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BACKGROUND: Asthma is a significant source of chronic illness. Across Colorado, 12% of adolescents surveyed in the Youth Behavioral Risk Surveillance System reported having asthma. Demographic and environmental factors associated with poorly controlled asthma include race/ethnicity, income, and exposure to tobacco smoke or air pollution. The Colorado Hospital Association (CHA) receives patient utilization data from Colorado emergency departments (EDs) and hospitals, including diagnosis (ICD-9) and procedure codes, patient residence and demographics, and utilization dates. Public health agencies collaborated with CHA to perform demographic and place-based analyses of asthma-related utilization at EDs and hospitals by Denver residents.
METHODS: Asthma-related inpatient (2004-2011) and ED (2011-2012) encounters were used as two indicators of poorly controlled asthma. Medical encounters were analyzed for differences in the racial/ethnic, economic, and geographic distribution of Denver patients under 20 years old. Asthma-related encounters were ones where any of the first three ICD-9 codes pertained to asthma. Annual healthcare utilization rates were calculated using the US Census and American Community Survey (ACS). Patient race/ethnicity was imputed from the Census because documentation was unreliable in the CHA data. Demographic and income distributions from the Census and ACS were compared among neighborhoods and census tracts with high and low utilization rates.
RESULTS: There were 8,171 asthma-related ED encounters from 2011-2012 (a yearly rate of 28.5 / 1000) and 5,053 inpatient encounters from 2004-2011 (4.4 / 1000). Neighborhood-level ED utilization rates ranged from 2.1 - 83.0 / 1000 and inpatient rates spanned 0.7 - 14.6 / 1000. In the two neighborhoods with the lowest ED rates and the two with the lowest inpatient rates, the predominant race/ethnicity was non-Hispanic White (86%, 84%, 57%, and 87%, respectively). In the two neighborhoods with the highest ED rates, the most common groups were Hispanic and Black (56% and 44%) and in the two with the highest inpatient rates, the most common were Hispanic and non-Hispanic White (56% and 45%). At the census tract level, the tract with the highest ED and inpatient rates had a median household income of $9,874; the tract with the lowest ED rate had a median income of $116,118 and the tract with the lowest inpatient rate had a median income of $82,386.
CONCLUSIONS: Asthma-related healthcare utilization among Denver children and adolescents varied by neighborhood, with higher rates in predominantly Hispanic, African-American, and lower-income neighborhoods. Sources of these differences likely include primary care access, disease management, and exposure to asthma triggers.