Objectives were to examine geographic variation in rates of infant hospitalizationfor diagnostic clusters in Monroe County (Rochester), New York and to assess these clusters as indexes of child health. ICD-9 codes were used to cluster all 7,883 hospitalizations of infants (< 24 months) between 1985 and 1991 on the basis oftheiravoidability. Environmentally sensitive clusters accounted for 63% of admissions. These clusters included environmental, environmental/constitutional, and other infectious disease. Disparities in morbidity between inner city and suburbs were greatest for the environmental cluster, followed by the environmental/constitutional, and other infectious disease clusters. For the constitutional and quality indicator clusters, differences between inner-city and suburban risk were minimal. Environmental interventions may be more important than improved health services to reducing racial and economic disparities in child health. Analysis of morbidity clusters, ascertained from available administrative data bases and aggregated.for small geographic areas, may guide child health policy well.
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References
1.
Billings, J.
, Zeitel, L., Lukomnik, J., Carey, T. S., Blank, A. E., & Newman, L. (1993). Impact of socioeconomic status on hospital use in New York City. Health Affairs, 12, 162-173.
2.
Carr, W.
, Zeitel, L., & Weiss, K. (1992). Variations in asthma hospitalization and deaths in New York City. American Journal of Public Health, 82, 59-65.
3.
Center for Health Economics Research for the Robert Wood Johnson Foundation
. (1993). Access to care: Key indicators for policy (pp. 56-57). Princeton, NJ: Robert Wood Johnson Foundation.
4.
Connell, F. A.
, Day, R. W., & LoGerfo, J. P. (1981). Hospitalization of Medicaid children: Analysis of small area variations in admission rates. American Journal of Public Health, 71, 606-613.
5.
Conway, S. P.
, Phillips, R. R., & Panday, S. (1990). Admission to hospital with gastroenteritis. Archives of Disease in Childhood, 65, 579-584.
6.
Cronbach, L. J.
, & Meehl, P. E. (1955). Construct validity in psychological tests. Psychological Bulletin, 52, 281-302.
7.
Durkin, M. S.
, Davidson, L. L., Kuhn, L., O'Connor, P., & Barlow, B. (1994). Low-income neighborhoods and the risk of severe pediatric injury: A small area analysis in northern Manhattan. American Journal of Public Health, 84, 587-592.
8.
Eddy, D. M.
(1984). Variations in physician practice: The role of uncertainty. Health Affairs, 3, 74-89.
9.
Goodman, D. C.
, Fisher, E. S., Grittelsohn, A., Chang, C. H., & Fleming, C. (1994). Why are children hospitalized? The role of non-clinical factors in pediatric hospitalizations. Pediatrics, 93, 896-902.
10.
Homer, C. J.
, Perrin, J. M., Kemper, K., & Freeman, J. (1995). Effect of socioeconomic status on variation in pediatric hospitalization. Ambulatory Child Health, 1, 33-41.
11.
International Classification of Disease: 9th Revision. Clinical Modification. (1980) (DHHS Publicaton No. PHS 80-126). Washington, DC: U.S. Department of Health and Human Services.
12.
Landy, F. J.
(1986). Stamp collecting versus science. American Psychologist, 41, 1183-1192.
13.
Maclure, A.
, & Stewart, G.T. (1984). Admission of children to hospitals in Glascow: Relation to unemployment and other deprivation variables. The Lancet, 22, 682-685.
14.
McConnochie, K. M.
, Roghmann, K. J., & Liptak, G. S. (1995). Hospitalization for lower respiratory tract illness in infants: Variation in rates among countries in New York State and areas in Monroe County. Journal of Pediatrics, 126, 220-229.
15.
McConnochie, K. M.
, Roghmann, K. K., & Liptak, G. S. (1997a). Avoidable morbidity in infants: A classification based on diagnoses in administrative data bases. Medical Care, 35, 237-254.
16.
McConnochie, K. M.
, Roghmann, K. J., & Liptak, G. S. (1997b). Socioeconomic variation in discretionary and mandatory hospitalization of infants: An ecological analysis. Pediatrics, 99,774-784.
17.
McMahon,L. F.
, McLaughlin, C. G., Petroni, G. R., &Tedeschi, P. J. (1991). Small area analysis of hospital discharges for musculoskeletal diseases in Michigan: The influence of socioeconomic factors. American Journal of Medicine, 91, 173-178.
18.
McMahon, L. R.
, Wolfe, R. A., Griffith, J. R., & Cuthbertson, D. (1993). Socioeconomic influence on small area hospital utilization. Medical Care, 32, YS29-YS36.
19.
Murray, C. J.
(1988). The infant mortality rate, life expectancy at birth a linear index of morality as measures of general health status. International Journal of Epidemiology, 17, 122-128.
20.
Newberger, E. H.
, Reed, R. B., & Daniel, J. H., Hyde, J. N., & Kotelchuck, M. (1977). Pediatric social illness: Toward an etiologic classification. Pediatrics, 60(2), 178-185.
21.
Newsholme, A. (1910). Report by the medical officer on child mortality. 30th Annual Report of the Local Government Board[Suppl.]. London.
22.
Paul-Shaheen, P.
, Clark, J. D., & Williams, D. (1987). Small area analysis: A review and analysis of the North American Literature. Journal of Health Politics Policy and Law, 12,741-809.
23.
Perrin, J. M.
, Homer, C. J., Berwick, D. M., Woolf, A. D., Freeman, J. L., & Wennberg, J. E. (1989). Variations in rates of hospitalization of children in three urban communities. New England Journal of Medicine, 320, 1183-1187.
24.
Roghmann, K. J.
(1985). Intervention strategies for children: A research agenda. Health Services Research, 19, 887-943.
25.
Roghmann, K. J.
(1993). Immunization Survey. Rochester, NY: Monroe County Health Department.
26.
Roos, L. L.
(1983). Supply, workload and utilization: A population-based analysis of surgery. American Journal of Public Health, 73, 414-421.
27.
Roos, N. P.
, Wennberg, J. E., & McPherson, K. (1988). Using diagnosis-related groups for studying variations in hospital admissions. Health Care Financing Review, 9, 53-62.
28.
Schlesselman, J. J.
(1982). Case-control studies: Design, conduct, analysis. New York: Oxford University Press.
29.
Streiner, D. L.
, & Norman, G. R. (1989). Health measurement scales: A practical guide to their development and use. New York: Oxford University Press.
30.
Weiss, K. B.
, & Budetti, P. (1993). Examining issues in health care delivery for asthma: Background and workshop overview. Medical Care, 32, MS9-MS19.
31.
Weissman, J. S.
, Gatsonis, C., & Epstein, A. M. (1992). Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. Journal of the American Medical Association, 268, 2388-2394.
32.
Wennberg, J. E.
(1979). Factors governing utilization of hospital services. (1979). Hospital Practice, 114, 15-117.
33.
Wennberg, J. E.
, Barnes, B. A., & Zubkoff, M. (1982). Professional uncertainty and the problem of supplier-induced demand. Social Science in Medicine, 15, 811-824.
34.
Wennberg, J. E.
, Freeman, R. M., Shelton, R. M., & Bubholz, T. A. (1989). Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. New England Journal of Medicine, 321, 1168-1173.
35.
Wennberg, J. E.
, & Kim, S.Y.S. (1977). Common uses of hospitals: A look at Vermont. In Harvard child health project: Vol. 2. Developing a better health system for children (pp. 353-382). Cambridge, MA: Ballinger.
36.
Wennberg, J. E.
, McPherson, K., & Caper, P. (1984). Will payment based on diagnosis related groups control hospital costs?New England Journal of Medicine, 311, 295-300.
37.
Wissow, L. S.
, Gittelsohn, A. M., Szklo, M., Starfield, B., & Mussman, M. (1988). Poverty, race, and hospitalization for childhood asthma. American Journal ofPublic Health, 78,777-782.
38.
Wolfe, B. L.
, & Detmer, D. E. (1984). The economics of surgical signatures. Hospital Medical Staff, 13, 2-9.
39.
World Health Organization
. (1948). Constitution of the World Health Organization. In Basic Documents. Geneva: Author.
