Are physician estimates of asthma severity less accurate in black than in white patients?
BACKGROUND
Racial differences in asthma care are not fully explained by socioeconomic status, care access, and insurance status. Appropriate care requires accurate physician estimates of severity. It is unknown if accuracy of physician estimates differs between black and white patients, and how this relates to asthma care disparities.


OBJECTIVE
We hypothesized that: 1) physician underestimation of asthma severity is more frequent among black patients; 2) among black patients, physician underestimation of severity is associated with poorer quality asthma care.


METHODS
We conducted a cross-sectional survey among adult patients with asthma cared for in 15 managed care organizations in the United States. We collected physicians' estimates of their patients' asthma severity. Physicians' estimates of patients' asthma as being less severe than patient-reported symptoms were classified as underestimates of severity.


METHODS
Frequency of underestimation, asthma care, and communication.


RESULTS
Three thousand four hundred and ninety-four patients participated (13% were black). Blacks were significantly more likely than white patients to have their asthma severity underestimated (OR = 1.39, 95% CI 1.08-1.79). Among black patients, underestimation was associated with less use of daily inhaled corticosteroids (13% vs 20%, p < .05), less physician instruction on management of asthma flare-ups (33% vs 41%, p < .0001), and lower ratings of asthma care (p = .01) and physician communication (p = .04).


CONCLUSIONS
Biased estimates of asthma severity may contribute to racially disparate asthma care. Interventions to improve physicians' assessments of asthma severity and patient-physician communication may minimize racial disparities in asthma care.
Okelo
Sande O
SO
Department of Pediatrics, Johns Hopkins University, 200 N. Wolfe Street, Suite 3025, Baltimore, MD 21287, USA. sandeokelo@jhmi.edu
Wu
Albert W
AW
Merriman
Barry
B
Krishnan
Jerry A
JA
Diette
Gregory B
GB
D000328:Adult; D001741:Black or African American; D001249:Asthma / Q000145:classification* / Q000208:ethnology* / Q000628:therapy; D002983:Clinical Competence; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D012720:Severity of Illness Index; D044465:White People