A Cox regression analysis of covariates for asthma hospital readmissions

Analyzing Racial Disparities in Pediatric Atopic Comorbidity Emergency Department Visitation Using Electronic Health Records

BACKGROUND

Although atopic diseases and associated comorbidities are prevalent in children, little is known about racial differences in emergency department (ED) visitation.

OBJECTIVE

We sought to examine racial differences in ED visitation among children with allergic comorbidities.

METHODS

We conducted a retrospective study of patients (<21 years) who visited the ED at a large pediatric hospital for atopic dermatitis (AD), food allergy (FA), asthma, allergic rhinitis (AR), and eosinophilic esophagitis (EoE) from 2015 to 2019. We determined the probability of ED encounter-free survival time using hazard ratios (HRs) and time to recurrence (TTR) of ED encounter for patients identified as Black/African American (AA) and White/European American (EA). We assessed potentially underlying allergic, demographic, and place-based factors and potential interactions between factors.

RESULTS

A total of 30,894 patients (38% AA and 62% EA) had 83,078 ED encounters (38,378 first ED encounters and 44,700 recurrent ED encounters) during the study period. Asthma and AR showed the highest rate of comorbidity in ED encounters in both AA and EA children. AA children exhibited a higher HR for encounter following index AD and asthma encounters. We found an interaction between the type of insurance and race in ED encounters for AD, FA, AR, and EoE. In AA children, those insured by Medicaid demonstrated a higher HR for any encounter than those with commercial insurance. Conversely, in EA children, those with Medicaid insurance showed a lower HR than their commercially insured peers. Regardless of race, allergic comorbidity increased the HR of ED encounter (1.12-1.62) for all allergic diseases. At 5-year follow-up, mean differences in TTR were shorter in AA children than EA children in AD, FA, and asthma.

CONCLUSIONS

Identification of disease-specific racial disparities in ED visitation related to atopic diseases is a necessary first step toward the design and implementation of interventions capable of equitably reducing emergency care in atopic comorbid children.

Predictive Factors of Hospitalization and Emergency Visits Among Children With Asthma

Introduction A chronic diverse inflammatory disease, asthma affects millions of people worldwide. To control asthma, standardized care is essential. Children with asthma who receive appropriate care have lower emergency room (ER) visits and hospital stays as well as a higher quality of life than children who do not receive appropriate care. We aim to evaluate the predictive variables of hospitalization and ER visits in children with asthma. Methodology In 2022 and 2023, a cross-sectional descriptive study was carried out on children with asthma and their caregivers who were attending primary health care clinics in the eastern region of Saudi Arabia. We used the Childhood Asthma Control Test (C-ACT) to evaluate asthma control. A C-ACT score of less than 19 indicates uncontrolled childhood asthma. To investigate the relationships between the risk factors and the rate of ER visits and hospitalizations, we performed a multiple logistic descriptive analysis. Results In this study, 124 asthmatic children from primary health care centers matched the inclusion criteria. The majority of children had atopy, and their mean age was 10.8±3.4 years. Concerning the risk factors linked to ER visits and hospitalization, there is evidence that not following up with physicians, using more frequent and short-acting beta-agonists, exposure to smoke and household pets, and poor asthma control are linked to increased rates of both ER visits and hospitalizations. Conclusion Better asthma control in children and adolescents may be achieved by providing inexpensive asthma care services, more thorough parental and child education, and effective symptom management. These measures can help reduce exacerbations of asthma and the consequences that accompany them.

Incidence, risk factors and re-exacerbation rate of severe asthma exacerbations in a multinational, multidatabase pediatric cohort study

BACKGROUND

There are sparse real-world data on severe asthma exacerbations (SAE) in children. This multinational cohort study assessed the incidence of and risk factors for SAE and the incidence of asthma-related rehospitalization in children with asthma.

METHODS

Asthma patients 5-17 years old with ≥1 year of follow-up were identified in six European electronic databases from the Netherlands, Italy, the UK, Denmark and Spain in 2008-2013. Asthma was defined as ≥1 asthma-specific disease code within 3 months of prescriptions/dispensing of asthma medication. Severe asthma was defined as high-dosed inhaled corticosteroids plus a second controller. SAE was defined by systemic corticosteroids, emergency department visit and/or hospitalization all for reason of asthma. Risk factors for SAE were estimated by Poisson regression analyses.

RESULTS

The cohort consisted of 212 060 paediatric asthma patients contributing to 678 625 patient-years (PY). SAE rates ranged between 17 and 198/1000 PY and were higher in severe asthma and highest in severe asthma patients with a history of exacerbations. Prior SAE (incidence rate ratio 3-45) and younger age increased the SAE risk in all countries, whereas obesity, atopy and GERD were a risk factor in some but not all countries. Rehospitalization rates were up to 79% within 1 year.

CONCLUSIONS

In a real-world setting, SAE rates were highest in children with severe asthma with a history of exacerbations. Many severe asthma patients were rehospitalized within 1 year. Asthma management focusing on prevention of SAE is important to reduce the burden of asthma.

Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study

Background

Recent studies have demonstrated an association between high blood eosinophil counts and greater risk of asthma exacerbations. We sought to determine whether patients hospitalized for an asthma exacerbation were at greater risk of readmission if they had a high blood eosinophil count documented before the first hospitalization.

Methods

This historical cohort study drew on 2 years of medical record data (Clinical Practice Research Datalink with Hospital Episode Statistics linkage) of patients (aged ≥5 years) admitted to hospital in England for asthma, with recorded blood eosinophil count within 1 baseline year before admission. We analyzed the association between high blood eosinophil count (≥0.35x10⁹ cells/L) and readmission risk during 1 year of follow-up after hospital discharge, with adjustment for predefined, relevant confounders using forward selection.

Results

We identified 2,613 eligible patients with asthma-related admission, of median age 51 years (interquartile range, 36–69) and 76% women (1,997/2,613). Overall, 835/2,613 (32.0%) had a preadmission high blood eosinophil count. During the follow-up year, 130/2,613 patients (5.0%) were readmitted for asthma, including 55/835 (6.6%) with vs. 75/1,778 (4.2%) without high blood eosinophil count at baseline (adjusted hazard ratio [HR] 1.49; 95% CI 1.04–2.13, p = 0.029). The association was strongest in never-smokers (n = 1,296; HR 2.16, 95% CI 1.27–3.68, p = 0.005) and absent in current smokers (n = 547; HR 1.00, 95% CI 0.49–2.04, p = 0.997).

Conclusions

A high blood eosinophil count in the year before an asthma-related hospitalization is associated with increased risk of readmission within the following year. These findings suggest that patients with asthma and preadmission high blood eosinophil count require careful follow-up, with treatment optimization, after discharge.

Inflammatory Bowel Disease: Predictors and Causes of Early and Late Hospital Readmissions

BACKGROUND AND AIMS

The rate of hospital readmission after discharge has been studied extensively in chronic conditions such as hepatic cirrhosis, diabetes mellitus, chronic obstructive pulmonary disease, and heart failure. Causative factors associated with hospital readmission have not been adequately investigated in patients with inflammatory bowel disease (IBD). We studied the rate, causes, and factors that predict readmissions at 1 month, 3 months, and 1 year in patients with IBD.

METHODS

We performed a retrospective cohort study using the electronic medical record of a tertiary academic medical center, encompassing 3 large hospitals to identify patients discharged between January 2007 and December 2010 with a primary discharge diagnosis of either ulcerative colitis or Crohn's disease. The index admission was defined as the first unplanned admission during this period. Readmission was defined as unplanned admission (because of any cause) occurring within 1 week, 1 month, 3 months, and 1 year from the index admission. To identify factors predictive of readmissions, we compared social, demographic, and clinical features at the index admission of patients with readmission and those with no readmissions. Multivariate logistic regression analyses were performed to identify variables associated with 1-month, 3-month, and 1-year readmissions.

RESULTS

A total of 439 index admissions with a primary discharge diagnosis of either ulcerative colitis or Crohn's disease were eligible for inclusion in the study. These patients accounted for a total of 785 admissions to the health system during the study period. The unplanned readmission rates were 5% at 1 week, 14% at 1 month, 23.7% at 3 months, and 39.2% at 1 year. The most common reasons for readmissions were IBD exacerbations, infections, and abdominal pain. On multivariate analysis, receiving total parenteral nutrition (odds ratio [OR] = 2.3; 95% confidence interval [CI], 1.22-4.30) and intensive care unit stay during index admission (OR = 3.61; 95% CI, 1.38-9.46) predicted both early and late readmissions, whereas sex, race, insurer, and outside hospital transfers predicted 1-year readmission. Receiving steroids (OR = 0.52; 95% CI, 0.23-1.15) at index admission was protective against 1-month readmission; being discharged on biologics (OR = 0.44; 95% CI, 0.19-1.02) was protective against 3-month readmission.

CONCLUSIONS

Both early and late hospital readmissions are common in patients with IBD. Because frequent readmissions are indicators of poor quality of care, future prospective studies using larger cohorts of patients are needed to identify modifiable factors in patient care before discharge to improve quality of care, prevent readmissions, and consequently reduce health care costs.

Asthma exacerbations: risk factors for hospital readmissions

OBJECTIVE

The aim of our study is to analyse hospital readmissions due to asthma, as well as the factors associated with their increase.

STUDY DESIGN

We carried out a retrospective study including all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010.

METHODS

The data were gathered by two members of the research team, by reviewing the clinical records. The first hospital admission of each patient was included for this study. An early readmission (ER) was defined as that which occurred in the following 15 days after hospital discharge and late readmission (LR) to that occurring from 16 days after discharge.

RESULTS

This study included 2166 hospital admissions and 1316 patients, with a mean age of 62.6 years. Of the 1316 patients analysed, 36 (2.7%) had one ER and 313 (23.8%) one LR. The only factor independently associated with a higher probability of an ER was poor lung function. A higher probability of LR was associated with a greater severity of the asthma (OR: 17.8, for severe asthma versus intermittent asthma), to have had any hospital admission in the previous year (OR: 3.5) and the use of a combination of ICS-LABA as maintenance treatment.

CONCLUSIONS

About 25% of the patients in our area admitted to hospital due to asthma exacerbation had repeat episodes of hospitalisation.

Age-Related Differences in the Rate, Timing, and Diagnosis of 30-Day Readmissions in Hospitalized Adults With Asthma Exacerbation

BACKGROUND

Reducing hospital readmissions has attracted attention from many stakeholders. However, the characteristics of 30-day readmissions after asthma-related hospital admissions in adults are not known. It is also unclear whether older adults are at higher risk of 30-day readmission.

OBJECTIVES

To investigate the rate, timing, and principal diagnosis of 30-day readmissions in adults with asthma and to determine age-related differences.

METHODS

Retrospective cohort study of adults hospitalized for asthma exacerbation using the population-based inpatient samples of three states (California, Florida, and Nebraska) from 2005 through 2011. Patients were categorized into three age groups: younger (18-39 years), middle aged (40-64 years), and older (≥ 65 years) adults. Outcomes were 30-day all-cause readmission rate, timing, and principal diagnosis of readmission.

RESULTS

Of 301,164 asthma-related admissions at risk for 30-day readmission, readmission rate was 14.5%. Compared with younger adults, older adults had significantly higher readmission rates (10.1% vs 16.5%; OR, 2.15 [95% CI, 2.07-2.23]; P < .001). The higher rate attenuated with adjustment (OR, 1.19 [95% CI, 1.13-1.26]; P < .001), indicating that most of the age-related difference is explained by sociodemographics and comorbidities. For all age groups, readmission rate was highest in the first week after discharge and declined thereafter. Overall, only 47.1% of readmissions were assigned respiratory diagnoses (asthma, COPD, pneumonia, and respiratory failure). Older adults were more likely to present with nonrespiratory diagnoses (41.7% vs 53.8%; P < .001).

CONCLUSIONS

After asthma-related admission, 14.5% of patients had 30-day readmission with wide range of principal diagnoses. Compared with younger adults, older adults had higher 30-day readmission rates and proportions of nonrespiratory diagnoses.

Risk factors for asthma-related healthcare use: longitudinal analysis using the NHI claims database in a Korean asthma cohort

BACKGROUND

Though insurance claims data are useful for researching asthma, they have important limitations, such as a diagnostic inaccuracy and a lack of clinical information. To overcome these drawbacks, we used the novel method by merging the clinical data from our asthma cohort with the National Health Insurance (NHI) claims data.

METHODS AND RESULTS

Longitudinal analysis of asthma-related healthcare use from the NHI claims database, merged with data of 736 patients registered in a Korean asthma cohort, was conducted for three consecutive years from registration of the cohort. Asthma-related asthma healthcare referred to outpatient and emergency department visits, hospitalizations, and the use of systemic corticosteroids. Univariate and multivariate logistic regression analysis was used to evaluate risk factors for asthma-related healthcare. Over three years after enrollment, many patients changed from tertiary to primary/secondary hospitals with a lack of maintenance of inhaled corticosteroid-based controllers. An independent risk factor for emergency visits was a previous history of asthma exacerbation. In hospitalizations, old age and Asthma Control Test (ACT) score variability were independent risk factors. An independent risk factor for per person cumulative duration of systemic corticosteroids was the FEV1 (Forced expiratory volume in one second)%. The use of systemic corticosteroids was independently associated with being female, the FEV1%, and ACT score variability.

CONCLUSION

We found that old age, being female, long-standing asthma, a low FEV1%, asthma brittleness, asthma drug compliance, and a history of asthma exacerbation were independent risk factors for increased asthma-related healthcare use in Korea.

Factors related with the higher percentage of hospitalizations due to asthma amongst women: the FRIAM study

INTRODUCTION

The reason why there is a higher hospitalization rate due to asthma exacerbations amongst women is unclear. The objective of this study is to explore the possible causes that may explain this fact.

METHODS

A multi-center, prospective study including asthma patients hospitalized in the pulmonary medicine departments during a two-year period. By means of a questionnaire, the following data were collected: demographic characteristics and treatment compliance, anxiety-depression, hyperventilation and asthma control, both prior to and during the hospitalization.

RESULTS

183 patients were included, 115 (62.84%) of whom were women. The women were older (52.4 ± 18.3/43.4 ± 18.7; P=.02), were more frequently prescribed inhaled corticosteroids (63.2%/47.1%; P=.03) and had a higher rate of hyperventilation syndrome (57.3/35.9; P=.02) and a longer mean hospital stay (7.3 ± 3.4/5.9 ± 3.6; P=.02). The percentage of smokers among the women was lower (21.2%/38.8%; p=0.01) and the FEV(1) was lower at admittance (58.2% ± 15.9/67.5% ± 17.4; P=.03). In the 40 to 60-year-old age range, an association was demonstrated between being female and the 'previous hospitalizations' variable (OR, 16.1; 95% CI, 1.6-156.7); sex and obesity were also independently associated (OR, 4.8; 95% CI, 1.06-22).

CONCLUSIONS

In this cohort, the rate of hospitalization for asthma was higher in women than in men. Being a woman between the ages of 40 and 60 is associated with previous hospitalizations and is a risk factor for asthma-related hospitalization. This situation could partially be explained by the hormonal changes during menopause, where polyposis and obesity are independent risk factors.

A scoring system to predict readmission of patients with acute pancreatitis to the hospital within thirty days of discharge

BACKGROUND & AIMS

Reducing rapid readmission of patients after discharge could improve quality of treatment and reduce costs. Little is known about clinical predictors of early readmission for acute pancreatitis (AP). We developed a strategy to identify and stratify patients with AP at risk for readmission within 30 days of discharge.

METHODS

We derived and validated a model in a cohort of patients hospitalized with AP from June 2005-October 2009. Early readmission was defined as admission to the hospital or reevaluation in the emergency department within 30 days of discharge. The cohort was divided into a derivation cohort (admitted June 2005-December 2007, n = 248) and a validation cohort (admitted January 2008-October 2009, n = 198). A weighted scoring system was developed using logistic regression for the prediction of early readmission. Accuracy was assessed by area under the receiver-operator characteristic (ROC) curve analysis.

RESULTS

Of the total patients, 21% (92/446) had early readmission. Multivariable analysis identified the following discharge characteristics as independent risk factors for early readmission: gastrointestinal symptoms, eating less than a solid diet, pancreatic necrosis, treatment with antibiotics, and pain (P < .05). Weighted risk scores stratified patients into groups of low, moderate, and high risk for early readmission: 4%, 15%, and 87%, respectively, in the derivation cohort and 5%, 18%, and 68%, respectively, in the validation cohort. Area under the ROC curve demonstrated an accurate prediction (c-statistic = 0.83).

CONCLUSIONS

We created a scoring system that accurately predicts which patients with AP have high and low risk of readmission within 30 days of discharge.

Early readmission in acute pancreatitis: incidence and risk factors

OBJECTIVES

Early unplanned readmission is a potential target for quality improvement and cost reduction. The aims of this study were to (i) determine the frequency of early readmission following hospitalization for acute pancreatitis (AP) and (ii) identify risk factors for early readmission in patients hospitalized for AP.

METHODS

A retrospective, observational cohort study was performed including all inpatients with AP at a tertiary-care hospital between June 2005 and December 2007. Early readmission was defined as admission to the hospital or reevaluation in the emergency department within 30 days of discharge. We analyzed demographics, etiology, markers of severity (according to Atlanta symposium), comorbidities, complications, therapeutic interventions, and discharge symptoms as potential risk factors for readmission.

RESULTS

There were a total of 248 patients discharged with AP during the study period, of whom 19% (47/248) had an early readmission. Median time to readmission was 9 days (interquartile range, 5-15). Median rehospitalization length of stay was 4 days (2.5-8). In multivariate analysis, the strongest risk factors for early readmission included (i) gastrointestinal symptoms (nausea, vomiting, or diarrhea) at discharge (odds ratio (OR) 44.2; 95% confidence interval (CI) 4.1-472.1); (ii) discharge on less than a solid diet (OR 23.8; 95% CI 4.8-118.2); and (iii) moderate to heavy alcohol use (OR 10.1; 95% CI 1.2-82.6).

CONCLUSIONS

(i) Early readmission is a common occurrence in AP. (ii) Risk factors for early readmission included moderate to heavy alcohol use, persistent symptoms, and diet at the time of discharge.

Regional and racial disparities in asthma hospitalizations in Mississippi

BACKGROUND

In the United States, asthma hospitalization rates are disproportionately high among blacks compared with other racial/ethnic groups and vary by geographic region. These disparities among asthma hospitalizations might be affected by social, environmental, and health-care access factors.

OBJECTIVE

To determine demographic risk factors for asthma hospitalizations in urban versus rural areas of Mississippi.

METHODS

A cross-sectional study using data from the Mississippi Asthma Surveillance System was conducted to compare asthma hospitalizations in the urban Jackson metropolitan statistical area and rural Delta regions of Mississippi from 2003 to 2005. Factors including race, sex, age, and household income that might be associated with multiple hospitalizations for asthma (3 or more during the study period) were assessed using logistic regression.

RESULTS

Asthma hospitalization rates were significantly higher among all demographic groups in the rural Delta region compared with the urban Jackson Metropolitan Statistical Area (P < .001). In both regions, hospitalization rates were higher among blacks and females (P < .001). Asthma hospitalization rates were highest among children (0-17 years) and older adults (>or=65 years). In both regions, blacks were more likely to have 3 or more asthma hospitalizations (P < .001). Residents of the Delta had higher odds for multiple hospitalizations controlling for race, sex, age, and household income (P < .05).

CONCLUSION

Blacks with asthma are more likely to have multiple asthma hospitalizations in Mississippi. Higher odds of multiple asthma discharges for Delta residents were not explained by race, sex, age, or income, indicating that other contributing factors (eg, environmental, social, and access to care factors) need further investigation.

Reattendance at hospital for asthma in two Australian states, 2000-2003

OBJECTIVE AND BACKGROUND

Reattendance rates at hospitals and emergency departments (ED) can provide a valuable marker of the quality and effectiveness of clinical care. Linked hospital and ED data from New South Wales and Victoria, Australia, were used to examine reattendances for asthma.

METHODS

Hospital and ED data were linked to identify individuals who reattended hospital or ED for asthma within 28 days of an initial attendance. The sociodemographic characteristics that predicted reattendance were examined using logistic regression.

RESULTS

There were 139,043 attendances for asthma between July 2000 and June 2003 attributed to 95,042 people. Overall, 7.1% of people reattended for asthma within 28 days. There was a significantly higher risk of reattendance among females (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03-1.14), people who lived in areas of greater socioeconomic disadvantage (OR 1.20, 95% CI 1.12-1.29) and Indigenous people (OR 1.15, 95% CI 1.00-1.32). Reattendance rates differed among age groups (P < 0.001), with the lowest rate being in 5- to 14-year-olds.

CONCLUSION

The availability of linked hospital and ED data has provided a rare opportunity to investigate predictors of reattendance for asthma. Surveillance of trends in reattendances for asthma can be used to monitor the effectiveness of interventions to improve asthma control across the continuum of care, particularly in higher-risk groups such as Indigenous people, young children and those with greater socioeconomic disadvantage.

Sample size for regression analyses of theory of planned behaviour studies: case of prescribing in general practice

OBJECTIVES

Interest has been growing in the use of the theory of planned behaviour (TBP) in health services research. The sample sizes range from less than 50 to more than 750 in published TPB studies without sample size calculations. We estimate the sample size for a multi-stage random survey of prescribing intention and actual prescribing for asthma in British general practice. To our knowledge, this is the first systematic attempt to determine sample size for a TPB survey.

METHODS

We use two different approaches: reported values of regression models' goodness-of-fit (the lambda method) and zero-order correlations (the variance inflation factor or VIF method). Intra-cluster correlation coefficient (ICC) is estimated and a socioeconomic variable is used for stratification. We perform sensitivity analysis to estimate the effects of our decisions on final sample size.

RESULTS

The VIF method is more sensitive to the requirements of a TPB study. Given a correlation of .25 between intention and behaviour, and of .4 between intention and perceived behavioural control, the proposed sample size is 148. We estimate the ICC for asthma prescribing to be around 0.07. If 10 general practitioners were sampled per cluster, the sample size would be 242.

CONCLUSIONS

It is feasible to perform sophisticated sample size calculations for a TPB study. The VIF is the appropriate method. Our approach can be used with adjustments in other settings and for other regression models.

Factors associated with acute health care use in a national adult asthma management program

BACKGROUND

The use of acute health care resources for asthma is considerable. Disease severity is an established risk factor, but ethnicity and health care factors are less well studied.

OBJECTIVE

To investigate the independent associations of ethnicity and health care factors with acute resource use for asthma.

METHODS

Longitudinal data from a national adult asthma management program providing universal access to care were analyzed. Outcome measures were unscheduled physician visits with urgent nebulization, emergency department (ED) visits, and hospitalizations.

RESULTS

In multivariate analyses, markers of disease severity were found to be significantly associated with all acute resource use. After controlling for disease severity, ethnicity was associated with increased risk of all acute resource use; Indian (vs Chinese) ethnicity was associated with increased risk of unscheduled physician visits (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.03-1.70), ED visits (HR, 1.61; 95% CI, 1.12-2.32), and hospitalizations (HR, 1.49; 95% CI, 1.03-2.16). Malay ethnicity was associated with unscheduled physician visits (HR, 1.30; 95% CI, 1.01-1.68) and ED visits (HR, 1.55; 95% CI, 1.09-2.19). Default of follow-up appointments was associated with unscheduled physician visits (HR, 1.47; 95% CI, 1.08-2.00), ED visits (HR, 2.35; 95% CI, 1.59-3.45), and hospitalizations (HR, 1.74; 95% CI, 1.09-2.76). Poor inhaler technique was associated with ED visits (HR, 1.86; 95% CI, 1.05-3.30) and smoking with unscheduled physician visits (HR, 1.38; 95% CI, 1.09-1.76).

CONCLUSIONS

In addition to markers of asthma severity, ethnicity, smoking, discontinuity of care, and self-care behavior are risk factors for acute resource utilization and represent target groups and elements of asthma intervention for improving asthma outcomes.

Disparities in asthma hospitalization in Massachusetts

OBJECTIVES

We examined racial disparities in asthma morbidity in Massachusetts.

METHODS

We used Massachusetts case-mix data from 1994 to 2002 to screen and track individual asthma morbidity and hospitalizations, which resulted in a sample of 10145 patients who were first hospitalized for asthma between 1997 and 2000. We followed these patients for 2 years after their first hospitalization. Because asthma is widely considered a preventable cause of hospitalization, we interpreted a readmission for asthma as an indication of failed asthma management.

RESULTS

We found substantial racial/ethnic disparities in readmission rates that persisted after control for comorbidities, payer type, and income. We estimated that the costs of repeat hospitalizations for asthma are in excess of one quarter of all asthma hospitalization costs.

CONCLUSION

Racial/ethnic disparities in asthma readmission rates show that Massachusetts is not on the frontier of asthma treatment.