{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:53:39Z","timestamp":1791294819989,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Asthma is one of the most common chronic diseases affecting children in the United States, with millions impacted annually. There is ongoing concern and disparity in the pediatric workforce. However, there is limited research evaluating how the geographic distribution of these providers aligns with pediatric asthma burden across states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the degree of geographic alignment between pediatric asthma prevalence and the distribution of general pediatricians and pediatric hospitalists in the United States using inequality metrics and spatial analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a cross\u2010sectional, state\u2010level ecological study using publicly available data. Pediatric asthma prevalence was obtained from the CDC Behavioral Risk Factor Surveillance System. Pediatric provider data were sourced from the American Board of Pediatrics, and child population estimates were retrieved from the U.S. Census Bureau. Workforce density was calculated as the number of general pediatricians and pediatric hospitalists per 100,000 children in each state. Lorenz curves and Gini coefficients were used to quantify geographic inequality in asthma burden and workforce distribution. Bivariate choropleth maps and Pearson correlation coefficients were employed to assess spatial mismatch and association between asthma prevalence and provider availability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      General pediatricians had a mean state\u2010level density of 70.6 per 100,000 children, while pediatric hospitalists had a mean density of 5.3 per 100,000 children (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Gini coefficients revealed moderate inequality in the distribution of general pediatricians (0.20) and higher inequality among pediatric hospitalists (0.33). In contrast, the Gini index for pediatric asthma prevalence was 0.11. Correlation analysis showed a weak, marginally significant association between asthma prevalence and general pediatrician density (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.30,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032), and a non\u2010significant association with pediatric hospitalist density (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.24,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.094). Bivariate mapping identified several states with high asthma burden and low provider density, revealing substantial spatial mismatches.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There is a misalignment between the burden of pediatric asthma and the distribution of pediatric healthcare providers in the U.S., particularly in pediatric hospital medicine. States with higher asthma prevalence are not consistently supported by proportionally larger pediatric workforces. Policies that support provider redistribution, rural practice incentives, and data\u2010driven workforce modeling are essential to improving health equity and optimizing care for children with asthma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71840","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T16:55:31Z","timestamp":1789836931000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographic Inequalities in Pediatric Asthma and Workforce Distribution"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4344-7032","authenticated-orcid":false,"given":"Anand","family":"Gourishankar","sequence":"first","affiliation":[{"name":"Children's National Hospital\/George Washington University Washington, DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0302-2576","authenticated-orcid":false,"given":"Eugene","family":"Suwandhi","sequence":"additional","affiliation":[{"name":"Children's National Hospital\/George Washington University Washington, DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Centers for Disease Control and Prevention National Center for Health Statistics. Percentage of Current Asthma for Children Under Age 18 United States 2021. National Health Interview Survey. Accessed October 1 2025 https:\/\/wwwn.cdc.gov\/nhisdataquerytool\/SHS_child\/index.html."},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2025.114824"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/aci.0000000000001127"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-0150"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.100.2.172"},{"key":"e_1_2_13_7_1","unstructured":"Current Asthma by State. American Lung Association. Accessed October 1 2025 https:\/\/www.lung.org\/research\/trends-in-lung-disease\/asthma-trends-brief\/data-tables\/asthma-current-state."},{"key":"e_1_2_13_8_1","unstructured":"The American Board of Pediatrics. Data and Workforce. Accessed October 1 2025 https:\/\/www.abp.org\/content\/data-and-workforce."},{"key":"e_1_2_13_9_1","unstructured":"Explore Census Data. United States Census Bureau. Accessed October 1 2025 https:\/\/data.census.gov\/."},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2013.01.064"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2025.102835"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/nursrep15020030"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.pu.16.050195.002311"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzw110"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/nursrep15070235"},{"key":"e_1_2_13_16_1","unstructured":"Projecting the Future U.S. Pediatric Subspecialty Workforce. The American Board of Pediatrics. Accessed on December 12 2025 https:\/\/www.abp.org\/content\/projecting-future-us-pediatric-subspecialty-workforce."},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2024.5110"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-013292"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023-063678M"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.4300\/jgme-d-23-00453.1"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-023-02603-4"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2022.08.014"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/mlr.0000000000001531"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-025-04527-7"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2021.02.004"}],"container-title":["Pediatric Pulmonology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.71840","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ppul.71840","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.71840","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:52:45Z","timestamp":1791291165000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ppul.71840"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":24,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/ppul.71840"],"URL":"https:\/\/doi.org\/10.1002\/ppul.71840","archive":["Portico"],"relation":{},"ISSN":["8755-6863","1099-0496"],"issn-type":[{"value":"8755-6863","type":"print"},{"value":"1099-0496","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-01-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71840"}}