Health insurance v. asthma

Having health insurance doesn’t eliminate Black-White disparities in asthma and its effects, according to a new study, which studied only children in the extensive Military Health System, who all have access to the same government-run healthcare in an HMO-style service. The press release says:

Black and Hispanic children were more likely to be diagnosed with asthma at all ages. Black children of all ages and Hispanic children age 5 to 10 were more likely to have potentially avoidable hospitalizations or emergency department visits related to asthma.

Whites were also more likely to see a specialist while Blacks were more likely to go to emergency rooms.

So, some of the asthma gap persists even when everyone has health insurance coverage. But access to insurance coverage per se isn’t the only thing that generates health inequality. Everything from health behavior and education to environmental conditions to racism in the medical system can contribute.

We shouldn’t be surprised that a gap persists even when people have access to medical care. However, when you compare the asthma prevalence rates in the Military Health System to those in the general population of children, in this report, which I covered previously, it appears asthma rates are lower among children in the military system, and the Black-White gap is lower as well.

Note: Includes children only. Total population rates from p. 21 of this report, military rates from this paper in the Archives of Pediatrics and Adolescent Medicine.

Universal health coverage can’t be counted on to eliminate race-ethnic gaps in health and health care, but it probably wouldn’t hurt.

Asthma, environment, inequality

It’s not surprising that local environment plays a role in asthma rates. But new research shows just how much the micro environment — specifically, living in a census tract near a highway or railway intersection — increases the risk of asthma for children.

Co-author Young Juhn says,

…children who lived in census tracts facing the intersection with major highways or railways had about 40 to 70 percent increased risk of developing childhood asthma. … What this tells us is that clinicians need to be concerned about neighborhood environment beyond home environment to understand the individual asthma case.

Once again, I’m not an expert on this, but I’m guessing this local environment connection might help explain both the run-up in asthma rates in the 1980s and 1990s…

And the income inequality in which children get asthma:

The new study is in the Journal of Allergy and Clinical Immunologyhere.

Asthma unequal

A new report from George Washington University public health researchers shows the prevalence of asthma, its concentration among poor children and African Americans, and the cost of failing to take the relatively inexpensive steps necessary to prevent it.

Children with asthma are almost twice as likely as all children to be below the poverty line, and less than half as likely to live at 4-times the poverty line or higher.

My chart from data in the report.

The report estimates that having asthma increases the medical costs for a child by 50%. And the more than 1 million asthma-afflicted children who don’t have health insurance are especially costly to care for – accounting for a large portion of emergency room visits.