Neighborhood characteristics associated with hospital readmission for pediatric asthma in Rhode Island, 2001-2005

In 2004, nine million children in the US have been diagnosed with asthma. Asthma risk factors include substandard housing, exposure to environmental pollution, and living in an impoverished neighborhood. To assess the association between neighborhood characteristics and hospital readmissions for pediatric asthma, we merged data from the 2000 US Census with the 2001-2005 Rhode Island Hospital Discharge Data. Children were 18 or younger at time of first admission, had a primary diagnosis of asthma (ICD code 493) for at least one hospital admission in 2001 – 2005, had no prior hospital admissions for asthma during the three years before 2001, and reported a census tract (n = 3,981). After adjusting for age at first admission, gender, year of first admission, race, insurance and clustering by census tract, we found that residing in a census tract with more than 5% of the population living in crowded conditions (adjusted hazards ratio (adjHR) = 1.51, 95% CI=1.19-1.92) and sharing a zip code with a hospital (adjHR=1.25, 95% CI=1.05-1.49) was associated with hospital readmissions. Residing in an economically deprived census tract was not statistically significant. Children with public health insurance were also more likely to have a hospital readmission compared to children with private health insurance (adjHR=1.41, 95% CI=1.17-1.69). These findings suggest hospital readmission for pediatric asthma may reflect barriers in access to primary care or substandard treatment in primary care, thus increasing a family's dependency on inpatient care for a child's asthma care. Results may aid policy makers in crafting targeted public health interventions.