Risk areas for pediatric acute care: asthma differs from upper and lower respiratory illness.

OBJECTIVE

To determine if emergency department utilization for pediatric respiratory illness varies across small geographic jurisdictions within a large urban city.

DESIGN

A retrospective analysis of Maryland Health Services Cost Review Commission Emergency Department discharge data.

SETTING/PATIENTS: All non-neonatal, Baltimore City residents <18 years old with valid diagnoses admitted and discharged from emergency departments (ED) in the state of Maryland from April 1, 1997 to December 31, 2000 (n=245,339).

MAIN OUTCOME MEASURES

Crude and adjusted ED visit rates for asthma, upper and lower respiratory illnesses (per 1000 population). To evaluate the effect of geography on pediatric ED visit rates, odds of an asthma ED visit, URI, or LRI vs. non-respiratory ED visit were compared across regions of the city.

RESULTS

We determined that residential areas with high ED utilization rates for upper and lower respiratory illnesses, as well as non-respiratory illnesses correlate with regions of high ED utilization for asthma, even after adjusting for race, gender and age of the population. The regions with high odds ratios that an ED visit was for asthma were different from those with high ORs for URI and LRI after also controlling for poverty.

CONCLUSIONS

This suggests that poverty accounts for high utilization of the ED in urban settings, but suggests that environmental exposures that increase the risk of ED care for asthma differ from those that lead to URI and LRI.