Health Disparities
Income-related differences in pediatric asthma hospitalization cost and risk in the United States Luke Barry* Luke Barry Barry Barry Barry UCLA
Why children from lower-income areas incur lower costs per asthma hospitalization despite a higher overall inpatient cost burden remains unclear. This study identifies modifiers of socioeconomic differences in pediatric inpatient costs and estimates income-related differences in asthma hospitalization risk. Using the Healthcare Cost and Utilization Project, National Inpatient Sample (2016–2019), we identified U.S. asthma hospitalizations among children aged 5–17 years. Exposure was residence in the lowest ZIP Code–level income quartile, and the outcome was inpatient service delivery cost (2020 USD). Causal forests were used to estimate average and heterogeneous effects of lower versus higher income on hospitalization costs across patient, admission, and hospital characteristics. We estimated income-stratified asthma hospitalization risks by dividing age, sex, year, census division, and income-specific inpatient counts by corresponding population counts from the American Community Survey. Among hospitalized children (n=28,634), admissions from lower-income areas had modestly lower average costs (−$207; 95% CI: −375,−39). However, cost differences were heterogeneous, with the largest reductions observed among admissions with major or extreme illness severity (−$1,282; 95% CI: −2,184,−380) and in the Pacific region (−$950; 95% CI: −1,563,−337). In contrast, children from lower-income areas were 1.91 (95% CI: 1.86, 1.96) times more likely to be hospitalized than those from higher-income areas. Socioeconomic disparities in pediatric asthma-related hospital cost burden are therefore driven primarily by higher hospitalization rates rather than greater costs per admission. Lower per-admission costs among lower-income children are most pronounced in settings characterized by greater clinical discretion. Distinguishing hospitalization risk from inpatient resource use clarifies socioeconomic patterns in pediatric asthma costs and highlights settings where equity-relevant differences are most evident.