title: A population-based study of health service deficits for US adults with asthma.
abstract: OBJECTIVE
  Asthma prevalence in the United States is higher than it is in many other countries and its impact in terms of healthcare expenditures and morbidity and mortality is staggering. In the United States, many groups bear a disproportionate burden of asthma. Understanding the epidemiology of adult asthma and deficits in health care can identify opportunities for improving care and effectively managing resources.
  
  
  METHODS
  The computed dependent variable, health service deficits, entails a lack of health insurance, not having a healthcare provider, deferring medical care because of cost, and having had no routine medical exam. Bivariate and multivariate analyses were performed on 2005 Behavioral Risk Factor Surveillance Survey data to examine the relationship between health service deficits experienced by adults with asthma and socioeconomic status (SES), race and ethnicity, and geographic locale. The variable was also calculated for each US state.
  
  
  RESULTS
  Hispanic (OR = 1.594, 95% CI = 1.588-1.599) and Other/Multiracial (OR = 1.447, 95% CI = 1.441-1.452) adults with current asthma had greater odds of having a health service deficit. Rural adults with current asthma had greater odds of having a health service deficit (OR = 1.086, 95% CI = 1.083-1.089) when compared with non-rural adult residents. Low-SES (OR = 1.976, 95% CI = 1.971-1.982) and middle-SES (OR = 1.596, 95% CI = 1.592-1.600) adults with current asthma had greater odds of having a health service deficit. The percentage of current asthma adults experiencing at least one health service deficit by state ranged from a low of 28.5% (Delaware) to a high of 58.8% (Wyoming).
  
  
  CONCLUSIONS
  There are clear patterns of disparity associated with health services and asthma that can help target interventions.
authors.affiliation: Research Division, Essentia Institute of Rural Health, Duluth, MN 55805, USA. mlutfiyya@eirh.org
authors.forename: May Nawal
authors.initials: MN
authors.lastname: Lutfiyya
authors.forename: Joel Emery
authors.initials: JE
authors.lastname: McCullough
authors.forename: Martin Stephen
authors.initials: MS
authors.lastname: Lipsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D055815:Young Adult