Race and sex differences in consistency of care with national asthma guidelines in managed care organizations.
BACKGROUND
In the United States, morbidity from asthma disproportionately affects African Americans and women. Although inadequate care contributes to overall asthma morbidity, less is known about differences in asthma care by race and sex.


METHODS
To examine the relationships of race and sex with asthma care, we analyzed responses to questionnaires administered to adults enrolled in 16 managed care organizations participating in the Outcomes Management System Asthma Study between September and December 1993. Indicators of care consistent with National Asthma Education and Prevention Program (1991) recommendations were assessed. Of a random sample of 8640 patients asked to participate, 6612 (77%) completed the survey. This study focused on 5062 (14% African American, 72% women) patients with at least moderate asthma symptom severity.


RESULTS
Fewer African Americans than whites reported care consistent with recommendations for medication use (eg, daily inhaled corticosteroid use, 34.9% vs 54.4%; P =.001), self-management education (eg, action plan, 42.0% vs 53.8%; P =.001), avoiding triggers (37.6% vs 53.6%; P =.001), and specialist care (28.3% vs 41.0%; P =.001). Differences in asthma care by sex were smaller and tended to favor women except for daily inhaled corticosteroid use (women vs men: 49.6% vs 58.3%; P =.001) and having specialist care (37.7% vs 43.1%; P =.001). Similar race and sex differences were observed after adjusting for age, education, employment, and symptom frequency.


CONCLUSIONS
Even among patients with health insurance, disparities in asthma care for African Americans compared with whites exist and may contribute to race disparities in outcomes. Women generally reported better asthma care but may benefit from greater use of inhaled corticosteroids.
Krishnan
J A
JA
Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Cir, Room 4B.74, Baltimore, MD 21224, USA. satish@welch.jhu.edu
Diette
G B
GB
Skinner
E A
EA
Clark
B D
BD
Steinwachs
D
D
Wu
A W
AW
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D044383:Black People; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
D000305:Adrenal Cortex Hormones