PURPOSE: Asthma exacerbations account for 1% of all ambulatory visits in the United States and almost half a million hospitalizations annually. Socioeconomic factors are consistently associated with asthma-related emergency department (ED) visits in the USA. The purpose of the current study is to determine if the socioeconomic status of adult patients with asthma who visit the ED in Ontario, Canada is related to ED visits.
METHODS: Using data from the Ontario Asthma Regional Variation Study (Lougheed et al. Chest 2006; 129:909-917), the 2001 Statistics Canada Population Census Long Form Census of the Population, and the National Ambulatory Care Reporting System, socioeconomic stratum-specific univariate and multivariate poisson regression analyses of Age category, Sex, Household Income category, and Highest Level of Educational Attainment category on ED visit counts were conducted.
RESULTS: Univariate poisson regression analysis demonstrated that Age and Sex were related to an increased risk for ED visits: Age (20-39 years [RR: 2.26, p<.0001], 40-59 years [RR: 1.49, p=0.0084], 60 years and over [RR: 1.00, p=Reference]) and Sex (Female [RR: 1.82, p<.0001], Male [RR: 1.00, p=Reference]). Age- and Sex-adjusted poisson regression analysis demonstrated that Household Income and Highest Level of Educational Attainment were related to an increased risk of ED visits: Household Income (Persons in households with household income $50,000 and over [RR: 1.00, p=Reference], Persons in households with household income $25,000 to 49,999 [RR: 4.13, p=<0.0001], Persons in households with household income <= $24,999 [RR: 5.38, p=<0.0001]), Highest Level of Educational Attainment (Some or completed university certificates or degrees [RR: 1.00, p=Reference], Without high school graduation certificate [RR: 1.51, p=0.0078], Some or completed trade or college [RR: 1.91, p=<0.0001], High school graduation certificate only [RR: 2.74 , p=<0.0001]). Similar findings were demonstrated in a multivariate poisson regression analysis.
CONCLUSIONS: This study demonstrated strong and graduated increases in the risk of ED visits with increasing markers of socioeconomic deprivation.
CLINICAL IMPLICATIONS: Socioeconomic differences in ED use highlight specific groups of individuals who may be more susceptible to asthma morbidity and mortality. Targeted interventions such as asthma education, prescription drug subsidies, and environmental modification subsidies may decrease the overall burden of asthma in these individuals.
DISCLOSURE: Paul Heffernan: Consultant fee, speaker bureau, advisory committee, etc.: GlaxoSmithKline, Boehringer Ingelheim
Diane Lougheed: University grant monies: Queen, Grant monies (from sources other than industry): Government of Ontario, Ontario Lung Association, Canadian Institute of Health Information, Public Health Agency of Canada, Workplace Saftey and Insurance Board of Canada, PSI Foundation, Bell University Laboratories - University of Toronto, Grant monies (from industry related sources): AllerGen NCE Inc., Ception Therapeutics Inc., Schering-Plough, GlaxoSmithKline, Consultant fee, speaker bureau, advisory committee, etc.: Ontario Lung Association
The following authors have nothing to disclose: Andrew Day, Miao Wang, Miu Lam
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