Asthma Hospitalizations Far More Common Among Homeless Children

By Will Boggs MD

July 05, 2019

NEW YORK (Reuters Health) - Asthma-hospitalization rates are far higher among homeless children than among those with a home, according to a study of New York State youth.

"An asthma-hospitalization rate that is 31 times higher among homeless children than non-homeless children is disturbing," said Dr. Rie Sakai-Bizmark from Harbor-UCLA Medical Center, in Torrance, and David Geffen School of Medicine at the University of California, Los Angeles.

"Not only does the hospitalization rate take a human toll on these children, but the costs to the healthcare system when preventive asthma control is not available or heavily promoted are staggering," she told Reuters Health by email.

Nearly 35% of homeless youth in New York have asthma symptoms, and previous studies have shown that children from disadvantaged households are more likely to discontinue preventive medication (even if prescribed) and to seek treatment of asthma at the emergency department (ED). How this contributes to asthma-attributed healthcare use remains unclear.

Dr. Sakai-Bizmark and colleagues used data from the Healthcare Cost and Utilization Project's State Inpatient Database from New York to examine differences between homeless and non-homeless youth in asthma-symptom severity and healthcare use.

The study included more than 71,000 asthma hospitalizations, including 11,202 homeless patients and 60,635 non-homeless patients.

Homeless patients were significantly more likely to be African American and Hispanic, more likely to be girls and more likely to be on public insurance or be uninsured, compared with non-homeless patients.

The overall rate of asthma hospitalization was 73.8 per 1,000 homeless children, compared with 2.3 per 1,000 non-homeless children, between 2009 and 2014, the researchers report in Pediatrics, online July 1.

Compared with non-homeless patients, homeless patients had nearly twice the odds of admission from the ED (P<0.01), and, among patients older than 5 years, had 45% greater odds of receiving ventilation (P=0.04).

Within a given year, 13.0% of pediatric patients with asthma were readmitted to the hospital for asthma-related care, and readmission rates were significantly higher for homeless patients (16.0%) than for non-homeless patients (12.5%).

Annually, accumulated per-patient costs were significantly lower among homeless patients ($2,550) than among non-homeless patients ($3,487).

"We expect many factors are involved in this disparity, including severity of the asthma case, ability of the patient to follow post-hospitalization instructions, and availability of needed medications," Dr. Sakai-Bizmark said. "So, from both preventive and institutional perspectives, the healthcare system can improve outcomes for homeless children with asthma through greater attention to homeless family routines, environments, and access to healthcare."

"Even with full healthcare funding, the situational problems must be addressed to improve the quality of life for young asthmatics who are homeless," she said. "Education must extend not only to the homeless family, but other caretakers in the system. Social workers, shelter administrators, and teachers are just some of the people who can help homeless children manage their asthma so their health will improve, and hospitalization will be unneeded."

"In the long run, by extending the necessary resources during the preventive phase and reducing hospitalizations, resources will be saved," Dr. Sakai-Bizmark said. "Most importantly, quality of life can improve for the affected children."

She added, "I think also we may have to seriously consider a program of homelessness specialist physicians as well. I envision that there will be wide disparities in the degree of attention physicians pay to homelessness status, and that might well require distinct physician training to ensure that the response in terms of the health care system is uniform, compassionate, and maximally effective."


Pediatrics 2019.