Asthma Prevalence Among Medicaid-Enrolled Children

• Type of Material: Article
• Authors: Anna Smith, Georgia Institute of Technology; Nicoleta Serban, Georgia Institute of Technology; Anne Fitzpatrick, Emory University
• Language: English
• Date: 2019-04-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 American Academy of Allergy, Asthma & Immunology
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jaip.2018.10.008
• Title of Journal or Parent Work: Journal of Allergy and Clinical Immunology: In Practice
• Volume: 7
• Issue: 4
• Start Page: 1207
• End Page: +
• Grant/Funding Information: No sources of funding to be reported.
• Keywords: Life Sciences & Biomedicine; In-contact prevalence; Pollution; Risk factors; Wheeze; Science & Technology; Care; Health; Allergy; Immunology; Outdoor air quality; Medicaid claims; Cough; Pediatric asthma; Small-area estimates
• Research Categories: Health Sciences, Public Health; Health Sciences, Immunology; Engineering, System Science

Abstract

Background: Small-area asthma prevalence measures, which are crucial for targeting interventions, are currently sparsely available for children. Objective: To provide measures of in-contact asthma prevalence for the 2012 Medicaid child population so as to highlight areas in need of targeted asthma interventions. Methods: Using the 2012 Medicaid Analytic eXtract claims files, we developed 2 prevalence metrics differentiated by persistent and diagnosed asthma. We developed prevalence measures at the state, county, and census tract levels, with statistical inferences to highlight areas of high prevalence where interventions should be focused. We compared the measures with asthma prevalence estimates derived from a sample of the child population that self-reported whether they have been diagnosed with asthma regardless of in-contact asthma. Results: A total of 1.98 million (8.1%) and 1.71 million (6.9%) Medicaid-enrolled children were identified with in-contact asthma diagnosis and persistent asthma, respectively. Among 40 states, 17 had lower prevalence estimates for the Medicaid-enrolled children compared with similar child asthma self-reported prevalence estimates from the Centers for Disease Control and Prevention. High-prevalence regions spanned primarily in the southern Midwest region, from Texas to West Virginia and from Illinois to north Florida. Conclusion: There are large variations in the differences between the self-reported estimates from the Centers for Disease Control and Prevention for the general population and the in-contact estimates for the Medicaid-enrolled children, highlighting potential asthma misdiagnosis in the Medicaid population in many states. Small-area estimates point to areas of high prevalence, consistently throughout the south and southeast.