Investigators at Cincinnati Children’s Hospital Medical Center initiated a study to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models.

According to the study published online in the eFirst pages of the journal Pediatrics, investigators found that 23% of black children were readmitted to the hospital for asthma within a year, compared to 11% of other children in the study, most of whom were white. Nearly 19% of all children were readmitted to the hospital within 12 months.

In all, 774 children, ages 1 to 16 years, were enrolled in a population-based prospective observational cohort, which aligned with the Greater Cincinnati Asthma Risks Study (GCARS). The patients were evaluated based on being admitted to the hospital for asthma or bronchodilator-responsive wheezing.

Child race and socioeconomic status, which was measured by lower income and caregiver educational attainment, and hardship (defined as caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded.

In the study period between August 2010 and October 2011, more than half of the children (57%) surveyed were black. Researchers found caregivers of black children were significantly more likely than caregivers of white children to report financial and social hardships, which, together with traditional measures of low socioeconomic status, explained about half of the disparity in readmission.

What’s more, researchers found that financial and social hardships, such as lack of employment and not owning a car, accounted for nearly 40% of the increased likelihood of asthma readmission among black children, according to the study.

“Readmission rates are a central focus of healthcare reform,” says Andrew Beck, MD, a pediatrician at Cincinnati Children’s and lead author of the study. “Reducing disparities in such outcomes will be critical, especially since payment reform will be based more on quality outcomes and less so on healthcare encounters.

Our findings suggest a more intense patient- and population-level focus on the financial and social hardships that underlie racial disparities may provide one path for achieving better outcomes,” Beck said. “Identifying hardships could prompt partnerships with individuals and agencies poised to provide added community support for families.”

Beck expects that additional factors, such as pollution, tobacco exposure, and substandard housing quality, may explain “residual disparities and provide further targets for intervention,” he said.