The democratization of asthma

Asthma hospitalizations in Chicago. (2000-2010). Age-adjusted hospitalization rates per 10,000 population (ages 5-64), in nine Chicago zip codes. DATASOURCE: WIDGET:

An over-reaction

Most children happily avoid hospitals, except for maybe one or two days around the time of their birth. For those few who do return, the instigator is often asthma or its loosely related predecessor, bronchiolitis.

Asthma is an immune phenomenon — an over-reaction to what should be a reasonably – tolerated stimulus. Here is an illustration: three kids walk under a tree in springtime. A gust of wind releases a cloud of pollen that envelops the children. One of the kids revels in the beauty of the event. The second one gets tears in his eyes and a stuffy nose. The third child starts to wheeze.

The radar graph above depicts asthma hospitalization rates in nine representative postal codes in the city of Chicago. The graph below shows the median household incomes in these same neighborhoods. Hospitalization rates (across all ages) were highest in the poorest neighborhoods. Relative access to care is a likely culprit.

Median household income in Chicago. (2000 vs. 2011). Median household income (US$) in nine Chicago zip codes. DATASOURCE: US Census Bureau. WIDGET:

Hospitalization is a logical next step, if the preceding step in the cascade of events is a visit to the emergency department. The ED often reluctantly acts as primary caregiver to a population that is un- or under-insured.

Public insurance accessibility is often more robust for children. But if the clinics they must access are overcrowded or oversubscribed, they may be less likely to be consistent in their compliance with preventative therapies. And sometimes realities within the home lead to inconsistent asthma maintenance. The latter issue is not restricted to poor neighborhoods.

The cost of living

Nor is asthma necessarily a disease of the poor. Asthma is becoming more common, affecting one in twelve adults in the United States, with similar rates in the United Kingdom. Yet access to care is the low-hanging fruit in the possible solutions to asthma morbidity. A preventative visit to the pediatrician usually runs under $100. An urgent care clinic visit averages $150, while an emergency department visit for the same ailment costs ten times that. Hospitalization costs are often multiples of the initial emergency department charge.

. . .

You can be a DBLOGS

Joseph DiCarlo
Founder ||
A physician + scientist, and until recently an associate professor of pediatrics at Children's Hospital Los Angeles / USC.
Joseph DiCarlo on EmailJoseph DiCarlo on LinkedinJoseph DiCarlo on Twitter