Effect of race on asthma management and outcomes in a large, integrated managed care organization.
BACKGROUND
Morbidity from asthma disproportionately affects black people. Whether this excess morbidity is fully explained by differences in asthma severity, access to care, or socioeconomic status (SES) is unknown.


METHODS
We assessed whether there were racial disparities in asthma management and outcomes in a managed care organization that provides uniform access to health care and then determined to what degree these disparities were explained by differences in SES, asthma severity, and asthma management. We prospectively studied 678 patients from a large, integrated health care delivery system. Patients who had been hospitalized for asthma were interviewed after discharge to ascertain information about asthma history, health status, and SES. Small-area socioeconomic data were ascertained by means of geocoding and linkage to the US Census 2000. Patients were followed up for subsequent emergency department (ED) visits or hospitalizations (median follow-up, 1.9 years).


RESULTS
Black race was associated with a higher risk of ED visits (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.39-2.66) and hospitalizations (HR, 1.89; 95% CI, 1.30-2.76). This finding persisted after adjusting for SES and differences in asthma therapy (adjusted HR for ED visits, 1.73; 95% CI, 1.07-2.81; and adjusted HR for hospitalizations, 2.01; 95% CI, 1.33-3.02).


CONCLUSIONS
Even in a health care setting that provides uniform access to care, black race was associated with worse asthma outcomes, including a greater risk of ED visits and hospitalizations. This association was not explained by differences in SES, asthma severity, or asthma therapy. These findings suggest that genetic differences may underlie these racial disparities.
Erickson
Sara E
SE
Department of Medicine, University of California, San Francisco, CA 94143, USA. sara.erickson@ucsf.edu
Iribarren
Carlos
C
Tolstykh
Irina V
IV
Blanc
Paul D
PD
Eisner
Mark D
MD
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D002140:California / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012923:Social Class; D012959:Socioeconomic Factors