Statewide Analysis
In 1993, there were a total of 35,800 hospitalizations for asthma among individuals 0 through 64 years of age in California (Table 1). Approximately half (56.4%) of all asthma hospitalizations in California were among blacks, Hispanies, and Asians. The age-adjusted asthma hospitalization rate for blacks 0 to 64 years was 42.5/10,000, nearly four times as high compared with the age-adjusted rates for Hispanies (13.0/10,000), whites (10.3/10,000), and Asians (9.4/ 10,000). For blacks and Hispanies, the principal source of payment for asthma hospitalizations was Medicaid, while private insurance paid for most asthma hospitalizations for whites and Asians. For each racial/ethnic group, the main route of asthma inpatient admission was via the emergency department.
Blacks of all ages and Hispanic and Asian young children were found to have elevated rates of asthma hospitalization in California compared with same-age whites. Blacks in each of the four age groups were hospitalized for asthma 4.6 to 6.0 times more frequently than whites, 2.5 to 3.8 times more frequently than Hispanics, and 2.7 to 7.3 times more frequently than Asians. Moreover, Hispanic and Asian children <5 years were at nearly twice the risk of asthma hospitalization than their white counterparts. Among the older age groups, differences in asthma hospitalization rates among whites, Hispanics, and Asians were minimal. buy zyrtec online

Small Area Analysis
Across the state’s 57 three-digit zip code areas, asthma hospitalizations varied nearly 10-fold, from 4.0/10,000 in Santa Barbara to 39.3/10,000 in Oakland (Fig 1). In Los Angeles, rates varied fourfold, from 6.2/10,000 to 24.3/10,000. The descriptive relationship between asthma hospitalization in California and age, race, and income is presented in Table 2. In each of the four age groups, regardless of race, asthma hospitalization rates were approximately 1.5 times higher for persons residing in the poorest areas (with median household incomes of <$35,000) compared with persons residing in the wealthiest areas (with median household incomes >$35,000). The association between asthma hospitalization rates and area income levels was examined by conducting a test for trend analysis. Within each race/ethnicity group, the risk of asthma hospitalization significantly decreased with increasing median household income (p<0.01 for each race/ethnicity-age group). However, in each income-age strata, blacks consistently exhibited the highest asthma rates of hospitalization compared with the other race/ethnic groups. For example, black children <5 years in every income strata were hospitalized 1.9 to 6.4 times more frequently than whites, Hispanics, and Asians.
Table 1—Asthma Hospitalizations Among California Residents Aged 0 to 64 Years in 1993, by Race/Ethnicity

Characteristic Rate of Asthma Hospitalization per 10,000 Population
White (n = 14,997) Black(n=8,240) Hispanic (n=9,575) Asians (n=2,370)
Age, vr
<5 22.7 108.2 39.9 44.1
5-19 7.8 44.6 12.3 8.0
20-34 4.5 18.0 4.8 2.5
35-64 8.7 37.6 10.9 7.6
0-64 (age adjusted) 10,3 42.5 13.0 9.4
Sex
Male 8.2 39.9 12.8 10.8
Female 12,5 45.1 13.2 8.1
Percent of All Asthma Discharges
Primary source of payment
Medicaid 25,3 51.6 54.6 41.1
Medicare 5.7 4.7 2.0 1.4
Private insurance 58.3 33.8 34.1 49.1
Other 10.6 9.9 9.3 8.4
Source of admission
Emergency department 61.6 68.8 57.9 61.7
Other Source* 38.4 31.2 42.1 38.3

Table 2—Rates of Asthma Hospitalizations by Race, Age, and Income Level in California in 1993

Age Category Median Household Income by Quartiles* Rates per 10,000
White Black Hispanic Asian
<5 yr
Qi 20.77 131.96 48,56 32.24
Q2 30.24 101.22 46.87 56.47
Q3 20.54 97,54 36.48 37.83
Q4 20.75 81.73 43.89 35.12
5-19 vr
Ql 8.37 50.90 13.30 9.70
Q2 9.83 43.44 13,52 9.36
Q3 7.00 43.46 11.74 8.02
Q4 6.74 35.87 11.00 6.23
20-34 yr
Qi 4.65 19.42 4.86 2.35
Q2 5.00 21.19 5.32 3.08
Q3 4.03 13.99 4.93 2.36
Q4 4.28 14.81 4.28 2.21
35-64 vr
Ql 9.85 42.91 13.41 10.62
Q2 9.99 41.73 11.95 7.85
Q3 8.25 25.42 9.81 6.11
Q4 7.62 30,55 8.92 6.89

 

Figure 1. Rates of asthma hospitalization for persons with age <65 years old, by three-digit zip code, in 1993Figure 1. Rates of asthma hospitalization for persons with age