Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid

J Allergy Clin Immunol. 2017 Sep;140(3):822-827. doi: 10.1016/j.jaci.2017.01.036. Epub 2017 Mar 8.


Background: Although poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner cities do not have higher prevalent pediatric asthma. Whether asthma morbidity is higher in inner-city areas across the United States is not known.

Objective: This study sought to examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma who are enrolled in Medicaid.

Methods: Children aged 5 to 19 enrolled in Medicaid in 2009 to 2010 were included. Asthma was defined by at least 1 outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2-year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty, and race/ethnicity on rates of asthma outpatient visits, ED visits, and hospitalizations.

Results: This study included 16,860,716 children (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but it was associated with significantly more asthma-related ED visits and hospitalizations among those with asthma in crude analyses (risk ratio, 1.48; 95% CI, 1.24-1.36; and 1.97; 95% CI, 1.50-1.72, respectively) and when adjusted for race/ethnicity, age, and sex (adjusted risk ratio, 1.23; 95% CI, 1.08-1.15; and 1.62; 95% CI, 1.26-1.43). Residence in urban or poor areas and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma-related ED visits and hospitalizations.

Conclusions: Residence in poor and urban areas is an important risk factor for asthma morbidity, but not for prevalence, among low-income US children.

Keywords: Asthma; inner city; poverty; urbanization.

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Care / statistics & numerical data
  • Asthma / epidemiology*
  • Asthma / ethnology
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data
  • Ethnicity
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Medicaid / statistics & numerical data
  • Morbidity
  • Poverty
  • Prevalence
  • Racial Groups
  • Residence Characteristics
  • Risk Factors
  • United States / epidemiology
  • Urban Population / statistics & numerical data
  • Young Adult