POVERTY, RACE, AND MEDICATION USE ARE CORRELATES OF ASTHMA HOSPITALIZATION RATES - A SMALL-AREA ANALYSIS IN BOSTON

Hospitalization rates for asthma in New York City are highest in poor urban neighborhoods, although the reasons for this are unknown. We per formed a small area analysis of asthma hospitalization rates in Boston , to determine whether this pattern of asthma hospitalization also obt ained in a medium-sized city and to identify characteristics of neighb orhoods with high hospitalization rates, including the relative use of inhaled anti-inflammatory medication. Zip codes were used to define 2 2 small areas within Boston. The number of asthma hospitalizations for residents of each area in 1992 was obtained from the Codman Research Group. Population and demographic characteristics of each area were ob tained from the 1990 US Census. Estimates of inhaled asthma medication s (beta-agonists, steroids, and cromolyn) dispensed in each area in 19 92 were obtained from IMS America. Asthma hospitalization rates for ea ch of the six areas with the highest rates (5.3 to 9.8 per 1,000 perso ns) were significantly greater than the citywide average of 4.2 hospit alizations per thousand persons (p<0.001 for each comparison). Asthma hospitalization rate was positively correlated with poverty rate and w ith the proportion of nonwhite residents and inversely correlated with income and educational attainment. Asthma hospitalization rate was in versely correlated with the ratio of inhaled anti-inflammatory to beta -agonist medication use (r=-0.55, p=0.008). We conclude that asthma ho spitalization rates in Boston are highest in poor inner city neighborh oods, and that these high rates affect both genders and all age groups . Underuse of inhaled anti-inflammatory medication may be one of the m any factors that contributes to this excess hospitalization.