Asthma Symptom Perception, School Absenteeism, and Healthcare Utilization

Asthma costs the US healthcare system $56 billion dollars (approximately $1,039/child annually) and does not account for lost productivity costs due to school absenteeism. Parents’ under-perception of children’s symptoms and lay model illness representations (IR) may lead to inadequate controller medication use resulting in absenteeism and increased healthcare utilization. This study examined parents’ symptom perception and IRs on controller medication use, school absenteeism and healthcare utilization. Subjects: Mexican and Puerto Rican (PR) parents (N=267) and children ages 5-12 years (N=267) were enrolled from two school-based health centers and a mobile asthma clinic in Phoenix, AZ and two inner-city hospitals in Bronx, NY.  Method: Interviews with parents and children, spirometry, and children’s medical records were reviewed at: enrollment, 3, 6, 9 and 12 months post-enrollment. Results: PR children were more likely to miss school (OR=1.81, 95% CI=1.12, 2.94, p=.02), have an ED visit (OR=5.61, 95% CI=3.05, 10.31, p=<.0001), and hospitalization (OR=2.35, 95% CI=1.16, 4.76, p=.02) than Mexican children. Children of parents whose IRs were congruent with the professional model were less likely to have an ED visit (OR=3.37, 95% CI=1.42, 7.97, p=.006). Children of parents who under-perceived symptoms were more likely to have an ED visit than those of parents who magnified symptoms (OR=2.13, 95% CI=1.04, 4.35, p=.04).  Conclusion: Children of PR ethnicity, whose parents under-perceived their symptoms, and had IRs aligned with the lay model had higher healthcare utilization and absenteeism. Interventions to improve symptom perception and reframe IRs may result in decreases in healthcare utilization and absenteeism.