Urban Residence, Neighborhood Poverty, race/ethnicity and Asthma Morbidity Among Children in Medicaid

Abstract Background Although poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner-cities do not have higher prevalent pediatric asthma. Whether asthma morbidity is higher in inner-city areas across the U.S. not known. Objective To examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma enrolled in Medicaid. Methods Children aged 5-19 enrolled in Medicaid in 2009-2010 were included. Asthma was defined by at least one outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2 year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty and race/ethnicity on rates of asthma outpatient visits, ED visits and hospitalizations. Results 16,860,716 children were included (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but was associated with significantly more asthma-related emergency room visits and hospitalizations among those with asthma in crude analyses (RR 1.48, 95%CI:1.24-1.36 and 1.97, 95%CI:1.50-1.72, respectively) and when adjusted for race/ethnicity, age and gender (aRR 1.23, 95%CI:1.08-1.15 and 1.62, 95%CI:1.26-1.43). Residence in urban or poor areas, and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma related emergency room visits and hospitalizations. Conclusions Residence in poor and urban areas is an important risk factor for asthma morbidity, but not prevalence, among low-income U.S. children.