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Cohort studyThe Journal of allergy and clinical immunology · 2026

Associations of rurality, child opportunity, and distance with use of pediatric asthma specialists.

James Bohnhoff, Anya Cutler, Elizabeth A Jacobs … Yvonne Jonk

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PediatricsCohort study

Children living farther from specialists are less likely to receive asthma specialty care.

Associations of rurality, child opportunity, and distance with use of pediatric asthma specialists.

James Bohnhoff et al. · The Journal of allergy and clinical immunology · 2026

Background

Receipt of asthma specialty care reduces asthma morbidity in children, but children living in rural, socioeconomically disadvantaged, and remote areas face potential barriers to accessing specialists.

Purpose

We sought to evaluate the associations of rurality, Child Opportunity Index (COI), and distance with pediatric asthma specialist utilization among children with an indication for specialist referral.

Methods

In this retrospective cohort study using 2015-2021 Maine Health Data Organization All-Payer Claims Data, we identified children (<18 years old) with asthma and one of the following indications for specialist referral: a complicating comorbidity, higher-level controller medications, 3 or more courses of systemic corticosteroids within a year, or a respiratory hospitalization.

n = 12,014 children

Results

for every additional hour of driving, children were less likely to see a specialist

AOR by subgroup · 95% CI

More results

Among 12,014 children with indications for pediatric asthma specialist referral, 47% lived in micropolitan or rural areas, and 15% lived more than 1 hour from any specialist.

A total of 2,296 children (19%) received care from specialists within a year of their indication.

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Conclusion

Children in rural areas, in areas of low socioeconomic opportunity, and far from specialists are at an increased risk of not receiving indicated asthma specialist care.

Post

Associations of rurality, child opportunity, and distance with use of pediatric asthma specialists.

Children living farther from specialists are less likely to receive asthma specialty care.

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