Social and family-related correlates of medical care utilization by asthmatic children in Upper Silesia, Poland
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Department of Epidemiology, Medical University of Silesia, Katowice, Poland
Department of Pneumonology, Medical University of Silesia, Katowice, Poland
Ann Agric Environ Med. 2012;19(1):141–145
Studies on childhood asthma demonstrate socioeconomic disparities in medical care utilization. A lack of information for Poland prompted our investigation into this question. Its goal was to discover if the utilization of medical services by asthmatic children depends on social and family factors.

Subjects were 186 children with physician-diagnosed asthma, identified through a questionnaire survey of 4,535 school children in Katowice District, Poland. Utilization of medical care was assessed by such past year events as medical visits (44.0%), any diagnostic test (35.4%) and spirometry (30.6%). Association of those events with socioeconomic variables was explored by means of logistic regression, according to the criterion p<0.1.

After adjustment for disease severity and gender medical visits were related to younger age (p=0.009), family history of respiratory diseases (p=0.08) and rural residence (p=0.09), any diagnostic tests to younger age (p=0.08), smaller number of siblings (p=0.01) and rural residence (p=0.004); spirometry to smaller number of siblings (p=0.09) and rural residence (p=0.006).

Clinical status and age are important determinants of utilization of medical services by asthmatic children. The effects of rural residence and family size may reflect a more attentive response to the needs of a sick child.

Jan E. Zejda   
Department of Epidemiology, Medical University of Silesia, Katowice, Poland
1. Bacharier LB, Boner A, Carlsen KH, Eigenmann PA, Frischer T, Gotz M, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy. 2008; 63: 5-34.
2. Bousquet J., Ansotegui IJ, van Ree R, Burney PG, Zuberbier T, van Cauwenberge P. European Union meets the challenge of the growing importance of allergy and asthma in Europe. Allergy. 2004; 59: 1-4.
3. Dahl R, Bjermer L. Nordic consensus report on asthma management. Nordic Asthma Consensus Group. Respir Med. 2000; 94: 299-327.
4. Global Strategy for Asthma Management and Prevention. The Global Initiative for Asthma 2006. (access: 25.01.2011).
5. National Asthma Education and Prevention Program: The Expert Panel Report 3 (EPR–3) Full Report 2007: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health publication No. 07-4051. (access: 25.01.2011).
6. Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics. 2002; 110: 315-322.
7. Finkelstein JA, Brown RW, Schneider LC, Weiss ST, Quintana JM, Goldmann DA, et al. Quality of care for preschool children with asthma: the role of social factors and practice setting. Pediatrics. 1995; 95: 389-394.
8. Kattan M, Mitchell H, Eggleston P, Gergen P, Crain E, Redline S, et al. Characteristics of inner-city children with asthma: the National Cooperative Inner-City Asthma Study. Pediatr Pulmonol. 1997; 24: 253-262.
9. Kim H, Kieckhefer GM, Greek AA, Joesh JM, Baydar N. Health care utilization by children with asthma. Prev Chron Dis. 2009; 6: A12. (access: 25.01.2011).
10. Piper CN, Glover S, Elder K, Baek JD, Wilkinson L. Disparities in access to care among asthmatic children in relation to race and socioeconomic status. J Child Health Care. 2010; 14: 271-279.
11. Seid M, Opipari-Arrigan L, Gelhard LR, Varni JW, Driscoll K. Barriers to care questionnaire: reliability, validity, and responsiveness to change among parents of children with asthma. Acad Pediatr. 2009; 9: 106-113.
12. Smith MJ, Rascati KL, Barner JC. A descriptive analysis of asthma-related medical services and prescription utilizing among recipients in a Medicaid program. J Asthma. 2005; 42: 447-453.
13. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. The Milbank Quarterly. 2005; 83: 1-28.
14. Brożek M, Zejda JE, Kowalska M, Gębuś M, Kępa K, Igielski M. Opposite trends of allergic disorders and respiratory symptoms in children over a period of large-scale ambient air pollution decline. Pol J Environ Stud. 2010; 19: 1133-1138.
15. Leonardi GS, Houthuijs D, Nikiforov B, Volf J, Rudnai P, Zejda J, et al. Respiratory symptoms, bronchitis and asthma in children of Central and Eastern Europe. Eur Respir J. 2002; 20: 890-898.
16. Uijen JH, Schellevis FG, Bindels PJE, Willemsen SP, van der Wouden JC. Low hospital admission rates for respiratory diseases in children. BMC Family Practice. 2010; 11: 76. (access: 25.01.2011).
17. Homer CJ, Szilagyi P, Rodewald L, Bloom SR, Greenspan P, Yazdgerdi S, et al. Does quality of care affect rates of hospitalization for childhood asthma? Pediatrics. 1996; 98: 18-23.
18. Ensor T, Cooper S. Overcoming barriers to health service access: influencing the demand side. Health Policy Plann. 2004; 19: 69-79.
19. Siersted HC, Boldsen J, Hansen HS, Mostgaard G, Hyldebrandt N. Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study. BMJ. 1998; 316: 651-657.
20. Contoli M, Papi A. When asthma diagnosis becomes a challenge. Eur Respir J. 2010; 36: 231-233.
21. Luks VP, Vandemheen KL, Aaron SD. Confirmation of asthma in an era of overdiagnosis. Eur Respir J. 2010; 36: 255-260.
22. Doniec Z, Wroński M, Willim G, Pisiewicz K, Kurzawa R. Czy astma oskrzelowa u dzieci jest nadal chorobą ,,niedodiagnozowaną”? [Is bronchial asthma In children still „underdiagnosed” disease?]. Acta Pneumonol Allergol Pediatr. 2001; 4: 56-60.
23. Kuprys-Lipińska I, Elgalal A, Kuna P. Niedodiagnozowanie i brak właściwej terapii astmy – badanie populacji ogólnej mieszkańcow województwa łódzkiego (Polska) [The underdiagnosis and undertreatment of asthma in general population of the Lodz Province (Poland)]. Pneumonol Alergol Pol. 2010; 78: 21-27.