Predictors of asthma-related health care utilization and quality of life among inner-city patients with asthma.
BACKGROUND
Asthma morbidity and mortality are highest among minority inner-city populations.


OBJECTIVE
To identify factors associated with acute health care resource utilization and asthma-related quality of life among high-risk, minority patients with asthma.


METHODS
We interviewed a prospective cohort of 198 adults hospitalized for asthma in an inner city hospital over a period of 1 year. Detailed information about sociodemographics, asthma history, access to care, asthma medications, and self-reported allergy to aeroallergens was collected at baseline. Data on resource utilization (emergency department visits and hospital admissions for asthma) and asthma-related quality of life were obtained at 6 months after discharge. Multivariate analyses were used to identify predictors of resource utilization and quality of life.


RESULTS
The mean age of patients was 49.9 +/- 17.4 years, 78% were women, and 97% were nonwhite. At 6 months, 49% of patients had an emergency department visit or hospitalization. In multivariate analysis, adjusting for age, sex, medication regimen, and asthma severity, patients with a physician in charge of their asthma care had lower odds of resource utilization (odds ratio, 0.4; P=.03). Conversely, a self-reported history of cockroach allergy was associated with greater utilization (odds ratio, 2.3; P=.05). Asthma-related quality of life was worse among patients who spoke mostly Spanish or who reported allergy to cockroaches (P < .004).


CONCLUSIONS
Lack of an established asthma care provider, language barriers, and self-reported allergy to cockroaches are associated with higher resource utilization and worse quality of life among minority, inner-city patients with asthma. Interventions targeting these factors may lead to better outcomes among these patients.
Wisnivesky
Juan P
JP
Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. juan.wisnivesky@mssm.edu
Leventhal
Howard
H
Halm
Ethan A
EA
D000818:Animals; D001249:Asthma; D003058:Cockroaches / Q000276:immunology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D011788:Quality of Life