Third, the rates of asthma hospitalization for blacks and Hispanics may be inflated to an unknown degree due to the potential undercounting of minority populations in the data obtained from the Bureau of the Census. Additionally, the identification and coding of race and ethnicity are also subject to reporting error in the 1993 California Discharge file. The effect of the reporting error present in both databases on the rates of hospitalization calculated in this analysis is unknown. Finally, the small area analysis of asthma hospitalization rates was based on ecologic data, ie, median household income and racial composition, and is subject to the biases associated with ecologic analyses. Ecologic studies cannot provide information about the basic causality of a relationship; rather, only information on potential associations can be identified. The results of the multivariate regressions cannot be used to infer person-level relationships because of the risk of ecologic fallacies. However, as used in this and other studies, a small area analysis is a valuable tool to identify high-risk areas and subgroups that may benefit from public health programs aimed at the prevention and/or amelioration of asthma. canadian health and care mall
In conclusion, this study documents the substantial morbidity associated with asthma hospitalizations in the state of California. We found a differential independent risk of asthma hospitalization based on socioeconomic status and race. In particular, the risk of asthma hospitalization is elevated among blacks of all ages, among minority children, and among persons (especially blacks) residing in poorer areas. With the advent of managed care, intense pressure has been applied to reduce health-care costs, with a particular focus on inpatient care. Since asthma is a leading cause of hospitalization for selected age groups, the management of this condition will face increasing scrutiny regarding both its clinical and cost-effectiveness. The resultant impact on the care of minority, young, and poor patients with a chronic disease, such as asthma, requires further investigation.