Geographic Disparity in Asthma Hospitalizations: The Role of Race/Ethnicity, Socioeconomic Status, and Other Factors.

Background In the United States, asthma is the most common chronic disease in children, and is associated with low sociodemographic, economic, and environmental factors.  Objective To investigate geographic disparities in asthma hospitalizations and the roles that race/ethnicity, health insurance, and other environmental factors played on these disparities in Lubbock County, Texas.  Methods Data were obtained from the Texas Inpatient Public Use Data File for the years 1999-2018. International classification of disease codes were used to identify primary diagnoses of asthma among all severe inpatient admissions. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).  Results Of the 248,768 patients admitted for severe conditions, 4,224 had a primary diagnosis of asthma. In multivariable-adjusted models, the odds of asthma hospitalizations varied across geographic regions of Lubbock with the Northeast having the highest age-adjusted prevalence (7.17 per 1,000) and ORs for asthma hospitalizations (OR: 1.25, CI: 1.12-1.40). Data suggested that non-Hispanic Blacks using federal insurance in the Northeast region had the highest odds for asthma hospitalizations (OR: 4.88, CI: 3.06-7.79; p-interaction = 0.001). Across all regions, a 1 μg/m increase in particulate matter 2.5 was associated with a 27% higher likelihood of asthma hospitalization (OR: 1.27, 95% CI: 1.23-1.31).  Conclusion In this study, geographic disparities in asthma hospitalizations were observed within Lubbock County and were significantly influenced by a disparate distribution of socioeconomic factors related to health insurance and race/ethnicity. The potential contributory role of particulate matter needs further investigation.