Chest
Volume 113, Issue 5, May 1998, Pages 1277-1284
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Clinical Investigations: Asthma
Race, Income, Urbanicity, and Asthma Hospitalization in California: A Small Area Analysis

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Study objectives

To explicate the interrelationship between asthma hospitalization and race/ethnicity and income.

Design

Small area ecologic analysis using census and administrative data.

Setting and participants

All asthma hospitalizations in California were identified using the 1993 California Hospital Discharge file. Small area analyses of Los Angeles (LA) were compared with published rates in New York City (NYC).

Results

In 1993, the age-adjusted asthma hospitalization rate in California for nonelderly blacks was 42.5/10,000—approximately four times higher than other populations. Black rates remained fourfold higher after stratification by age, income, and urbanicity. Multivariate analyses suggest that the association between black race and asthma hospitalization is independent of income. Regardless of race, children and persons living in poverty were at increased risk for asthma hospitalization. Urbanicity was not a predictor for asthma hospitalization. Overall, asthma hospitalization rates in NYC were 2.8 times higher compared with rates in LA; while rates were similar among blacks (60 vs 40/10,000, respectively), Puerto Rican Hispanics in NYC had dramatically higher rates compared with Mexican Hispanics in LA (63 vs 14/10,000, respectively).

Conclusions

After controlling for socioeconomic status, notable differences in asthma hospitalization by race and ethnicity persist. The reasons for the significantly elevated risk of asthma morbidity among blacks remain unclear.

Section snippets

Definition of Population at Risk

Since the nonelderly population comprises 93% of the asthma population nationwide,15 this asthma hospitalization analysis was restricted to California residents ≤64 years. Information on hospitalizations was obtained from the 1993 California Hospital Discharge file, maintained by the California Office of Statewide Health Planning and Development. This data set represents all of the 3.7 million discharges from acute care nonfederal general hospitals in California in 1993. Information used from

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, Hispanics, 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 Hispanics (13.0/10,000), whites (10.3/10,000), and Asians (9.4/10,000). For blacks and

DISCUSSION

Asthma, a multifactorial disease associated with familial, infectious, allergenic, socioeconomic, psychosocial, and environmental factors, is one of the leading chronic diseases that afflicts children and young adults in the United States. The frequency and length of stay of asthma hospitalizations in California in 1993 were consistent with nationwide rates.18 The annual rate of asthma hospitalization in California was 13.4/10,000 compared with 17.0/10,000 in the United States. The average

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