Neighborhood-level variability in asthma-related emergency department visits in Central Texas - 24/06/24

Doi : 10.1016/j.jaci.2024.05.024

Rebecca. A. Zárate, PhD, MA ^a,^b, Darlene Bhavnani, PhD, MPH ^a,^b, Sarah Chambliss, PhD ^a,^b, Emily M. Hall, MPH ^b,^c, Corwin Zigler, PhD ^b,^d, Catherine Cubbin, PhD ^b,^e, Matthew Wilkinson, MD, MPH ^f, Elizabeth C. Matsui, MD, MHS ^a,^b,^f,^⁎
^a Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Tex
^b Center for Health and Environment: Education and Research, Dell Medical School, University of Texas at Austin, Austin, Tex
^c Department of Women’s Health, Dell Medical School, University of Texas at Austin, Austin, Tex
^f Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Tex
^d Department of Statistics and Data Sciences, University of Texas at Austin, Austin, Tex
^e Steve Hicks School of Social Work, University of Texas at Austin, Austin, Tex

^∗Corresponding author: Elizabeth C. Matsui, MD, MHS, Department of Population, Dell Medical School at University of Texas at Austin, 1701 Trinity St, Stop 0Z500, Austin, TX 75712.Department of PopulationDell Medical School at University of Texas at Austin1701 Trinity StStop 0Z500AustinTX75712

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Abstract

Background

The extent to which incidence rates of asthma-related emergency department (ED) visits vary from neighborhood to neighborhood and predictors of neighborhood-level asthma ED visit burden are not well understood.

Objective

We aimed to describe the census tract–level spatial distribution of asthma-related ED visits in Central Texas and identify neighborhood-level characteristics that explain variability in neighborhood-level asthma ED visit rates.

Methods

Conditional autoregressive models were used to examine the spatial distribution of asthma-related ED visit incidence rates across census tracts in Travis County, Texas, and assess the contribution of census tract characteristics to their distribution.

Results

There were distinct patterns in ED visit incidence rates at the census tract scale. These patterns were largely unexplained by socioeconomic or selected built environment neighborhood characteristics. However, racial and ethnic composition explained 33% of the variability of ED visit incidence rates across census tracts. The census tract predictors of ED visit incidence rates differed by racial and ethnic group.

Conclusions

Variability in asthma ED visit incidence rates are apparent at smaller spatial scales. Most of the variability in census tract–level asthma ED visit rates in Central Texas is not explained by racial and ethnic composition or other neighborhood characteristics.

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Key words : Asthma disparities, neighborhood, spatial analysis, environment

Abbreviations used : ACS, CrI, ED, PBIR, SES