title: Racial/ethnic differences in asthma-related emergency department visits and hospitalizations among children with wheeze in Buffalo, New York.
abstract: This study examined whether racial/ethnic minority (i.e., Black, Hispanic) children with wheeze have a higher proportion of urgent care use (i.e., emergency department visit or hospitalization) for asthma compared to their White counterparts. We also assessed the contribution of disease severity and sociodemographic, access to care, and home environmental risk factors to racial/ethnic differences in utilization. A cross-sectional study was conducted among children aged 0 to 17 in Buffalo, New York. We compared rates of urgent care visits and physician-diagnosed asthma among racial/ethnic groups, and conducted race/ethnicity stratified analyses by number of symptoms, asthma severity, insurance types, and medical care access. Multivariate regression analyses were used to examine differences in urgent care use by race/ethnicity after controlling for multiple confounders and to identify factors associated with urgent care utilization by race/ethnicity. Asthma symptom severity was the primary factor contributing to urgent care use in this population, followed by race/ethnicity and Medicaid enrollment. Minority children with wheeze were nearly twice as likely as Whites to have used urgent care for asthma, after controlling for disease severity, access to care, and environmental factors. Not having a home remedy in place for asthma or reporting trouble getting care also contributed to the greater use of urgent care resources among minority children. Minority children still had a significantly higher proportion of urgent care use for acute asthma care compared to Whites, even after controlling for multiple risk factors. Disease severity and inadequate access to medical care may partially explain higher rates among minority children. Future studies should examine racial/ethnic differences in other factors potentially associated with urgent care use, including asthma management and use of routine asthma care.
authors.affiliation: New York State Department of Health, Bureau of Environmental and Occupational Epidemiology, Troy, NY 12180, USA. rrj01@health.state.ny.us
authors.forename: Rena
authors.initials: R
authors.lastname: Jones
authors.forename: Shao
authors.initials: S
authors.lastname: Lin
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Munsie
authors.forename: Marleen
authors.initials: M
authors.lastname: Radigan
authors.forename: Syni-An
authors.initials: SA
authors.lastname: Hwang
mesh_terms: D000293:Adolescent; D001741:Black or African American; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D009518:New York; D012135:Respiratory Sounds; D044465:White People