The Journal of Pediatrics
Volume 155, Issue 5 , Pages 634-639.e4 , November 2009

Association of Socioeconomic Status with the Use of Chronic Therapies and Healthcare Utilization in Children with Cystic Fibrosis

  • Michael S. Schechter, MD, MPH

      Affiliations

    • Division of Pulmonary, Allergy/Immunology, Cystic Fibrosis and Sleep, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
    • Corresponding Author InformationReprint requests: Michael S. Schechter, MD, MPH, Emory University School of Medicine, 1547 Clifton Road, Atlanta, GA 30322.
  • ,
  • Susanna A. McColley, MD

      Affiliations

    • Northwestern University Feinberg School of Medicine, Denver, CO
  • ,
  • Stefanie Silva, MS

      Affiliations

    • ICON Clinical Research, Denver, CO
  • ,
  • Tmirah Haselkorn, PhD

      Affiliations

    • EpiMetrix, Inc
  • ,
  • Michael W. Konstan, MD

      Affiliations

    • Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Denver, CO
  • ,
  • Jeffrey S. Wagener, MD

      Affiliations

    • University of Colorado Denver School of Medicine, Denver, CO
  • ,
  • Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis and the North American Scientific Advisory Group for ESCF

      Affiliations

    • A list of the members of the ESCF and the North American Scientific Advisory Group for ESCF is available at www.jpeds.com (Appendix 1).

Received 1 December 2008 ,Revised 20 February 2009 ,Accepted 24 April 2009.

References 

  1. O'Connor GT, Quinton HB, Kahn R, Robichaud P, Maddock J, Lever T, et al. Case-mix adjustment for evaluation of mortality in cystic fibrosis. Pediatr Pulmonol. 2002;33:99–105
  2. Schechter MS, Shelton BJ, Margolis PA, FitzSimmons SC. The association of socioeconomic status with outcomes in cystic fibrosis patients in the United States. Am J Respir Crit Care Med. 2001;163:1331–1337
  3. Halfon N, Newacheck PW. Childhood asthma and poverty: differential impacts and utilization of health services. Pediatrics. 1993;91:56–61
  4. Konstan MW, Butler SM, Schidlow DV, Morgan WJ, Julius JR, Johnson CA. Patterns of medical practice in cystic fibrosis, part II: use of therapies. Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Pediatr Pulmonol. 1999;28:248–254
  5. Konstan MW, Butler SM, Schidlow DV, Morgan WJ, Julius JR, Johnson CA. Patterns of medical practice in cystic fibrosis, part I: evaluation and monitoring of health status of patients. Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Pediatr Pulmonol. 1999;28:242–247
  6. Johnson C, Butler SM, Konstan MW, Morgan W, Wohl ME. Factors influencing outcomes in cystic fibrosis: a center-based analysis. Chest. 2003;123:20–27
  7. Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, et al. Socioeconomic status in health research: one size does not fit all. JAMA. 2005;294:2879–2888
  8. Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378
  9. Kawachi I, Kennedy BP. Income inequality and health: pathways and mechanisms. Health Serv Res. 1999;34(1 Pt 2):215–227
  10. Gazmararian JA, Adams MM, Pamuk ER. Associations between measures of socioeconomic status and maternal health behavior. Am J Prev Med. 1996;12:108–115
  11. Davey Smith G, Hart C, Hole D, MacKinnon P, Gillis C, Watt G, et al. Education and occupational social class: which is the more important indicator of mortality risk?. J Epidemiol Community Health. 1998;52:153–160
  12. Fein O. The influence of social class on health status: American and British research on health inequalities. J Gen Intern Med. 1995;10:577–586
  13. Zill N. Parental schooling and children's health. Public Health Rep. 1996;111:34–43
  14. Morgenstern H. Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health. 1995;16:61–81
  15. Morgan WJ, Butler SM, Johnson CA, Colin AA, FitzSimmons SC, Geller DE, et al. Epidemiologic Study of Cystic Fibrosis: design and implementation of a prospective, multicenter, observational study of patients with cystic fibrosis in the US and Canada. Pediatr Pulmonol. 1999;28:231–241
  16. Wang X, Dockery DW, Wypij D, Fay ME, Ferris BG. Pulmonary function between 6 and 18 years of age. Pediatr Pulmonol. 1993;15:75–88
  17. Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general US population. Am J Respir Crit Care Med. 1999;159:179–187
  18. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd edition. Hillsdale, NJ: Lawrence Erlbaum; 1988;
  19. Blumenthal SJ, Kagen J. The effects of socioeconomic status on health in rural and urban America. JAMA. 2002;287:109
  20. Saiman L, Marshall BC, Mayer-Hamblett N, Burns JL, Quittner AL, Cibene DA, et al. Azithromycin in patients with cystic fibrosis chronically infected with Pseudomonas aeruginosa: a randomized controlled trial. JAMA. 2003;290(13):1749–1756
  21. Cystic Fibrosis Foundation Patient Registry . 2005 Annual Data Report. Bethesda, MD: Cystic Fibrosis Foundation; 2006;
  22. Pincus T, Esther R, DeWalt DA, Callahan LF. Social conditions and self-management are more powerful determinants of health than access to care. Ann Intern Med. 1998;129:406–411
  23. Schechter MS. Non-genetic influences on cystic fibrosis lung disease: the role of sociodemographic characteristics, environmental exposures, and healthcare interventions. Semin Resp Crit Care Med. 2003;24:639–652
  24. Goldman DP, Smith JP. Can patient self-management help explain the SES health gradient?. Proc Natl Acad Sci USA. 2002;99:10929–10934
  25. Schuster MA, Franke T, Pham CB. Smoking patterns of household members and visitors in homes with children in the United States. Arch Pediatr Adolesc Med. 2002;156:1094–1100
  26. Collaco JM, Vanscoy L, Bremer L, McDougal K, Blackman SM, Bowers A, et al. Interactions between secondhand smoke and genes that affect cystic fibrosis lung disease. JAMA. 2008;299:417–424
  27. Goss CH, Newsom SA, Schildcrout JS, Sheppard L, Kaufman JD. Effect of ambient air pollution on pulmonary exacerbations and lung function in cystic fibrosis. Am J Respir Crit Care Med. 2004;169:816–821
  28. Litonjua AA, Carey VJ, Weiss ST, Gold DR. Race, socioeconomic factors, and area of residence are associated with asthma prevalence. Pediatr Pulmonol. 1999;28:394–401
  29. Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–120
  30. Grimes DA, Schulz KF. Bias and causal associations in observational research. Lancet. 2002;359:248–252
  31. Diez Roux AV. Investigating neighborhood and area effects on health. Am J Public Health. 2001;91:1783–1789
  32. Kronebusch K, Elbel B. Simplifying children's Medicaid and SCHIP. Health Aff (Millwood). 2004;23:233–246
  33. LaVeist TA. Disentangling race and socioeconomic status: a key to understanding health inequalities. J Urban Health. 2005;(2 Suppl. 3):82;iii26-34

 Funding and conflict of interest disclosure information is available at www.jpeds.com (Appendix 2).

PII: S0022-3476(09)00455-7

doi: 10.1016/j.jpeds.2009.04.059

The Journal of Pediatrics
Volume 155, Issue 5 , Pages 634-639.e4 , November 2009