title: Acute asthma among adults presenting to the emergency department: the role of race/ethnicity and socioeconomic status.
abstract: OBJECTIVE
  To investigate racial/ethnic differences in acute asthma among adults presenting to the emergency department (ED), and to determine whether observed differences are attributable to socioeconomic status (SES).
  
  
  METHODS
  Prospective cohort studies performed during 1996 to 1998 by the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers provided 24-h coverage for a median duration of 2 weeks per year. Adults with acute asthma were interviewed in the ED and by telephone 2 weeks after hospital discharge.
  
  
  METHODS
  Sixty-four North American EDs.
  
  
  RESULTS
  A total of 1,847 patients were enrolled into the study. Black and Hispanic asthma patients had a history of more hospitalizations than did whites (ever-hospitalized patients: black, 66%; Hispanic, 63%; white, 54%; p < 0.001; patients hospitalized in the past year: black, 31%; Hispanic, 33%; white, 25%; p < 0.05) and more frequent ED use (median use in past year: black, three visits; Hispanic, three visits; white, one visit; p < 0.001). The mean initial peak expiratory flow rate (PEFR) was lower in blacks and Hispanics (black, 47%; Hispanic, 47%; white, 52%; p < 0.001). For most factors, ED management did not differ based on race/ethnicity. After accounting for several confounding variables, blacks and Hispanics were twice as likely to be admitted to the hospital. Blacks and Hispanics also were more likely to report continued severe symptoms 2 weeks after hospital discharge (blacks, 24%; Hispanic, 31%; white, 19%; p < 0.01). After adjusting for sociodemographic factors, the race/ethnicity differences in initial PEFR and posthospital discharge symptoms were markedly reduced.
  
  
  CONCLUSIONS
  Despite significant racial/ethnic differences in chronic asthma severity, initial PEFR at ED presentation, and posthospital discharge outcome, ED management during the index visit was fairly similar for all racial groups. SES appears to account for most of the observed acute asthma differences, although hospital admission rates were higher among black and Hispanic patients after adjustment for confounding factors. Despite asthma treatment advances, race/ethnicity-based deficiencies persist. Health-care providers and policymakers might specifically target the ED as a place to initiate interventions designed to reduce race-based disparities in health.
authors.affiliation: Department of Emergency Medicine, Cooper Hospital, One Cooper Plaza, Camden, NJ 08103-1489, USA. boudreaux-edwin@cooperhealth.edu
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Boudreaux
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Emond
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology