Comparison of associations of household-level and neighbourhood-level poverty markers with paediatric asthma care utilisation by race/ethnicity in an open cohort of community health centre patients

• Authors: Jennifer A Lucas, Oregon Health & Science University; Miguel Marino, Oregon Health & Science University; Steffani R Bailey, Oregon Health & Science University; Audree Hsu, California University; Roopradha Datta, Oregon Health & Science University; Erika Cottrell, OCHIN Inc, Portland; Ye Ji Kim, Emory University; Shakira F Suglia, Emory University; Andrew Bazemore, American Board of Family Medicine, Lexington; John Heintzman, Oregon Health & Science University
• Journal Title: Family Medicine and Community Health
• Volume: Volume 11, Number 3
• Publisher: BMJ | 2023-07-31
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/fmch-2022-001760
• Subjects: Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: child health services; healthcare disparities; primary health care; social determinants of health; Humans; Child; Ethnicity; Poverty; Income; Asthma; Albuterol

Abstract

Objective The objective of this research was to examine how different measurements of poverty (household-level and neighborhood-level) were associated with asthma care utilisation outcomes in a community health centre setting among Latino, non-Latino black and non-Latino white children. Design, setting and participants We used 2012-2017 electronic health record data of an open cohort of children aged <18 years with asthma from the OCHIN, Inc. network. Independent variables included household-level and neighborhood-level poverty using income as a percent of federal poverty level (FPL). Covariate-adjusted generalised estimating equations logistic and negative binomial regression were used to model three outcomes: (1) ≥2 asthma visits/year, (2) albuterol prescription orders and (3) prescription of inhaled corticosteroids over the total study period. Results The full sample (n=30 196) was 46% Latino, 26% non-Latino black, 31% aged 6-10 years at first clinic visit. Most patients had household FPL <100% (78%), yet more than half lived in a neighbourhood with >200% FPL (55%). Overall, neighbourhood poverty (<100% FPL) was associated with more asthma visits (covariate-adjusted OR 1.26, 95% CI 1.12 to 1.41), and living in a low-income neighbourhood (≥100% to <200% FPL) was associated with more albuterol prescriptions (covariate-adjusted rate ratio 1.07, 95% CI 1.02 to 1.13). When stratified by race/ethnicity, we saw differences in both directions in associations of household/neighbourhood income and care outcomes between groups. Conclusions This study enhances understanding of measurements of race/ethnicity differences in asthma care utilisation by income, revealing different associations of living in low-income neighbourhoods and households for Latino, non-Latino white and non-Latino black children with asthma. This implies that markers of family and community poverty may both need to be considered when evaluating the association between economic status and healthcare utilisation. Tools to measure both kinds of poverty (family and community) may already exist within clinics, and can both be used to better tailor asthma care and reduce disparities in primary care safety net settings.