PURPOSE OF THE STUDY.
To assess the association between population-level violent (and all) crime rates and population-level childhood asthma utilization and patient-level risk of asthma reutilization after hospitalization.
Four thousand six hundred and thirty-eight children aged 2 to 17 years who visited the emergency department (ED) or were hospitalized for asthma at Cincinnati Children’s Hospital Medical Center between January 1, 2011, and December 31, 2013.
In this retrospective cohort study, we identified subjects by using diagnosis code 493.XX and classified them demographically by using electronic medical record information. Street addresses were geocoded and linked to 2010 census tracts. The population- and patient-level asthma utilization rates were calculated by dividing the number of asthma ED and hospitalizations per tract by number of children aged 2 to 17 years within that tract. This measurement was annualized over the data collection period. Patient-level reutilization was calculated for 981 hospitalized children who were followed for ≥12 months to identify time to first asthma-related ED revisit and/or rehospitalization. Cincinnati Police Department data were used to calculate violent crime rates (VCRs) and all crime rates (ACRs) by dividing the crime per tract by total people residing in the tract. Crime rates were then stratified as low, low medium, high medium, and high. Poverty rate, unemployment, asthma-related housing code violation density, and traffic-related air pollution were identified as covariates of the study.
Both VCRs and ACRs were associated with asthma utilization with the average asthma utilization rate of 28.0 per 1000 patients and the average VCR and ACR of 10.5 per 1000 patients and 118.7 per 1000 patients per year, respectively. There was a trend toward hospitalized children being more likely to reutilize if they lived in an area with a higher VCR and ACR in unadjusted models.
Crime data may help facilitate early identification of risk factors or stressors relevant to asthma utilization patterns.
Asthma, as any other chronic illness, is affected by social and environmental factors. Crime rates can be used to assess the stress imposed by the environment on a child’s health, particularly in instigating an acute exacerbation, compliance with controller medication, and follow-up with the primary care provider. In this study, a basis is provided for identifying potentially modifiable population-level and patient-level environmental factors which play an important role in the management of asthma, the most common pediatric chronic illness.
- Copyright © 2017 by the American Academy of Pediatrics