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John R. Meurer, MD, MM; Varghese George, PhD; Steve Subichin, MS, MBA; Jennifer Yauck, MSc; Peter Layde, MD, MSc

Arch Pediatr Adolesc Med. 2000;154:143-149.

Background  During the past decade, the number of children with asthma increased; however, the number of asthma hospitalizations for children decreased.

Objective  To assess the proportion of high-severity cases among children hospitalized with asthma and the association of high-severity asthma with patient and hospital characteristics.

Design  The data set used was the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Records were selected of patients 18 years and younger who had the principal diagnosis of asthma. Records were analyzed of 29 077 patients at 746 hospitals in 1990 and 33 443 patients at 811 hospitals in 1995. Asthma severity was classified by All Patient Refined–Diagnosis-Related Groups. Cross-sectional logistic regression analysis was performed using survey data analysis software.

Results  The most common diagnoses associated with high-severity asthma were respiratory distress and respiratory failure. The proportion of high-severity asthma cases did not change significantly between 1990 (4.2%) and 1995 (4.6%) (P = .08). Adolescents and boys were more likely to have high-severity asthma than children aged 5 to 12 years and girls. Western, southern, and north-central hospitals and urban teaching hospitals had a higher proportion of high-severity asthma cases than northeastern hospitals and nonteaching hospitals.

Conclusions  Between 1990 and 1995, the proportion of high-severity cases among children hospitalized with asthma did not change significantly. However, patient age, sex, region of the country, and hospital teaching status were associated with variations in the proportion of high-severity asthma cases.

From the Departments of Pediatrics (Dr Meurer) and Family and Community Medicine (Dr Layde) and the Health Policy Institute (Dr George, Mr Subichin, and Ms Yauck), Medical College of Wisconsin, Milwaukee.

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