Asthma Prevalence Among Medicaid-Enrolled Children

Abstract

Background: Small-area asthma prevalence measures, which are crucial for targeting interventions, are currently sparsely available for children.Objective: This study aims to provide measures of in-contact asthma prevalence for the 2012 Medicaid child population, to highlight areas in need of targeted asthma interventions.Methods: Using the 2012 Medicaid Analytic eXtract (MAX) claims files, we develop two prevalence metrics differentiated by persistent or diagnosed asthma. We develop prevalence measures at the state, county, and census tract levels, with statistical inferences to highlight areas of high-prevalence where intervention should be focused. We compare the measures to asthma prevalence estimates derived from a sample of the child population who have self-reported whether they have been diagnosed with asthma regardless whether in-contact.Results: 1.98 million (8.1%) and 1.71 million (6.9%) Medicaid-enrolled children are identified with in-contact asthma diagnosis and persistent asthma, respectively. Among 40 states, 17 have lower prevalence estimates for the Medicaid-enrolled children than similar Centers for Disease Control and Prevention (CDC) child asthma self-reported prevalence estimates. High prevalence regions span primarily in the southern Midwest region, from Texas to West Virginia and Illinois to north Florida. Conclusions:There are large variations in the differences between CDC self-reported estimates for the general population and the in-contact estimates for the Medicaid-enrolled children, highlighting potential asthma misdiagnosis in the Medicaid population in many states. Small area estimates point to areas of high prevalence, consistently throughout the south and southeast.

Impact of a pharmaceutical care incentive program on the asthma medication ratio among pediatric patients with persistent asthma enrolled in a Medicaid program

“…In the United States, the highest prevalence of asthma among Medicaid-enrolled children is within the southern Midwest region, which includes Texas. 5 Texas HSR 11 had the third highest proportion of pediatric beneficiaries with asthma care inpatient hospitalizations, outpatient hospitalizations, or physician visits in the Texas Medicaid program during 2014 (17.64%). 7 However, no asthma prevalence data have been reported for HSR 11 since 2013.…”

“…4 The state of Texas is one of the highest-ranking states for childhood asthma prevalence among Medicaid enrollees (12.97%). 5 As of 2020, Medicaid and the Children's Health Insurance Program (CHIP) provided health care benefits to 3,707,183 children in Texas. 6 The Texas Department of Health and Human Services reported that 7.00% of the children in Texas had a diagnosis of asthma during 2016.…”

“…The estimated prevalence of asthma medication utilization in our study is slightly higher than the reported prevalence of asthma using medical and pharmacy claims data among Medicaid pediatric patients in the state of Texas (13.00%). 5 This finding suggests that using pharmacy claims for asthma medication could serve as an excellent proxy to estimate asthma prevalence. Previous studies have reported a positive predictive value of 91% when using asthma pharmacy claims to identify asthma cases.…”

Reflecting on prediction strategies for epidemics

“…Resources include surveillance data from the CDC, 86 demographics data from the US Census Bureau, 87 and recent publications on asthma prevalence. 88 …”

“…Resources include surveillance data from the CDC, 86 demographics data from the US Census Bureau, 87 and recent publications on asthma prevalence. 88 The effectiveness of interventions varies depending whether deployed for the general population, 4,50,89 high-risk populations, 3,21 children, or multiple age groups. 90 Timing and duration of interventions 91 and decision on the types (pharmaceutical, nonpharmaceutical, or combinations) of the responses 5,20,22,80,92 possibly affect the outcome of the preventive actions.…”