Why do these Missourians have double the rate of asthma? New data shows health gaps
Asthma afflicts Black people in Missouri’s two largest metropolitan areas at twice the rate as their white counterparts — the biggest racial disparity among a number of health gaps, according to new data Missouri hospital officials released Monday.
in Jackson County, 5% of white patients were diagnosed with asthma during a three-year period ending in 2020, compared to 10.4% of Black patients. The St. Louis area has similar disparities.
In Jackson County, the worst rate of hospital-diagnosed asthma was among Black residents ages 20 to 39.
The data comes from new Health Equity Dashboards launched Monday by the Missouri Hospital Association that give a detailed look at where health inequities exist, right down to the ZIP codes.
“Hopefully this is at least an opening salvo in a broader effort to start to close those gaps,” said Mat Reidhead, vice president of research and analytics for the group.
The tool — web.mhanet.com/health-equity-dashboards — was designed for hospitals and anyone with a stake in the health of their community, including the public.
The dashboards, said to be unprecedented in scope, were created from 41 million individual hospital claims of 5.4 million Missourians — nearly 90% of the state’s 6.1 million residents. Inpatient, outpatient and emergency department claims from fiscal years 2018, 2019 and 2020 were collected.
“What it really delivers clearly is a view of where and how inequities exist in the system and what, with targeted efforts, can be done to improve health outcomes,” said Dave Dillon, spokesman for the association.
“The best part is that it digs deeply into the community. It doesn’t just look at Jackson County, for example, but down to the ZIP code level within.”
The dashboards complement the hospital association’s exploreMOhealth.org website, which also offers health data for specific counties and 939 ZIP codes in Missouri. The website identifies the most- and least-healthy ZIP codes in Missouri, as of April.
According to that ranking, 64113, south of Loose Park, is the healthiest ZIP code in Jackson County. The lowest is 64128, just west of the Truman Sports Complex — ranked third from the bottom in the state. Clay and Platte counties had overall higher health outcomes rankings than Jackson.
The new data drills deeper into specific health problems and who has them. For example, in 64128, asthma and uninsured hospital visits are debilitating factors.
“Without this type of data, it is really difficult to make headway on what often look like intractable health problems,” Dillon said.
A tenet of the group’s health equity committee, established in February, “is you can’t have meaningful change what you don’t have meaningfully measure,” said Reidhead. “These dashboards were definitely designed with that tenet in mind.”
Reidhead said there were no surprises — encouraging or otherwise — in the new data.
“You kind of get what you expect,” he said. “COVID has really served as a catalyst of a lot of attention, and resources at the federal level being devoted to promoting health equity.
“But these are historically long-standing and vexing problems in terms of every leading cause of death. There are just pronounced disparities for myriad factors.”
How to use it
A quick start” guide lets users identify the most pronounced disparities in an area. They can then choose two demographic groups to compare, such as Jackson County’s asthma rate disparity between Black and white residents.
“With that finding you can quickly, if it’s within your sphere of influence, go out and start assessing the situation in terms of what’s going on with Black people in Jackson County being diagnosed with asthma at twice the rate of white people,” said Reidhead.
“And you want to design a community health needs assessment and then some really targeted interventional approaches to start to move the needle on closing that gap.”
The data also revealed higher rates of hypertension, pain, diabetes, substance abuse disorder, obesity, tobacco use and anemia among Black county residents.
The new tool’s Health Disparity Explorer — “the most meaningful and chock full of information,” Reidhead said — goes deeper, identifying disparities by race, age, gender and insurance coverage.
“If you decided to look at this view by race and payer, you can see that 14% of Black residents in Jackson County with Medicaid are diagnosed with asthma,” said Reidhead.
“That makes a lot of sense considering the acute exacerbation of asthma that requires a trip to the emergency room is typically caused by an environmental trigger, so things like mold in the home, the presence of incense and air particulates from air fresheners and those types of things can trigger asthma.
“But it’s a very movable problem in terms of risk moderation — educating parents about the triggers for their children and keeping their home free of those triggers is really important.”
The largest disparity between Black and white asthma patients exists in the 64111 ZIP code — which includes Coleman Highlands, Roanoke and Old Westport. Black residents there were diagnosed with asthma at nearly three times the rate as white residents.
Closing the gaps
The hospital association uses a data company called Hospital Industry Data Institute to collect hospital claims from about 135 members. They include hospitals big and small, psychiatric, rehab and children’s hospitals, safety net clinics and long-term care facilities, said Reidhead.
“Missouri as a general rule tries to make as much hay with that information as we possibly can, so we try to take that data and advance public health causes, such as this,” Reidhead said.
“I think it’s important to note that most hospitals could conduct this type of analysis internally, but they would be limited to only what’s going on within their four walls.
“The vision behind this is to help hospitals in particular, but any stakeholder, in prioritizing which disparity needs addressing in their primary service areas.”
The hospital group also hopes the data encourages members to promote health equity, make it a part of their culture. Offer staff training for working with diverse patients. Make sure that staffs resemble the communities they serve. Hire vendors from the community.
“Really, the next step, and this is infinitely the more difficult step, is the task of intervening to close the disparity gaps that you’ve discovered with this tool or internal analysis of your own data,” said Reidhead. “And that really starts with identifying and engaging community partners.”
With asthma being so prevalent among young Black residents of Jackson and St. Louis counties, for instance, “schools are just an obvious partnership in addressing that challenge,” he said. “And a lot of our hospitals are doing just that with a lot of our school districts with really innovative interventions that have demonstrated a lot of great effectiveness.”
This story was originally published October 11, 2021 at 5:07 PM.
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