title: Health-care use among Puerto Rican and African-American children with asthma.
abstract: OBJECTIVE
  To compare the rates of emergency department (ED) visits, hospitalizations, hospital days, and outpatient clinic visits for asthma among children in two ethnic minority groups that are disproportionately affected by asthma (Puerto Ricans and African Americans).
  
  
  METHODS
  This cross-sectional study was part of an asthma intervention program in Hartford, CT, in which 6,554 children were screened for asthma by primary care providers using a parental survey. Medicaid and the supplementary State Children's Health Insurance Plan data about health-care utilization for asthma were obtained for each child for the 12 months preceding completion of the screening survey.
  
  
  RESULTS
  Among 2,304 children in whom asthma had been diagnosed, Puerto Ricans had more severe asthma than African Americans. In analyses adjusted for asthma severity and other potential confounders, Puerto Rican children had more clinic visits for asthma (rate ratio [RR], 1.31; 95% confidence interval [CI], 1.12 to 1.53) but spent fewer days in the hospital for asthma (RR, 0.36; 95% CI, 0.24 to 0.53) than African-American children. There were no differences in the rates of ED visits or hospitalizations between the two groups.
  
  
  CONCLUSIONS
  Puerto Rican children had more severe asthma but were less likely than African-American children to have prolonged hospitalizations for asthma. This finding may be due to the frequent clinic visits for asthma made by Puerto Rican children. Further research is needed to understand the cultural factors that contribute to different approaches to health-care utilization among ethnic minorities.
authors.affiliation: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. robyn.cohen@channing.harvard.edu
authors.forename: Robyn T
authors.initials: RT
authors.lastname: Cohen
authors.forename: Juan C
authors.initials: JC
authors.lastname: Celedón
authors.forename: Vanessa J
authors.initials: VJ
authors.lastname: Hinckson
authors.forename: Clare D
authors.initials: CD
authors.lastname: Ramsey
authors.forename: Dorothy B
authors.initials: DB
authors.lastname: Wakefield
authors.forename: Scott T
authors.initials: ST
authors.lastname: Weiss
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Cloutier
mesh_terms: D000293:Adolescent; D001741:Black or African American; D001249:Asthma / Q000208:ethnology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology