acknowledgements to disclose.

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Authors and Affiliations

  1. Department of Health Management and Policy, University of New Hampshire, Hewitt Hall, Suite 323, Durham, NH, 03824, USA

    Robert J. McGrath

  2. Department of Sociology, University of New Hampshire, Durham, NH, USA

    Michelle L. Stransky

  3. Department of Health Management and Policy, University of New Hampshire, Durham, NH, USA

    John W. Seavey

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  1. Robert J. McGrath
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  2. Michelle L. Stransky
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  3. John W. Seavey
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Correspondence to Robert J. McGrath.

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McGrath, R.J., Stransky, M.L. & Seavey, J.W. The Impact of Socioeconomic Factors on Asthma Hospitalization Rates by Rural Classification. J Community Health 36, 495–503 (2011). https://doi.org/10.1007/s10900-010-9333-7

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