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Rural Kids Have More Asthma, Get Less Medicine

inhaler

Asthma is known to be a major health issue for children in inner cities, but a new study suggests that it may be an even bigger problem for poor rural children.

Looking at data on 117,000 Tennessee children on Medicaid, researchers found that 13 percent of children in rural areas had asthma—higher than the rate in urban areas, which stood at 11 percent.

What's more, children in rural areas were somewhat less likely to be on inhaled corticosteroids—though use was generally low among all children in the study.

Inhaled corticosteroids help control asthma and prevent attacks of wheezing and breathlessness, so low rates of use are a concern.

Roughly one-third of asthmatic children in this study were prescribed an inhaled steroid, but those prescriptions were typically filled only one or two months out of the year.

"We think the important message of our (study) is, we know that asthma is a problem among poor urban children in the U.S., but it turns out it is also a problem among poor rural children," said lead researcher Dr. Robert S. Valet, of Vanderbilt University School of Medicine in Nashville.

The low use of inhaled-steroid prescriptions, regardless of where children lived, was surprising, Valet told Reuters Health in an e-mail.

"Improving adherence to inhaled corticosteroid medications is likely a major opportunity to improve asthma control in both our urban and rural Medicaid populations," he said.

The findings, reported in the Annals of Allergy, Asthma & Immunology, are based on records for 117,080 Tennessee children covered under Medicaid—the government health insurance program for the poor.

Overall, 11 percent of urban, 12 percent of suburban and 13 percent of rural children had an asthma diagnosis between the ages of 4 and 5.5.

When it came to inhaled corticosteroids, 31 percent of rural children had a prescription, as did 32 percent of suburban and 35 percent of urban children.

While all of the children were on Medicaid, Valet noted that a large proportion of Tennessee children are enrolled in the program—including 41 percent of children in rural areas.

So, he said, the results are likely to be representative of all urban and rural children in the state.
It's not exactly clear why children in rural areas had a higher asthma rate than urban children did. But Valet said it could have to do with high rates of maternal smoking and bronchiolitis—an infection that affects the tiny airways of the lungs, usually in infants.

Among rural children, 35 percent had a mother who smoked during pregnancy, compared with 16 percent of urban children. And 22 percent of rural children had bronchiolitis as infants, versus 17 percent of urban kids.

Rural families are also more likely to have to drive long distances to get medical care, and may not be able to get their children to a specialist in allergies and asthma—which may help explain why they were less likely to be on corticosteroids.

For rural children, pediatricians and other primary care doctors might need to take the lead in improving asthma control, according to the researchers.

The study found that urban children were more likely to visit the emergency room for asthma symptoms than rural kids were—which seemed to be because urban families often go the ER rather than a primary care doctor.

On the other hand, children in rural areas made more trips to the doctor (for any reason) than urban kids did.

So offering more asthma education in rural primary care clinics in the form of written materials or trained "asthma educators" could help, according to Valet and his colleagues.

There is only limited information on asthma in rural versus urban regions nationwide, Valet noted. But one study using government data found that 12 percent of adults in urban areas and 11 percent in rural areas said they had ever been diagnosed with asthma.