The association of race and socioeconomic factors with asthma severity was studied using 1997 asthma hospital encounter financial and clinical data obtained from five Chicagoland hospitals within a large integrated delivery system. The two hospitals located in the inner city had a higher proportion of African American, Medicaid, and self-paying patients and a lower median household income than the three suburban hospitals. The inner city hospitals also had a greater percentage of patients with multiple emergency department (ED) encounters and multiple admissions, a lower percentage of admission encounters, and higher median ED encounter charges, compared with the suburban hospitals. Similar relationships were found for ED and admission encounters and 1) African American compared with other races, 2) decreasing household income, and 3) Medicaid compared with commercial insurance.
Adjusted odds ratios for asthma hospital encounter severity were estimated using logistic regression models with variables for age, gender, race, household income, payment method, and hospital location. There were no longer any significant associations between race and hospital encounter severity. On the other hand, inner city hospital location remained associated with a greater percent of multiple ED encounters (OR=1.82), greater than median ED encounter charges (OR=3.53), a smaller proportion of admission encounters (OR=0.41), and less than median admission charges (OR=0.52), compared with suburban hospital location. More multiple ED encounters and higher charges per ED encounter, in combination with fewer admissions and lower charges per admission for inner city versus suburban hospitals suggests less access to continuous and appropriate care in the inner city.
Keywords: Asthma, Access to Health Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.