# Pediatric Asthma in a Universally Insured Military Population

## TL;DR

This study finds that while asthma treatment improved in a universally insured military population, racial disparities in asthma prevalence and outcomes still exist.

## Contribution

The study reveals racial disparities in pediatric asthma outcomes persist even with universal health insurance coverage.

## Key findings

- Black children had the highest odds of asthma diagnosis across all age groups.
- Black, Hispanic, and Native Hawaiian or Pacific Islander children had higher odds of asthma-related emergency department visits.
- Asthma treatment rates and inhaled corticosteroid prescriptions increased despite fewer emergency visits and hospitalizations.

## Abstract

Are there unexpected variations in the prevalence, treatment, and outcomes of pediatric asthma in the Military Health System?

In this cross-sectional study of asthma prevalence and outcomes among 950 896 Military Health System pediatric dependents, 31 288 children with asthma were identified (prevalence, 3.3%). There were decreases in overall asthma-related emergency department visits and potentially avoidable hospitalizations, but increases in asthma treatments, in particular, inhaled corticosteroid prescriptions; racial and ethnic disparities were also noted.

These findings suggest that the overall number of pediatric asthma attacks, emergency department visits, and hospitalizations among Military Health System pediatric dependents has decreased, but disparities in the prevalence and outcomes persist across racial and ethnic groups despite universal insurance coverage.

This cross-sectional study examines racial and ethnic differences in asthma diagnoses, potentially avoidable hospitalizations or emergency department visits, specialist visits, and asthma-related prescriptions among Military Health System pediatric beneficiaries.

Pediatric asthma risk is associated with socioeconomic characteristics at individual, household, and community levels. It is critical to understand how the prevalence, treatment, and outcomes of pediatric asthma differ among ethnic and racial groups in a universally insured population.

To investigate racial and ethnic differences in asthma diagnoses, potentially avoidable hospitalizations (PAHs) or emergency department (ED) visits, specialist visits, and asthma-related prescriptions among Military Health System (MHS) pediatric beneficiaries.

This cross-sectional study investigated the prevalence of pediatric asthma among MHS beneficiaries enrolled in TRICARE Prime during fiscal year (FY) 2023. Secondary health care and pharmacy claims data were obtained from the MHS Data Repository. Participants included TRICARE Prime–enrolled dependents, aged 2 to 17 years, who were seen in at least 1 inpatient or outpatient setting during FY 2023.

Race and ethnicity, derived from sponsor demographics, was the primary variable of interest. Controlling variables included sex, sponsor marital status, number of siblings, health care setting, region, and sponsor rank.

Outcomes of interest were asthma prevalence and asthma-related outcomes (PAHs, ED visits, specialist visits, and prescriptions). Multiple logistic regressions, with 95% CIs, were used to estimate outcomes of interest within each age group and among all ages. Odds ratios (ORs) for asthma diagnosis across both age group and race and ethnicity categories were assessed among the full pediatric cohort.

Among the cohort of 950 896 children (largest age group, 428 212 children [45.0%] aged 11-17 years; 483 988 [50.9%] male children; 24 150 [2.5%] Asian children; 157 709 [16.6%] Black children, 166 253 [17.5%] Hispanic children, 33 032 [3.5%] Native Hawaiian or Pacific Islander children, 526 324 [55.4%] White children, and 43 428 [4.6%] children of other races), 31 288 (3.3%) (18 130 boys [1.9%]) met the asthma diagnosis definition. Greater prevalence was found in older age groups, male children, and dependents with 1 or 2 siblings. Black children had the highest odds of diagnosis for all ages (OR, 1.85; 95% CI, 1.80-1.91; P < .001). Black (OR, 1.39; 95% CI, 1.29-1.50; P < .001), Hispanic (OR, 1.36; 95% CI, 1.25-1.48; P < .001), and Native Hawaiian or Pacific Islander (OR, 1.25; 95% CI, 1.05-1.48; P = .01) children had higher odds of an asthma-related ED visit. PAHs were too few (587 visits) to return statistically significant results. Within the asthma cohort, 27 625 children (88.3%) had a prescription for any asthma treatment and 19 961 (63.8%) had a prescription for an inhaled corticosteroid.

This cross-sectional study of asthma prevalence and outcomes found decreases in asthma diagnoses, asthma-related ED visits, and PAHs but increases in asthma treatment and inhaled corticosteroid prescriptions. The data highlighted how low-cost to no-cost health care may have led to better asthma outcomes among the MHS pediatric population.