MD-ScM Candidate Brown University Warren Alpert Medical School Brown University Warren Alpert Medical School Providence, Rhode Island, United States
Background: Asthma is the third leading cause of pediatric hospitalizations, with 1 in 20 children hospitalized annually. School-based policies are vital in reducing asthma morbidity. In the 1990s, states began enacting policies granting children the right to self-carry and self-administer (SCSA) asthma medications in schools. The association between state-level SCSA policies and asthma hospitalizations has not been researched.
Objective: Toexamine whether enactment of state SCSA laws is associated with decreased rates of asthma-related hospitalizations.
Design/Methods: Retrospective analysis of inpatient hospitalization discharge data for children (<18 years old) with a principal diagnosis of asthma from the multi-state Healthcare Cost and Utilization Project. Multivariable regression analysis was performed, using generalized linear models to adjust state-level variance for repeated measures over multiple years. Association of state-level SCSA policies with asthma hospitalization rates were evaluated for 25 states with data from 1999-2012, comparing state asthma-related hospital discharge rates pre- vs. post-SCSA law enactment, while excluding the year of SCSA law enactment in each state (Figure 1). To account for state-level variability attributable to known factors, analysis was adjusted for census region (Figure 2), and ratios comparing state vs. national data regarding race (CDC WONDER), median household income, and proportion of children with Medicaid coverage (US Census).
Results: Median state-level discharge rate for asthma hospitalizations was 433.6 per 100,000 children (IQR 341.3-639.9). When accounting for within-state variation over time, mean year-over-year change in annual asthma hospital discharge rates was -2.1 per 100,000 children (95% CI -3.4, -0.8; p<0.01). When accounting for race, median household income, Medicaid coverage, and census region, states with an SCSA law had significantly lower rates of annual asthma-related hospital discharges than states that had not yet enacted an SCSA law (-18.5, 95% CI -31.5, -5.6; p<0.01) (Table 1). Among covariates, state to national ratio of Black:White race, West and Midwest regions, were associated with asthma-related hospitalizations (Table 1). Conclusion(s): This analysis of 25 states over 14 years suggests enactment of state-level SCSA laws was associated with reduced pediatric asthma-related hospitalizations. Further research of school-based state policies is needed to understand their efficacy as a public health tool.
Figure 1: Timeline of self-carry self-administer policy enactment in 25 study states
Figure 2: Study states grouped by census region
Table 1. Factors associated with annual asthma-related hospital discharge rates per 100,000 children <18 years of age: 1999-2012
Authors/Institutions: Jessica Hoffen, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States; Kim Kaczor, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Kristin Kan, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Anna Volerman, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States; Matthew M. Davis, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States