Table Info

Table 4.

Odds ratios for non-routine disposition after asthma-related ED visit (regression using 10× imputed dataset, n = 44,196,290)

Variable	AOR	95% CI	p-value
Context
Year of visit
2005 (ref.)
2006	1.00	(0.98, 1.02)	0.9225
2007	1.04	(1.03, 1.06)	< 0.0001
2008	0.85	(0.84, 0.87)	< 0.0001
2009	0.90	(0.88, 0.91)	< 0.0001
2010	1.00	(0.98, 1.01)	0.539
2011	1.01	(1.00, 1.03)	0.1272
2012	1.01	(1.00, 1.03)	0.096
2013	1.05	(1.03, 1.06)	< 0.0001
2014	1.10	(1.09, 1.12)	< 0.0001
Patient three-digit zip code
Los Angeles (ref.)
Homeless/unknown	1.80	(1.73, 1.88)	< 0.0001
Bakersfield vicinity	1.29	(1.17, 1.41)	< 0.0001
Ventura	1.23	(1.10, 1.38)	0.0002
Santa Barbara	1.22	(0.98, 1.52)	0.0807
Mojave	1.19	(1.09, 1.31)	0.0002
Pasadena	1.16	(1.05, 1.28)	0.004
Glendale	1.15	(1.04, 1.26)	0.0045
Burbank	1.13	(0.99, 1.29)	0.0602
Santa Monica	1.12	(0.98, 1.29)	0.0996
San Francisco	1.11	(1.03, 1.21)	0.0097
Torrance	1.07	(0.97, 1.18)	0.1782
San Luis Obispo	1.07	(0.89, 1.28)	0.458
Alhambra	1.06	(0.92, 1.22)	0.3961
San Bernardino	1.06	(0.98, 1.14)	0.1374
San Rafael	1.06	(0.94, 1.18)	0.3311
Santa Ana vicinity	1.05	(0.98, 1.13)	0.1456
San Mateo	1.05	(0.94, 1.17)	0.4201
Sacramento vicinity 1	1.05	(0.98, 1.11)	0.1515
San Bernardino vicinity	1.04	(0.98, 1.10)	0.1969
Eureka	1.03	(0.84, 1.27)	0.7503
Long Beach vicinity	1.03	(0.97, 1.09)	0.2878
Santa Rosa	1.03	(0.92, 1.14)	0.6431
Fresno	1.01	(0.91, 1.12)	0.8441
Long Beach	1.01	(0.94, 1.07)	0.8557
Inglewood vicinity	1.00	(0.96, 1.05)	0.8904
Inglewood	1.00	(0.92, 1.07)	0.9305
Anaheim	0.99	(0.94, 1.05)	0.7281
San Diego North	0.99	(0.92, 1.06)	0.7574
Van Nuys vicinity	0.98	(0.92, 1.05)	0.6024
Redding	0.98	(0.84, 1.16)	0.8328
San Diego South	0.98	(0.91, 1.06)	0.6116
Richmond	0.98	(0.90, 1.06)	0.5837
Pasadena vicinity	0.98	(0.89, 1.07)	0.5829
Indio	0.98	(0.89, 1.07)	0.6124
Sacramento	0.97	(0.90, 1.03)	0.3128
San Diego	0.96	(0.90, 1.04)	0.3123
San Francisco South	0.96	(0.89, 1.03)	0.2601
Whittier	0.96	(0.91, 1.01)	0.1053
Hollywood	0.96	(0.87, 1.05)	0.353
Riverside	0.95	(0.90, 1.02)	0.1512
Fresno vicinity	0.94	(0.86, 1.03)	0.2095
Santa Ana	0.93	(0.86, 1.01)	0.0793
San Jose vicinity	0.93	(0.86, 1.01)	0.1001
Reno (NV)	0.92	(0.75, 1.12)	0.3821
Alhambra vicinity	0.92	(0.87, 0.96)	0.0005
San Jose	0.91	(0.84, 0.98)	0.0182
Van Nuys	0.91	(0.83, 0.99)	0.0235
Stockton North	0.89	(0.82, 0.97)	0.0103
Sacramento east/vicinity 2	0.89	(0.82, 0.97)	0.01
Stockton South	0.89	(0.82, 0.96)	0.0028
Bakersfield	0.88	(0.79, 0.98)	0.0214
Palo Alto	0.87	(0.78, 0.98)	0.0166
Oakland	0.86	(0.81, 0.92)	< 0.0001
Oakland vicinity	0.86	(0.82, 0.91)	< 0.0001
Marysville	0.85	(0.76, 0.96)	0.0078
Outside of California	0.84	(0.80, 0.89)	< 0.0001
Salinas	0.84	(0.68, 1.03)	0.1011
Berkeley	0.75	(0.67, 0.83)	< 0.0001
Hospital control
Government	1.38	(1.30, 1.47)	< 0.0001
For-Profit	0.86	(0.82, 0.90)	< 0.0001
Non-Profit (ref.)
Hospital teaching/location
Urban, non-teaching (ref.)
Rural, non-teaching	1.22	(1.14, 1.32)	< 0.0001
Urban, teaching	0.80	(0.76, 0.84)	< 0.0001
Hospital licensed bed size
0 to 49 beds	1.79	(1.52, 2.10)	< 0.0001
50 to 99 beds	0.94	(0.89, 0.99)	0.0262
100 to 149 beds	0.75	(0.72, 0.79)	< 0.0001
150 to 199 beds	0.91	(0.87, 0.96)	0.0001
200 to 299 beds	0.86	(0.82, 0.91)	< 0.0001
300 to 499 beds	1.15	(1.07, 1.23)	< 0.0001
500+ beds (ref.)
Hospital system status
In system of 3+ hospitals	0.99	(0.97, 1.01)	0.2128
Not in a system (ref.)
DSH status
DSH hospital	1.00	(0.99, 1.02)	0.7694
Non-DSH hospital (ref.)
Hospital Kaiser Permanente status
Non-Kaiser (ref.)
Kaiser	0.59	(0.53, 0.65)	< 0.0001
Pre-disposing
Sex
Male	1.06	(1.05, 1.06)	< 0.0001
Female (ref.)
Age group
0 to 17 years	0.98	(0.95, 1.00)	0.0716
18 to 64 years (ref.)
65 years and greater	1.23	(1.21, 1.26)	< 0.0001
Race
Non-White	1.00	(0.99, 1.01)	0.9535
White (ref.)
Ethnicity
Hispanic	0.96	(0.95, 0.97)	< 0.0001
Non-Hispanic (ref.)
Predisposing-vulnerable domain (any versus no diagnosis)
Anxiety disorders	1.04	(1.03, 1.05)	< 0.0001
Attention-deficit, conduct, and disruptive behavior disorders	1.16	(1.13, 1.19)	< 0.0001
Mood disorders	1.35	(1.34, 1.36)	< 0.0001
Schizophrenia and other psychotic disorders	1.97	(1.94, 1.99)	< 0.0001
Suicide and intentional self-inflicted injury	4.74	(4.67, 4.81)	< 0.0001
Enabling
Payer source
Self-pay	0.87	(0.86, 0.88)	< 0.0001
Medicare	1.15	(1.13, 1.17)	< 0.0001
Medicaid	0.77	(0.76, 0.78)	< 0.0001
Private insurance (ref.)
Other government	0.80	(0.78, 0.83)	< 0.0001
Other	1.68	(1.64, 1.71)	< 0.0001
Need
Asthma
Secondary diagnosis (ref.)
Primary diagnosis	0.87	(0.86, 0.87)	< 0.0001

Model also includes dummy variables to represent 349 unique hospitals. AOR: adjusted odds ratio; DSH: Disproportionate Share Hospital; CI: confidence interval

Declarations

Author contributions

JEB: Conceptualization, Formal analysis, Writing—original draft. ICE: Writing—review & editing. CG: Writing—review & editing. MW: Writing—review & editing. JMB: Writing—review & editing.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval for this study was obtained by the Loma Linda University Health Institutional Review Board which determined that this was not human subjects research (IRB# 5240531).

Consent to participate

The informed consent to participate in this study was exempted by Loma Linda University Health Institutional Review Board due to analyzing public-use data.

Consent to publication

Not applicable.

Availability of data and materials

Public-use data is no longer available. Confidential emergency department data for California may be obtained at: https://hcai.ca.gov/data-and-reports/research-data-request-information/#patient-discharge-data-pdd

Funding

Not applicable.

Copyright

References

Banta JE, Ramadan M, Alhusseini N, Aloraini K, Modeste N. Socio-demographics and asthma prevalence, management, and outcomes among children 1-11 years of age in California. Glob Health Res Policy. 2021;6:17. [DOI] [PubMed] [PMC]

Most recent national asthma data [Internet]. CDC; [cited 2024 August 7]. Available from: https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm

Qin X, Zahran HS, Malilay J. Asthma-related emergency department (ED) visits and post-ED visit hospital and critical care admissions, National Hospital Ambulatory Medical Care Survey, 2010-2015. J Asthma. 2021;58:565–72. [DOI] [PubMed] [PMC]

Codispoti CD, Greenhawt M, Oppenheimer J. The Role of Access and Cost-Effectiveness in Managing Asthma: A Systematic Review. J Allergy Clin Immunol Pract. 2022;10:2109–16. [DOI] [PubMed] [PMC]

Lotfata A, Moosazadeh M, Helbich M, Hoseini B. Socioeconomic and environmental determinants of asthma prevalence: a cross-sectional study at the U.S. County level using geographically weighted random forests. Int J Health Geogr. 2023;22:18. [DOI] [PubMed] [PMC]

Bentué‐Martínez C, Rodrigues M, Llorente González JM, ebastián Ariño AS, Zuil Martínez M, Zúñiga‐Antón M. Spatial patterns in the association between the prevalence of asthma and determinants of health. Geographical Analysis. 2023;56:265–83. [DOI]

Crank PJ, O'Lenick CR, Baniassadi A, Sailor DJ, Wilhelmi O, Hayden M. Sociodemographic Determinants of Extreme Heat and Ozone Risk Among Older Adults in 3 Sun Belt Cities. J Gerontol A Biol Sci Med Sci. 2024;79:glae164. [DOI] [PubMed] [PMC]

To T, Gray N, Ryckman K, Zhu J, Fong I, Gershon A. Sex differences in health services and medication use among older adults with asthma. ERJ Open Res. 2019;5:00242–2019. [DOI] [PubMed] [PMC]

Lin RY, Lee GB. The gender disparity in adult asthma hospitalizations dynamically relates to age. J Asthma. 2008;45:931–5. [DOI] [PubMed]

10.

Fitzpatrick AM, Gillespie SE, Mauger DT, Phillips BR, Bleecker ER, Israel E, et al. Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program. J Allergy Clin Immunol. 2019;143:2052–61. [DOI] [PubMed] [PMC]

11.

Ebell MH, Hall SP, Rustin RC, Powell-Threets K, Munoz L, Toodle K, et al. A Multicomponent, Multi-Trigger Intervention to Enhance Asthma Control in High-Risk African American Children. Prev Chronic Dis. 2019;16:E69. [DOI] [PubMed] [PMC]

12.

Trent SA, Hasegawa K, Ramratnam SK, Bittner JC, Jr CAC. Variation in asthma care at hospital discharge by race/ethnicity groups. J Asthma. 2018;55:939–48. [DOI] [PubMed]

13.

Volpato E, Toniolo S, Pagnini F, Banfi P. The Relationship Between Anxiety, Depression and Treatment Adherence in Chronic Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis. 2021;16:2001–21. [DOI] [PubMed] [PMC]

14.

Becerra MB. Factors associated with increased healthcare utilization among adults with asthma. J Asthma. 2017;54:376–82. [DOI] [PubMed]

15.

Qin X, Pate CA, Zahran HS. Factors associated with emergency department visits for asthma resulting in hospital admission-United States, 2020. J Asthma. 2024;61:717–24. [DOI] [PubMed]

16.

Haskard KB, Banta JE, Williams SL, Haviland MG, DiMatteo MR, Przekop P, et al. Binge drinking, poor mental health, and adherence to treatment among California adults with asthma. J Asthma. 2008;45:369–76. [DOI] [PubMed]

17.

Hospital annual financial data - selected data & pivot tables [Internet]. Department of Health Care Access and Information (HCAI); [cited 2024 February 7]. Available from: https://data.chhs.ca.gov/dataset/hospital-annual-financial-data-selected-data-pivot-tables

18.

Anderson, RM, Davidson PL, Baumeister SE. Improving access to care. In: Changing the U.S. Health care system: Key issues in health services policy and management. 3rd ed. San Francisco: Jossey-Bass; 2014. pp. 33–69.

19.

Becerra BJ, Banta JE, Ghamsary M, Martin LR, Safdar N. Burden of mental illness on hospital and patient outcomes among asthma hospitalizations. J Asthma. 2016;53:392–7. [DOI] [PubMed]

20.

Emergency Department (ED) and Ambulatory Surgery (AS) Data Dictionary Public Use File ED/AS 2010–2014 (Public Use File) [Internet]. HCAI; c2024 [cited 2020 January 8]. Available from: https://hcai.ca.gov/data/request-data/data-documentation/

21.

Gelberg L, Andersen RM, Leake BD. The Behavioral Model for Vulnerable Populations: application to medical care use and outcomes for homeless people. Health Serv Res. 2000;34:1273–302. [PubMed] [PMC]

22.

Appendix a - clinical classification software-diagnoses (january 1980 through september 2015) [Internet]. Agency for Healthcare Research and Quality; [cited 2020 October 10]. Available from: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/AppendixASingleDX.txt

23.

Banta JE, Rawal M, Bvute KM, Obiakor G. Mosher J. Banta JM. Diabetes and mental health in california emergency department visit. IJCMCR. 2023;35:004. [DOI]

24.

Multiple imputation in sas part 1 [Internet]. UCLA: Statistical Consulting Group; [cited 2024 July 15]. Available from: https://stats.oarc.ucla.edu/sas/seminars/multiple-imputation-in-sas/mi_new_1/

25.

Pate CA, Zahran HS. The Status of Asthma in the United States. Prev Chronic Dis. 2024;21:E53. [DOI] [PubMed] [PMC]

26.

Blumenthal D, Abrams M. The Affordable Care Act at 10 Years - Payment and Delivery System Reforms. N Engl J Med. 2020;382:1057–63. [DOI] [PubMed]

27.

Bardach NS, Harder VS, McCulloch CE, Thombley R, Shaw JS, Hart VC, et al. Follow-Up After Asthma Emergency Department Visits and Its Relationship With Subsequent Asthma-Related Utilization. Acad Pediatr. 2022;22:S125–32. [DOI] [PubMed]

28.

Al-Jahdali H, Anwar A, Al-Harbi A, Baharoon S, Halwani R, Al Shimemeri A, et al. Factors associated with patient visits to the emergency department for asthma therapy. BMC Pulm Med. 2012;12:80. [DOI] [PubMed] [PMC]

29.

Hochman SM, Catapano A, Shawl A, Somwaru B. Emergency department management of acute asthma exacerbations. Emerg Med Pract. 2022;24:1–32. [PubMed]

30.

Goff SL, Shieh M, Lindenauer PK, Ash AS, Krishnan JA, Geissler KH. Differences in Health Care Utilization for Asthma by Children with Medicaid versus Private Insurance. Popul Health Manag. 2024;27:105–13. [DOI] [PubMed]

31.

Eberhart NK, Burnam MA, Seelam R, Bogdan O, Breslau J. Monitoring Californians’ Mental Health: Population Surveillance Reveals Gender, Racial/Ethnic, Age, and Regional Disparities. Rand Health Q. 2019;16;8:5. [PubMed] [PMC]

32.

Oraka E, Iqbal S, Flanders WD, Brinker K, Garbe P. Racial and ethnic disparities in current asthma and emergency department visits: findings from the National Health Interview Survey, 2001-2010. J Asthma. 2013;50:488–96. [DOI] [PubMed] [PMC]

33.

Herrera-Luis E, Mak ACY, Perez-Garcia J, Martin-Gonzalez E, Eng C, Beckman KB, et al. Admixture mapping of severe asthma exacerbations in Hispanic/Latino children and youth. Thorax. 2023;78:233–41. [DOI] [PubMed] [PMC]

34.

Alarcon FJ. The Migrant Crisis and Access to Health Care. Dela J Public Health. 2022;8:20–5. [PubMed] [PMC]

35.

Kankaanranta H, Kauppi P, Tuomisto LE, Ilmarinen P. Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms. Mediators Inflamm. 2016;2016:3690628. [DOI] [PubMed] [PMC]

36.

Meng X, Muggli T, Baetz M, D'Arcy C. Disordered lives: Life circumstances and clinical characteristics of very frequent users of emergency departments for primary mental health complaints. Psychiatry Res. 2017;252:9–15. [DOI] [PubMed]

37.

Touilloux B, Casutt A, Strippoli MF, Lenoir A, Janett S, Vollenweider P, et al. Associations of Depressive and Anxiety Disorders with Pulmonary Disorders in the Community: The PneumoLaus and PsyCoLaus Studies. Respiration. 2024;103:503–12. [DOI] [PubMed] [PMC]

38.

Banta JE, Segovia-Siapco G, Crocker CB, Montoya D, Alhusseini N. Mental health status and dietary intake among California adults: a population-based survey. Int J Food Sci Nutr. 2019;70:759–70. [DOI] [PubMed]

39.

Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry. 2011;199:441–2. [DOI] [PubMed]

40.

Pai S, Mancuso CA, Loganathan R, Boutin-Foster C, Basir R, Kanna B. Characteristics of asthmatic patients with and without repeat emergency department visits at an inner city hospital. J Asthma. 2014;51:627–32. [DOI] [PubMed] [PMC]

41.

Sadler RC. Misalignment Between ZIP Codes and Municipal Boundaries: A Problem for Public Health. Cityscape. 2019;21:335–40. [PubMed] [PMC]

42.

Banta JE, Addison A, Beeson WL. Spatial patterns of epilepsy-related emergency department visits in California. J Public Health Res. 2015;4:441. [DOI] [PubMed] [PMC]