Demographic predictors of asthma treatment site: outpatient, inpatient, or emergency department

Objective: To identify the demographic predictors of asthma treatment site: outpatient clinic, emergency department, or hospital. Methods: From the November 1993 to July 1995 claims data of the University of Connecticut Health Center, asthmatic patient sex, age, racial/ethnic group, address, and health insurance status were examined to identify predictors of treatment site. Patient addresses generated maps and census data. Results: 3288 visits were made by 1455 patients; 8%, 34%, and 58% came from poverty level, low, and higher income residential areas, respectively. Insurance type and then age were the most significant predictors of treatment site. Adults having commercial insurance or Medicare were most likely treated as outpatients, self-pay patients 5 times more likely in the emergency department, and those receiving public assistance 2.4 times more likely in the hospital. Only 9% of Medicaid children and 22% with commercial insurance were evaluated as outpatients. Neither sex nor race/ethnicity was an important predictor of treatment site. Conclusion: Although not population-based, this group of asthmatic patients represents a group diverse in socioeconomic status and racial/ethnic background. Insurance category was the most influential factor predicting asthma treatment site, suggesting that economic status may be the most important determinant of higher morbidity. Children were treated predominantly in acute care settings.