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Rehospitalization for Asthma is Linked to Financial Strain

Saturday, May 02, 2009

While African-American and low-income children are at increased risk for asthma, the “financial strain” that many families are under better explains the risk of hospital readmission for asthma than does either race or income.

Children in families under the highest financial strain are four times more likely to be readmitted than those with the lowest strain, regardless of race or income, according to a new study by Cincinnati Children’s Hospital Medical Center.

“Understanding the financial strain families are under can help us identify children at greatest risk and provide the best asthma care to keep children out of the hospital,” says Jeff Simmons, MD, a pediatrician at Cincinnati Children’s and the study’s lead author.

The study will be presented Saturday May 2 at the annual meeting of the Pediatric Academic Societies in Baltimore.

Dr. Simmons and his colleagues at Cincinnati Children’s interviewed parents of 567 children and teens, age 1 to 16, hospitalized at Cincinnati Children’s for worsening asthma. The researchers explored the relationship of several risk factors for asthma, including race, income and financial strain, to patients’ histories of prior admission for asthma. 

They studied seven measures of financial strain.  Some were purely financial, such as the inability to pay full rent or mortgage at any time during the past year, and some were social measures, such as whether they had a network of family and friends to turn to for help.

Children of lower income families and African-American children had greater financial strain and risk of asthma readmission.  In the final analysis, however, financial strain explained most of the effects of race and income on readmission risk, suggesting that “these important risk factors may exert their impact on health through potentially modifiable hardships,” says Dr. Simmons.

“The question for physicians and those involved in healthcare quality improvement is, ‘What can we do to have a greater impact on reducing readmission rates?’” says Robert Kahn, MD, senior author on the study. “The answer might have to do with reducing medication co-pays, solving transportation issues or ensuring families are receiving the benefits for which they are eligible, such as food stamps. If families are under such strain that they can’t pay for food, how can we expect them to pay for a bus or cab to get to their doctor appointments?”

The PAS meeting is the largest international meeting focused on research in child health. It is sponsored by the American Academy of Pediatrics, the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association.

About Cincinnati Children's

Cincinnati Children's Hospital Medical Center is one of America’s top three children’s hospitals for general pediatrics and is highly ranked for its expertise in digestive diseases, respiratory diseases, cancer, neonatal care, heart care and neurosurgery, according to the annual ranking of best children's hospitals by U.S. News & World Report. One of the three largest children’s hospitals in the U.S., Cincinnati Children’s is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health.

For its achievements in transforming healthcare, Cincinnati Children's is one of six U.S. hospitals since 2002 to be awarded the American Hospital Association-McKesson Quest for Quality Prize ® for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases, so that children with the most difficult-to-treat diseases and conditions receive the most advanced care leading to better outcomes.  Additional information can be found at www.cincinnatichildrens.org.