Pediatric Asthma in a Universally Insured Military Population

Importance Pediatric asthma risk is associated with socioeconomic characteristics at individual, household, and community levels. It is critical to understand how the prevalence, treatment, and outcomes of pediatric asthma differ among ethnic and racial groups in a universally insured population. Objective To investigate racial and ethnic differences in asthma diagnoses, potentially avoidable hospitalizations (PAHs) or emergency department (ED) visits, specialist visits, and asthma-related prescriptions among Military Health System (MHS) pediatric beneficiaries. Design, Setting, and Participants This cross-sectional study investigated the prevalence of pediatric asthma among MHS beneficiaries enrolled in TRICARE Prime during fiscal year (FY) 2023. Secondary health care and pharmacy claims data were obtained from the MHS Data Repository. Participants included TRICARE Prime–enrolled dependents, aged 2 to 17 years, who were seen in at least 1 inpatient or outpatient setting during FY 2023. Exposures Race and ethnicity, derived from sponsor demographics, was the primary variable of interest. Controlling variables included sex, sponsor marital status, number of siblings, health care setting, region, and sponsor rank. Main Outcomes and Measures Outcomes of interest were asthma prevalence and asthmarelated outcomes (PAHs, ED visits, specialist visits, and prescriptions). Multiple logistic regressions, with 95% CIs, were used to estimate outcomes of interest within each age group and among all ages. Odds ratios (ORs) for asthma diagnosis across both age group and race and ethnicity categories were assessed among the full pediatric cohort. Results Among the cohort of 950 896 children (largest age group, 428 212 children [45.0%] aged 11-17 years; 483 988 [50.9%] male children; 24 150 [2.5%] Asian children; 157 709 [16.6%] Black children, 166 253 [17.5%] Hispanic children, 33 032 [3.5%] Native Hawaiian or Pacific Islander children, 526 324 [55.4%] White children, and 43 428 [4.6%] children of other races), 31 288 (3.3%) (18 130 boys [1.9%]) met the asthma diagnosis definition. Greater prevalence was found in older age groups, male children, and dependents with 1 or 2 siblings. Black children had the highest odds of diagnosis for all ages (OR, 1.85; 95% CI, 1.80-1.91; P <.001). Black (OR, 1.39; 95% CI, 1.29-1.50; P <.001), Hispanic (OR, 1.36; 95% CI, 1.25-1.48; P <.001), and Native Hawaiian or Pacific Islander (OR, 1.25; 95% CI, 1.05-1.48; P =.01) children had higher odds of an asthma-related ED visit. PAHs were too few (587 visits) to return statistically significant results. Within the asthma cohort, 27 625 children (88.3%) had a prescription for any asthma treatment and 19 961 (63.8%) had a prescription for an inhaled corticosteroid. Conclusions and Relevance This cross-sectional study of asthma prevalence and outcomes found decreases in asthma diagnoses, asthma-related ED visits, and PAHs but increases in asthma treatment and inhaled corticosteroid prescriptions. The data highlighted how low-cost to no-cost health care may have led to better asthma outcomes among the MHS pediatric population.