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Background <p>Asthma is the most prevalent pediatric chronic disease, with hospitalization rates disproportionately higher in vulnerable groups. This study examines how socioeconomic, environmental, and clinical factors influence hospitalization risk following an asthma-related emergency department (ED) visit.</p> Methods <p>45,083 pediatric asthma patients (ages 2–17) were identified using hospital discharge data from Maryland and Florida (2016–2020). Independent variables included age, sex, race, comorbidity score, ZIP-level income, and Air Quality Index (AQI). Previous visit types were categorized by previous inpatient admission (pIP) and previous ED visit (pED). Logistic regression was used to evaluate risk factors in follow-up inpatient admission within one year (fIP). Subgroup analysis was conducted by race, state, and previous visit type (pIP vs. pED).</p> Results <p>pIP patients had 4.28 times increased risk of fIP when compared with pED (odds ratio (OR) 4.28, 95% CI 3.65–5.01). Each additional year of age was associated with a 9% decreased risk of fIP (0.91, 0.90–0.93). Black patients had 29% increased risk of fIP relative to whites (1.29, 1.08–1.54). The highest income quartile (≥$69,910) demonstrated a 25% reduction in fIP risk (0.75, 0.61–0.91) when compared with the lowest. Subgroup analyses found that Black patients in the highest AQI quartile (≥ 47) had higher risk of fIP than those in the lowest (2.04, 1.09–3.84), while the highest income quartile was associated with lower fIP risk for Black and Hispanic patients (37% and 45% reductions, respectively). In state-stratified models, Blacks and Hispanics in Maryland had 2.91 (1.20–7.05) and 2.51 (1.21–5.20) times the risk of fIP compared with white patients; Black patients in Florida had 1.80 (1.10–2.93) times increased risk of fIP.</p> Conclusion <p>This study reveals the interplay and disparities between social, environmental, and clinical factors contributing to hospital readmission. Key findings are that younger, Black, pIP, and patients in higher AQI areas or with lower ZIP-level income have a higher risk of fIP. These findings highlight the need for better interventions in vulnerable groups.</p>

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Associations of Race, Area-level Income, and Air Quality on Hospitalization Risk in Pediatric Asthma Patients: A Retrospective Observational Cohort Study

  • 期刊论文

  • 发表日期：

    2026年3月14日

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  • Qingrui Wang,
  • Robert B. Barrett,
  • Maria Sanchez-Jauregui,
  • Hadi Kharrazi

摘要

Background

Asthma is the most prevalent pediatric chronic disease, with hospitalization rates disproportionately higher in vulnerable groups. This study examines how socioeconomic, environmental, and clinical factors influence hospitalization risk following an asthma-related emergency department (ED) visit.

Methods

45,083 pediatric asthma patients (ages 2–17) were identified using hospital discharge data from Maryland and Florida (2016–2020). Independent variables included age, sex, race, comorbidity score, ZIP-level income, and Air Quality Index (AQI). Previous visit types were categorized by previous inpatient admission (pIP) and previous ED visit (pED). Logistic regression was used to evaluate risk factors in follow-up inpatient admission within one year (fIP). Subgroup analysis was conducted by race, state, and previous visit type (pIP vs. pED).

Results

pIP patients had 4.28 times increased risk of fIP when compared with pED (odds ratio (OR) 4.28, 95% CI 3.65–5.01). Each additional year of age was associated with a 9% decreased risk of fIP (0.91, 0.90–0.93). Black patients had 29% increased risk of fIP relative to whites (1.29, 1.08–1.54). The highest income quartile (≥$69,910) demonstrated a 25% reduction in fIP risk (0.75, 0.61–0.91) when compared with the lowest. Subgroup analyses found that Black patients in the highest AQI quartile (≥ 47) had higher risk of fIP than those in the lowest (2.04, 1.09–3.84), while the highest income quartile was associated with lower fIP risk for Black and Hispanic patients (37% and 45% reductions, respectively). In state-stratified models, Blacks and Hispanics in Maryland had 2.91 (1.20–7.05) and 2.51 (1.21–5.20) times the risk of fIP compared with white patients; Black patients in Florida had 1.80 (1.10–2.93) times increased risk of fIP.

Conclusion

This study reveals the interplay and disparities between social, environmental, and clinical factors contributing to hospital readmission. Key findings are that younger, Black, pIP, and patients in higher AQI areas or with lower ZIP-level income have a higher risk of fIP. These findings highlight the need for better interventions in vulnerable groups.