Inequalities in Neighborhood Child Asthma Admission Rates and Underlying Community Characteristics in One US County - 23/07/13
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Abstract |
Objectives |
To characterize variation and inequalities in neighborhood child asthma admission rates and to identify associated community factors within one US county.
Study design |
This population-based prospective, observational cohort study consisted of 862 sequential child asthma admissions among 167 653 eligible children ages 1-16 years in Hamilton County, Ohio. Admissions occurred at a tertiary-care pediatric hospital and accounted for nearly 95% of in-county asthma admissions. Neighborhood admission rates were assessed by geocoding addresses to city- and county-defined neighborhoods. The 2010 US Census provided denominator data. Neighborhood admission distribution inequality was assessed by the use of Gini and Robin Hood indices. Associations between neighborhood rates and socioeconomic and environmental factors were assessed using ANOVA and linear regression.
Results |
The county admission rate was 5.1 per 1000 children. Neighborhood rates varied significantly by quintile: 17.6, 7.7, 4.9, 2.2, and 0.2 admissions per 1000 children (P < .0001). Fifteen neighborhoods containing 8% of the population had zero admissions. The Gini index of 0.52 and Robin Hood index of 0.38 indicated significant inequality. Neighborhood-level educational attainment, car access, and population density best explained variation in neighborhood admission rates (R2 = 0.55).
Conclusion |
In a single year, asthma admission rates varied 88-fold across neighborhood quintiles in one county; a reduction of the county-wide admission rate to that of the bottom quintile would decrease annual admissions from 862 to 34. A rate of zero was present in 15 neighborhoods, which is evidence of what may be attainable.
Le texte complet de cet article est disponible en PDF.Keyword : CCHMC, GCARS, SES
Plan
Supported by the Bureau of Health Professions (BHPR), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS), under the Cincinnati Children's Hospital Medical Center (CCHMC) NRSA Primary Care Research Fellowship in Child and Adolescent Health (T32HP10027). The Greater Cincinnati Asthma Risks Study was supported by the National Institutes of Health (1R01AI88116 [PI: R.S.; Co-PI: A.B., J.S., T.M., and B.H.]). Use of REDCap was supported by the National Center for Clinical and Translational Science and Training (UL1-RR026314-01). The information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPR, HRSA, DHHS, or the US government. The authors declare no conflicts of interest. |
Vol 163 - N° 2
P. 574 - août 2013 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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