Racial and ethnic disparities in asthma medication usage and health-care utilization: data from the National Asthma Survey.
BACKGROUND
Despite the availability of effective treatment, minority children continue to experience disproportionate morbidity from asthma. Our objective was to identify and characterize racial and ethnic disparities in health-care utilization and medication usage among US children with asthma in a large multistate asthma survey.


METHODS
We analyzed questions from the 2003-2004 four-state sample of the National Asthma Survey to assess symptom control, medication use, and health-care utilization among white, black, and Hispanic children < 18 years old with current asthma who were residing in Alabama, California, Illinois, or Texas.


RESULTS
Of the 1,485 children surveyed, 55% were white, 25% were Hispanic, and 20% were black. Twice as many black children had asthma-related ED visits (39% vs 18%, respectively; p < 0.001) and hospitalizations (12% vs 5%, respectively; p = 0.02) compared with white children. Significantly fewer black and Hispanic children reported using inhaled corticosteroids (ICSs) in the past 3 months (21% and 22%, respectively) compared to white children (33%; p = 0.001). Additionally, 26% of black children and 19% of Hispanic children reported receiving a daily dose of a short-acting beta-agonist compared with 12% of white children (p = 0.001). ED visits were positively correlated with short-acting beta-agonist use and were negatively correlated with ICS use when stratified by race/ethnicity.


CONCLUSIONS
Children with asthma in this large, multistate survey showed a dramatic underuse of ICSs. Black and Hispanic children compared with white children had more indicators of poorly controlled asthma, including increased emergency health-care utilization, more daily rescue medication use, and lower use of ICSs, regardless of symptom control.
Crocker
Deidre
D
Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, Atlanta GA. Electronic address: dvj4@cdc.gov.
Brown
Clive
C
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta GA.
Moolenaar
Ronald
R
Division of Global Public Health Capacity Development, Centers for Disease Control and Prevention, Atlanta GA.
Moorman
Jeanne
J
Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, Atlanta GA.
Bailey
Cathy
C
Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, Atlanta GA.
Mannino
David
D
Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington KY.
Holguin
Fernando
F
Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000407:Alabama; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000628:therapy*; D044383:Black People; D002140:California; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005006:Ethnicity; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006630:Hispanic or Latino; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois; D007407:Interviews as Topic; D044469:Racial Groups; D044465:White People; D001741:Black or African American
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents