PEDIATRICS Vol. 91 No. 1 January 1993, pp. 56-61
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Childhood Asthma and Poverty: Differential Impacts and Utilization of Health Services

Neal Halfon MD, MPH1 and Paul W. Newacheck DRPH2

1 From the Department of Community Health Sciences, School of Public Health, Department of Pediatrics, School of Medicine, University of California, Los Angeles, Center for the Vulnerable Child, Children's Hospital, Oakland
2 From the Institute for Health Policy Studies, and Department of Pediatrics, University of California, San Francisco

Data from the 1988 National Health Interview Survey on Child Health showed that 4.3% of all children younger than 17 years of age had asthma, with poor children demonstrating a slightly greater prevalence than nonpoor (4.8 poor vs 4.2 nonpoor). This poor/nonpoor differential was even greater for children younger than 6 years old (4.2 vs 3.1). Poor children were also more likely to have had more than 7 bed days in the past year because of their asthma. Measures of health service utilization showed that poor children had 40% fewer doctor visits (3.2 vs 5.4) and had 40% more hospitalizations in the previous year (10.6% vs 7.4%). Although more than 90% of all children had a usual source of routine and/or sick care, poor children were more likely to receive routine care in a neighborhood health center (15.1% vs 1.6%) or hospital-based clinic (11.1% vs 2.8%) than in a doctor's office (67.2% vs 91.1%) and, when sick, then were more than four times more likely to report an emergency department as a usual source of care (8.1% vs 1.7%). Diminished accessibility to appropriate outpatient health services for poor children with asthma was associated with increased morbidity, measured by hospitalization, and bed days. These findings have significant implications for the development of comprehensive models of care and the potential role that community clinics could play with increased funding as a result of Medicaid changes that were instituted as part of the 1989 Omnibus Budget Reconciliation Act.

Key Words: asthma • poverty • health services • hospitalization

Submitted on March 9, 1992
Accepted on June 22, 1992


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The Fresno Asthma Project: A Model Intervention to Control Asthma in Multiethnic, Low-Income, Inner-City Communities
Health Educ Behav, February 1, 1998; 25(1): 79 - 98.
[Abstract] [PDF]

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 PediatricsHome page
D. C. Goodman, T. A. Stukel, and C.-h. Chang
Trends in Pediatric Asthma Hospitalization Rates: Regional and Socioeconomic Differences
Pediatrics, February 1, 1998; 101(2): 208 - 213.
[Abstract] [Full Text] [PDF]

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 Arch Fam MedHome page
A. G. Mainous III and W. J. Hueston
The Cost of Antibiotics in Treating Upper Respiratory Tract Infections in a Medicaid Population
Arch Fam Med, January 1, 1998; 7(1): 45 - 49.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
R. F. Lemanske Jr and W. W. Busse
Asthma
JAMA, December 10, 1997; 278(22): 1855 - 1873.
[Abstract] [PDF]

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 PediatricsHome page
T. A. Lieu, C. P. Quesenberry Jr, A. M. Capra, M. E. Sorel, K. E. Martin, and G. R. Mendoza
Outpatient Management Practices Associated With Reduced Risk of Pediatric Asthma Hospitalization and Emergency Department Visits
Pediatrics, September 1, 1997; 100(3): 334 - 341.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
C. B. Forrest, B. Starfield, A. W. Riley, and M. Kang
The Impact of Asthma on the Health Status of Adolescents
Pediatrics, February 1, 1997; 99(2): e1 - e1.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
D. Evans, R. Mellins, K. Lobach, C. Ramos-Bonoan, M. Pinkett-Heller, S. Wiesemann, I. Klein, C. Donahue, D. Burke, M. Levison, et al.
Improving Care for Minority Children With Asthma: Professional Education in Public Health Clinics
Pediatrics, February 1, 1997; 99(2): 157 - 164.
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 BMJHome page
M. Shelley, P. Croft, S. Chapman, and C. Pantin
Is the ratio of inhaled corticosteroid to bronchodilator a good indicator of the quality of asthma prescribing? Cross sectional study linking prescribing data to data on admissions
BMJ, November 2, 1996; 313(7065): 1124 - 1126.
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 Arch Pediatr Adolesc MedHome page
J. M. Perrin, P. Greenspan, S. R. Bloom, D. Finkelstein, S. Yazdgerdi, J. M. Leventhal, L. Rodewald, P. Szilagyi, and C. J. Homer
Primary Care Involvement Among Hospitalized Children
Arch Pediatr Adolesc Med, May 1, 1996; 150(5): 479 - 486.
[Abstract] [PDF]

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 Arch Pediatr Adolesc MedHome page
P. L. Geltman, A. F. Meyers, J. Greenberg, and B. Zuckerman
Welfare Reform and Children's Health
Arch Pediatr Adolesc Med, April 1, 1996; 150(4): 384 - 389.
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 Arch Fam MedHome page
A. G. Mainous III, R. J. Zoorob, and W. J. Hueston
Current Management of Acute Bronchitis in Ambulatory Care: The Use of Antibiotics and Bronchodilators
Arch Fam Med, February 1, 1996; 5(2): 79 - 83.
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 JAMAHome page
P. W. Newacheck, D. C. Hughes, A. English, H. B. Fox, J. Perrin, and N. Halfon
The Effect on Children of Curtailing Medicaid Spending
JAMA, November 8, 1995; 274(18): 1468 - 1471.
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 CLIN PEDIATRHome page
A. M. Butz, F. J. Malveaux, P. Eggleston, L. Thompson, K. Huss, K. Kolodner, and C. S. Rand
Social Factors Associated With Behavioral Problems in Children With Asthma
Clinical Pediatrics, November 1, 1995; 34(11): 581 - 590.
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 Arch Pediatr Adolesc MedHome page
L. M. Pachter, M. M. Cloutier, and B. A. Bernstein
Ethnomedical (Folk) Remedies for Childhood Asthma in a Mainland Puerto Rican Community
Arch Pediatr Adolesc Med, September 1, 1995; 149(9): 982 - 988.
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 Arch Pediatr Adolesc MedHome page
E. F. Crain, K. B. Weiss, and M. J. Fagan
Pediatric Asthma Care in US Emergency Departments: Current Practice in the Context of the National Institutes of Health Guidelines
Arch Pediatr Adolesc Med, August 1, 1995; 149(8): 893 - 901.
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 Arch Pediatr Adolesc MedHome page
R. Bussing, N. Halfon, B. Benjamin, and K. B. Wells
Prevalence of Behavior Problems in US Children With Asthma
Arch Pediatr Adolesc Med, May 1, 1995; 149(5): 565 - 572.
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 Med Care Res RevHome page
S. T. Fleming
Primary Care, Avoidable Hospitalization, and Outcomes of Care: A Literature Review and Methodological Approach
Med Care Res Rev, March 1, 1995; 52(1): 88 - 108.
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 Arch Pediatr Adolesc MedHome page
S. M. C. Payne, C. Donahue, P. Rappo, J. J. McNamara, J. Bass, L. First, J. Kulig, S. Palfrey, B. Siegel, and C. Homer
Variations in Pediatric Pneumonia and Bronchitis/Asthma Admission Rates: Is Appropriateness a Factor?
Arch Pediatr Adolesc Med, February 1, 1995; 149(2): 162 - 169.
[Abstract] [PDF]

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 Arch Pediatr Adolesc MedHome page
I. Amirav and F. Burg
The Need to Educate Health Professionals About Childhood Asthma
Arch Pediatr Adolesc Med, December 1, 1994; 148(12): 1339 - 1343.
[Abstract] [PDF]

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 BMJHome page
F A Majeed, N Chaturvedi, R Reading, and Y Ben-Shlomo
Equity in the NHS Monitoring and promoting equity in primary and secondary care
BMJ, May 28, 1994; 308(6941): 1426 - 29.
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