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Pudasainee-Kapri S, Li Y, Kapri KP, Fu MR, Wiest D, Kandel P, Hussain MJ. Emergency department visits among children with asthma: Racial/ethnic disparities before and during the COVID-19 pandemic. Nurs Outlook 2025; 73:102394. [PMID: 40252520 DOI: 10.1016/j.outlook.2025.102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 03/21/2025] [Accepted: 03/22/2025] [Indexed: 04/21/2025]
Abstract
BACKGROUND Emergency department (ED) visits for asthma among school-aged children create substantial healthcare burdens. PURPOSE This study aimed to examine the longitudinal trends in asthma ED visits, focusing on the effects of sociodemographic factors (i.e., age, sex, and race/ethnicity) and pandemic influence among school-aged children before, during, and after the pandemic. METHODS We used a large, longitudinal, multisite data of 6,312 school-aged children from 2017 to 2022. Negative binomial regression was used for data analysis. DISCUSSION Stable patterns with higher ED visit rates in Hispanic and Black children were observed prior to the pandemic. During the pandemic, sharp declines in ED visits were observed across all groups, with Black and Hispanic children sustaining higher rates compared with White children. CONCLUSION Higher rates of ED visits continued for Black and Hispanic children. Future interventions should focus on improving the effects of racial disparities and incorporating effective strategies for asthma management.
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Affiliation(s)
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, NJ
| | - Kul Prasad Kapri
- Department of Political Science and Economics, Rowan University, Glassboro, NJ
| | - Mei Rosemary Fu
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO
| | | | - Prakash Kandel
- Department of Public Policy and Administration, Rutgers University-Camden, Camden, NJ
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Micheals K, Bhavnani D, Matsui EC. Examining disparities in biologic therapy initiation: The intersection of race/ethnicity and insurance type. J Allergy Clin Immunol 2025; 155:810-812. [PMID: 39761796 DOI: 10.1016/j.jaci.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 12/30/2024] [Accepted: 01/02/2025] [Indexed: 01/18/2025]
Affiliation(s)
- Khamron Micheals
- Department of Population Health, Dell Medical School, Austin, Tex; Steve Hicks School of Social Work, University of Texas at Austin, Austin, Tex
| | - Darlene Bhavnani
- Department of Population Health, Dell Medical School, Austin, Tex
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Bhavnani D, Lilley T, Rathouz PJ, Beaudenon-Huibregtse S, Davis MF, McCormack MC, Keet CA, Balcer-Whaley S, Newman M, Matsui EC. Indoor allergen exposure and its association to upper respiratory infections and pulmonary outcomes among children with asthma. J Allergy Clin Immunol 2024; 154:1434-1441. [PMID: 39168187 PMCID: PMC11955957 DOI: 10.1016/j.jaci.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Certain environmental allergen exposures are more common in disadvantaged communities and may contribute to differences in susceptibility to upper respiratory infections (URIs). OBJECTIVES We examined associations between indoor allergens and: (1) URI; (2) URI + cold symptoms; (3) URI + cold symptoms + pulmonary eosinophilic inflammation (fraction of exhaled nitric oxide ≥20 ppb); and (4) URI + cold symptoms + reduced lung function (percent predicted forced expiratory volume in 1 second of <80%). METHODS We used data from the Environmental Control as Add-on Therapy for Childhood Asthma (ECATCh) study. Allergen concentrations were measured in air (mouse) and settled dust (mouse, cockroach, dog, and cat). URI was determined by testing nasal mucus for upper respiratory viruses. We evaluated associations between allergen concentrations and URI-associated outcomes accounting for age, sex, study month, season, health insurance, and household size. RESULTS Ninety participants (92% Black, 92% public insurance) with 192 observations were included; 52 (27%) of observations were positive for URI. A doubling in cockroach allergen concentration increased the odds of a URI with cold symptoms by 18% (odds ratio [OR] = 1.18, 95% confidence interval [CI], 0.99-1.40), the odds of a URI + cold symptoms + pulmonary eosinophilic inflammation by 31% (OR = 1.31, 95% CI, 1.10-1.57), and the odds of a URI + cold symptoms + reduced lung function by 45% (OR = 1.45, 95% CI, 1.13-1.85). Mouse allergen concentrations were positively associated with all outcomes. Associations were suggestively stronger among children sensitized to pest allergens. CONCLUSIONS Cockroach and mouse, but not dog or cat, allergen exposure may predispose children with asthma to URIs with colds and lower respiratory outcomes.
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Affiliation(s)
- Darlene Bhavnani
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Tex.
| | - Travis Lilley
- Department of Statistics and Data Sciences, College of Natural Sciences, University of Texas at Austin, Austin, Tex
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Tex
| | | | - Meghan F Davis
- Department of Molecular and Comparative Pathobiology, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Md; Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Corinne A Keet
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Susan Balcer-Whaley
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Tex
| | - Michelle Newman
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Md
| | - Elizabeth C Matsui
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Tex
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Cockrell HC, Shah NR, Krinock D, Siddiqui SM, Englum BR, Meckmongkol TT, Koo N, Murphy J, Richards MK, Martin K. Health Disparities Research: What Every Pediatric Surgeon Should Know. J Pediatr Surg 2024; 59:161636. [PMID: 39122610 DOI: 10.1016/j.jpedsurg.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 06/05/2024] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
While the earliest published health disparity research in the United States dates to 1899, the field was not formally established until the late 20th century. Initially focused on race and ethnicity, the field has broadened to include socioeconomic status. Several measures have been developed to quantify socioeconomic disadvantage, including the Social Vulnerability Index, Area Deprivation Index, and Child Opportunity Index. These indices have been validated and demonstrate correlation with health outcomes. However, socioeconomic status cannot fully explain health inequities experienced by people of minoritized racial and ethnic identities. Three generations of health disparities research have been described-identification of disparities, root analysis, and development of interventions to mitigate health inequities. While there has been an increase in publication of health disparity research, there is little third generation work. It is imperative that health disparities research move beyond defining the problem and toward interventions that will reduce health inequities. LEVELS OF EVIDENCE: Level IV.
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Affiliation(s)
- Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Nikhil R Shah
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr, Ann Arbor, MI 48109, USA
| | - Derek Krinock
- Department of Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
| | - Sabina M Siddiqui
- Division of Pediatric Surgery, Arkansas Children's Northwest Hospital, 2601 Gene George Blvd, Springdale, AR 72762, USA
| | - Brian R Englum
- Division of Pediatric Surgery, University of Maryland Children's Hospital, 29 South Greene St Suite GS110, Baltimore, MD 21201, USA
| | - Teerin T Meckmongkol
- Division of Pediatric Surgery, Nemours Children's Health Orlando, 6535 Nemours Pkwy, Orlando, FL 32827, USA
| | - Nathaniel Koo
- Division of Pediatric Surgery, University of Illinois Hospital and Health Sciences System, 840 S. Wood Street, Suite 416, Chicago, IL 60612, USA
| | - Jennifer Murphy
- Division of Pediatric Surgery, Atlantic Medical Group, 1000 Madison Ave, Morristown, NJ 07960, USA
| | - Morgan K Richards
- Division of Pediatric Surgery, St. Luke's Children's Hospital, 305 E Jefferson St, Boise, ID 83712, USA
| | - Kathryn Martin
- Division of Pediatric Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, 100 Woods Rd, MFCH 1123, Valhalla, NY 10595, USA
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Hsiao CC, Cheng CG, Hong ZT, Chen YH, Cheng CA. The Influence of Fine Particulate Matter and Cold Weather on Emergency Room Interventions for Childhood Asthma. Life (Basel) 2024; 14:570. [PMID: 38792592 PMCID: PMC11122191 DOI: 10.3390/life14050570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Children are the most vulnerable to pollution due to their decreased stature, heightened respiratory rate, and frequent outdoor engagement. PM2.5, nitrogen dioxide (NO2), ozone, and cold weather are associated with pediatric asthma. In this study, we investigated the nexus between air pollution, climate factors, and pediatric asthma emergency room visits (ERVs). (2) Method: Pediatric asthma ERV data for healthcare quality from the Taiwanese National Insurance in the Taipei area were obtained from 2015 to 2019. Air pollution and climate factor data were also collected. Poisson regression was employed to determine the relationships with relative risks (RRs). (3) Results: The incidence of pediatric asthma ERVs decreased, with a crude RR of 0.983 (95% CI: 0.98-0.986, p < 0.001). Fine particulate matter (PM2.5) had an adjusted RR of 1.102 (95% CI: 1.037-1.172, p = 0.002) and a 7.7 µg/m3 increase, and air temperature had an adjusted RR of 0.813 (95% CI: 0.745-0.887, p < 0.001) comparing between the highest and lowest quarter air temperature associated with pediatric asthma ERVs. (4) Conclusions: This inquiry underscores the positive associations of PM2.5 and cold weather with pediatric asthma ERVs. The findings could guide the government to establish policies to reduce air pollution and promote children's health.
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Affiliation(s)
- Chih-Chun Hsiao
- Department of Nursing, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
| | - Chun-Gu Cheng
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Zih-Tai Hong
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
| | - Yu-Hsuan Chen
- Division of Chest Medicine, Department of Internal Medicine, Cheng Hsin General Hospital, Taipei 11220, Taiwan
| | - Chun-An Cheng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
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Bhavnani D, Wilkinson M, Chambliss SE, Croce EA, Rathouz PJ, Matsui EC. Racial and Ethnic Identity and Vulnerability to Upper Respiratory Viral Infections Among US Children. J Infect Dis 2024; 229:719-727. [PMID: 37863043 PMCID: PMC10938208 DOI: 10.1093/infdis/jiad459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/07/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND It is unclear whether there are racial/ethnic disparities in the risk of upper respiratory viral infection acquisition and/or lower respiratory manifestations. METHODS We studied all children and children with asthma aged 6 to 17 years in the National Health and Nutrition Examination Survey (2007-2012) to evaluate (1) the association between race/ethnicity and upper respiratory infection (URI) and (2) whether race/ethnicity is a risk factor for URI-associated pulmonary eosinophilic inflammation or decreased lung function. RESULTS Children who identified as Black (adjusted odds ratio [aOR], 1.38; 95% CI, 1.10-1.75) and Mexican American (aOR, 1.50; 95% CI, 1.16-1.94) were more likely to report a URI than those who identified as White. Among those with asthma, Black children were more than twice as likely to report a URI than White children (aOR, 2.28; 95% CI, 1.31-3.95). Associations between URI and pulmonary eosinophilic inflammation or lung function did not differ by race/ethnicity. CONCLUSIONS Findings suggest that there may be racial and ethnic disparities in acquiring a URI but not in the severity of infection. Given that upper respiratory viral infection is tightly linked to asthma exacerbations in children, differences in the risk of infection among children with asthma may contribute to disparities in asthma exacerbations.
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Affiliation(s)
| | | | - Sarah E Chambliss
- Department of Statistics and Data Sciences, College of Natural Sciences, University of Texas at Austin
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