High asthma prevalence and increased morbidity among rural children in a Medicaid cohort

Background: Urban children represent a group at high risk for asthma development and adverse asthma outcomes. Although rural children also encounter sociodemographic disparities that might be expected to worsen asthma, asthma in the rural United States is poorly studied. Objectives: To determine rural-urban differences in childhood asthma diagnosis and morbidity. Methods: We studied a statewide population of 117,080 children continuously enrolled in Tennessee Medicaid from birth through the sixth year of life, using linked Tennessee Medicaid, vital records, and pharmacy claims databases to determine asthma diagnosis and residence. Results: The cohort was 45% urban, 23% suburban, and 33% rural. Compared with urban children, rural children were more likely to be white, have a history of bronchiolitis, and have mothers who smoked. Eleven percent of urban, 12% of suburban, and 13% of rural children met study criteria for asthma diagnosis (adjusted odds ratio for rural children, 1.16; 95% confidence interval, 1.09-1.24; adjusted odds ratio for suburban children, 1.22; 95% confidence interval, 1.14-1.30; with urban as the referent; P < .001). Rural children had greater use of outpatient asthma care, whereas urban children had greater use of inhaled corticosteroids. Compared with urban children, rural children had fewer asthma emergency department visits but were hospitalized for asthma at similar rates and had similar use of asthma rescue medications. Conclusion: In this pediatric Medicaid population, rural children had increased asthma prevalence and similar asthma morbidity compared with urban children but differences in patterns of asthma care and resource use, suggesting that optimal interventions for asthma may differ in rural compared with urban populations. Ann Allergy Asthma Immunol. 2011;106:467-473.