A Small Area Analysis
During the last two decades, asthma-related hospitalizations have increased steadily, especially among children and young adults. The Centers for Disease Control and Prevention reported that from 1980 to 1993, asthma hospitalization increased by 28% from 16.8 to 21.4/10,000 persons <24 years.2 The trend of increasing asthma morbidity exists despite major advancements in the pharmacologic treatment of asthma and increased prescription of anti-inflammatoiy medications by physicians in the past two decades. Nationally, 14 million persons suffered from asthma in 1993 to 1994, resulting in nearly 500,000 hospitalizations, 13.7 million ambulatory care visits, and more than $6.2 billion in direct medical expenditures and indirect costs.
It has been well established that the increasing trend in asthma hospitalizations has not occurred uniformly across all patient groups. Ethnic minorities of low socioeconomic status are disproportionately represented in the trends of increasing asthma prevalence and adverse clinical sequelae. Elevated levels of asthma morbidity among blacks and Hispanic Puerto Rican children and young adults residing in poor neighborhoods have been found nationally and in New York City and Boston. Socioeconomic factors that have been implicated in this trend of increasing asthma morbidity include limited health-care access, inadequate health insurance, lack of recognition of asthma severity by patient or physician, psychosocial dysfunction of patient and family, overuse or inappropriate use of asthma medications, and exposure to indoor and outdoor environmental agents. mycanadianpharmacy
Although numerous studies have demonstrated that the concentration of asthma morbidity is found in impoverished urban neighborhoods and among minority populations, scant research has examined the differential risk of asthma hospitalization among and between minority populations residing in areas of similar socioeconomic status. To extend the previous research and address this epidemiologic gap, this study uses small area analyses to characterize, for the first time (to our knowledge), asthma hospitalizations in California in 1993. California was selected because of the occurrence of a disproportionate number of asthma deaths and because nearly half of the population is composed of minority groups. The three objectives of this study are as follows: (1) evaluate the relationship between race/ethnicity and income in the small area variation in asthma hospitalizations in California; (2) determine the role of urbanicity (ie, the degree that an area is urbanized) in contributing to asthma hospitalization; and (3) examine bicoastal (ie, east coast-west coast) differences in asthma hospitalization rates by comparing rates of hospitalization in Los Angeles with published rates in New York City.