A comparison of asthma prevalence and morbidity between rural and urban schoolchildren in Arkansas

Background: Asthma disproportionately affects minority and low-income children. Investigations that focus on high-risk pediatric populations outside the inner city are limited. Objective: To compare asthma prevalence and morbidity in urban and rural children in Arkansas. Methods: We administered a validated survey to parents of children enrolled in urban and rural school districts in Arkansas. Rates of asthma diagnosis, asthma symptoms, medication use, and health care utilization were compared between urban and rural groups. Results: Age and sex distributions were similar; however, 85% of rural and 67% of urban children were black and 78% of rural and 37% of urban children had state-issued medical insurance (P < .001 for both). Provider-diagnosed asthma was similar in the rural vs urban groups (19% vs 20%); however, rural children were more commonly diagnosed as having chronic bronchitis (7% vs 2%, P < .001). Rural children had more asthma morbidity compared with urban children, including recurrent trouble breathing (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.5-2.2), recurrent cough (OR, 2.2; 95% CI, 1.9-2.6), recurrent chest tightness (OR, 1.8; 95% CI, 1.5-2.2), and repeated episodes of bronchitis (OR, 2.2; 95% CI, 1.7-2.8) during the preceding 2 years. Rural children were more likely to report symptoms consistent with moderate to severe asthma compared with urban children (46% vs 35%, P < .001). There were no differences in health care utilization between groups. Conclusion: Asthma prevalence was similar between representative rural and urban groups in Arkansas, but asthma morbidity was significantly higher in the rural group.