American Public Health Association. Reducing the rising rates of asthma

Children's Environmental Health: Homes of Influence

Over the past two decades, diverse stakeholder groups, representing various disciplines and perspectives (e.g., federal, state and local policy makers; nonprofit organizations; health professionals; and industry), have devoted considerable resources, expertise, and influence toward efforts that wittingly and unwittingly affect children’s environmental health. In this article, we refer to these groups as “homes of influence,” and we summarize the wide reach and potential impacts of these homes on childhood asthma, as one example that illustrates how these varied groups impact childhood health outcomes. We posit that diverse homes of influence can be most successful in effecting positive change when they understand and acknowledge their respective influences and work together to develop informed, preventive initiatives under the framework of recommendations called, “A Blueprint for Protecting Children’s Environmental Health: An Urgent Call to Action.” This published resource was developed by a panel of thought leaders and experts in the field of children’s environmental health to guide cross-sector collaboration efforts to proactively protect the environmental health of all children.

Pediatric asthma surveillance using Medicaid claims

OBJECTIVE

The purpose of this study was to describe the prevalence of asthma among children using alternative case definitions applied to administrative claims data, and to assess year-to-year classification concordance.

METHODS

This study was a retrospective cohort analysis of 357,729 children 0-18 years using 2001-2002 Michigan Medicaid claims. Asthma cases were classified using six alternative definitions based on outpatient, emergency department, inpatient, and pharmacy claims for asthma, including the Health Plan Employer Data Information Set (HEDIS) persistent asthma criteria commonly used for assessments of asthma health care quality: at least one asthma inpatient admission or emergency department visit, four or more asthma medications events, or four asthma outpatient visits and two asthma medication events.

RESULTS

Overall, asthma prevalence varied widely between alternative case definitions, ranging from 14.9% based on claims evidence of any type of asthma utilization to 3.7% when restricted to those with four or more asthma medication dispensing events. Among cases meeting HEDIS persistent asthma criteria in 2001, 55.5% met these criteria in 2002. Those with four or more asthma medication dispensing events had the best overall classification concordance between 2001 and 2002. Utilization of asthma services and prevalence estimates were highest among children younger than 5 years old, but year-to-year classification concordance was poorest among these cases (p < 0.0001), irrespective of case definition.

CONCLUSIONS

While overall asthma prevalence may remain relatively stable from year to year, individuals may not be classified consistently as cases over time, regardless of case definition. Studies that identify asthma cases in one year and assess asthma outcomes in a subsequent year may introduce substantial bias as a result of case misclassification. Among the case definitions considered in this study, our findings suggest that this bias is minimized among cases classified using the four or more asthma medication dispensing events criterion.