title: Underuse of controller medications among children with persistent asthma in the Ohio medicaid population: evolving differences with new medications.
abstract: BACKGROUND
  Despite innovations in asthma care, morbidity and mortality have increased significantly. Underuse of controller medications is a major contributor to increased morbidity and mortality.
  
  
  OBJECTIVE
  To determine the extent of underuse of asthma controller medications among Ohio Medicaid children and to determine if there are racial differences in controller medication claims.
  
  
  METHODS
  We conducted a retrospective analysis of Ohio Medicaid claims data. The source data included all institutional, medical service, and pharmacy claims for fee-for-service patients between January 1, 1997, and December 31, 2001. We identified children with persistent asthma using Health Employer Data Information System criteria. The primary outcome was a controller medication claim. We used multivariable logistic regression to identify risk factors for underutilizing asthma controller medications and applied generalized estimating equations to account for repeated measures.
  
  
  RESULTS
  The proportion of children with claims for a controller medication increased from 53% in 1997 to 67% in 2001. Although there were no racial differences in medication claims in 1997, a smaller proportion of African American children had a claim for a controller medication in 2001 (64.8% vs 67.8%, P < .001). Leukotriene antagonists (LTAs) were driving this difference. Individuals residing in urban areas were significantly less likely to have claims for LTAs when compared with those who resided in nonurban areas.
  
  
  CONCLUSIONS
  Overall use of asthma controller medications among Ohio Medicaid children was poor. There was a widening racial difference in controller medication claims over the 5-year study. Regional differences in LTA claims were driving this racial difference.
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, University of Cincinnati, Ohio, USA. Stephen.Wilson@uc.edu
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Wilson
authors.forename: Anthony
authors.initials: A
authors.lastname: Leonard
authors.forename: Charles
authors.initials: C
authors.lastname: Moomaw
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
mesh_terms: D000293:Adolescent; D001741:Black or African American; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D008484:Medicaid; D009820:Ohio / Q000453:epidemiology
chemical_list: D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists