An Interdisciplinary Health Disparities Research and Intervention Strategy Applied to the Problem of Pediatric Asthma in Kansas City

Abstract

This dissertation presents a multilevel health disparities research strategy using pediatric asthma in Kansas City as a case study. The first chapter introduces the problem of pediatric asthma in Kansas City and the foundational theory, methods, and concepts used to develop the structure of the dissertation and specific research questions. This is followed by an overview of the research and findings from subsequent chapters, which include both population- and patient-level analyses. The first chapter is then concluded with a brief policy note framing future research to connect health disparities interventions with economic policy. In the second chapter, the distribution of pediatric asthma throughout the region is explored using address-level electronic health records (EHR) for asthma-related encounters occurring between 2000 and 2012. Spatial indicators of the burden in pediatric asthma were developed from the 2012 sample including census tract incidence and prevalence rate estimates. The third chapter develops census tract Environmental Justice Screening Method (EJSM) indicators, which are used in a scanning exercise, descriptive analysis, and a Bayesian Profile Regression (BPR) cluster analysis to explore complex patterns in both the population health risks and vulnerabilities that may be contributing to the burden in pediatric asthma. Moving from the population to the patient level, the fourth chapter uses pediatric asthma encounter data geocoded to the residential parcel geography in a BPR cluster analysis to investigate the relationship between a patient’s asthma severity, personal characteristics, their record of housing instability, and environmental exposure both in and around the home. The analyses presented in Chapters 2-4 help to characterize the disparity in pediatric asthma between socially disadvantaged and advantaged Kansas City communities and patients, providing insight into targets for population health research, intervention, and policy development strategies. The results of each chapter make it clear that social disadvantage and determinants like access to healthy and stable housing play a central role in driving the disparity in pediatric asthma between Kansas City children and communities. The findings support a combination of community-based and patient-centered interventions framed in terms of health equity to alleviate the burden of pediatric asthma and reduce the disparity over time.