Abstract 724 General Pediatrics I Topic Plenary, Monday, 5/3

Background: The relationship of social disadvantage to asthma incidence, severity, and treatment is complex. These issues have infrequently been examined in population-based studies.

Objective: To examine the association of social disadvantage to three outcomes: 1) risk of hospitalization for asthma; 2) severity of asthma among those hospitalized; 3) cost of hospital care.

Methods: We linked pediatric asthma discharges in the 1995 SPARCS database for New York state to census data for zip code of residence. Four measures of social disadvantage were examined: 1) zip code mean income; 2) insurance status (Medicaid/other); 3) race; and 4) New York City residence. Per capita hospitalization rates were calculated for each zip code. Severity of asthma was described on a three level scale (asthma alone/with comorbid conditions/requiring intensive care). Multiple regression quantified the independent association of the five measures of social disadvantage to these outcomes. Analyses adjusted for age, gender, and hospital type (public, private nonprofit, private for profit).

Results: There were 20,771 pediatric asthma discharges. Results are shown in the table.

Conclusion: Ecologic measures of social disadvantage were associated with higher rates of hospitalization for asthma but there was no clear relationship of social disadvantage to asthma severity. Hospitals caring for those poor neighborhoods, NYC residents, Medicaid recipients and non-whites experience significantly greater costs. Explanations may include unappreciated differences in severity and/or barriers to early discharge. Of note are the markedly increased costs of care among Hispanic patients, perhaps as a result of linguistic and cultural barriers to early discharge. Whatever the cause, hospitals may experience substantial cumulative costs in providing care for the disadvantaged; for example, pediatric Medicaid asthma patients alone accumulated an additional $2.1 million for inpatient costs during 1995 in the state of New York. (Table)

Table 1 No caption available
Full size table