Among pediatric patients in the United States, there was a greater prevalence of asthma among minorities compared with white children, and minority patients used emergency medical services for their asthma at higher rates, according to a study published in the Journal of Asthma.
Although racial and ethnic disparities exist among children with asthma and their use of emergency department (ED) services, most research has focused on the differences in white vs black populations only, without much regard for patients’ and parents’ asthma management knowledge. Investigators sought to examine these disparities among disaggregated minority subgroups, taking into consideration the impact of preventive asthma practices, which are poorly understood in terms of their impact on ED visit reduction.
A secondary review of cross-sectional data from the 2013 to 2015 National Health Interview Survey sample child component (age 2-17 years) identified 3336 (58.7% boys) participants with a current diagnosis of asthma. Researchers documented asthma prevalence among different racial and ethnic subgroups, as well as subgroup disparities in ED visits over a period of 12 months (18.33% for all groups). Multivariable logistic regression analyses were used to calculate adjusted odds ratios (aORs; adjusted for demographics and health variables) and 95% CIs for the likelihood of patients in these racial and ethnic subgroups seeking asthma treatment in the ED compared with white patients. Separate adjusted models accounted for 2013 asthma management variables, including action plan usage (50.82% overall), preventive medication usage (30.05% every 2 days or more often overall) and exposure to management courses (11.19% overall).
Among all children with asthma, Puerto Rican children demonstrated the highest disease prevalence at 21.2% (95% CI, 19.6%-24.8%), followed by nonHispanic black children (14.5%; 95% CI, 13.5%-15.6%), other Hispanic children (8.5%; 95% CI, 7.1%-9.9%), nonHispanic white children (8.2%; 95% CI, 7.6%-8.7%), Mexican American children (7.5%; 95% CI, 6.7%-8.2%), and other nonHispanic children (7.1%; 95% CI, 5.7%-8.4%).
Compared with nonHispanic white children, there were significantly higher chances of ED visits for asthma within 12 months in most minority subgroups, except other nonHispanic children. The elevated risk for children visiting an ED, in descending order, were found in these subgroups: other Hispanic (28.2%; aOR 2.44; 95% CI, 1.53-3.90), Puerto Rican (26.3%; aOR 1.98; 95% CI, 1.15-2.66), Mexican American (19.7%; aOR 1.79; 95% CI, 1.21-2.66), and nonHispanic black (24.3%; aOR 1.72; 95% CI, 1.24-2.38). Subanalyses, based on 2013 data only, revealed that management variable adjustments regarding those areas noted above yielded insignificant, small, or no effects in terms of ED visit risk secondary to asthma.
Study strengths included use of representative data allowing generalization to the US pediatric asthma population, division into 6 racial and ethnic subgroups representative of US diversity, and disaggregation of Hispanic children into subcategories.
Study limitations included inability to control for environmental exposures, possible reverse causality involving management measures, inability to assess disease severity measures, and potentially limited accuracy when using only 2013 data, owing to varying subgroup percentages across years.
“The high prevalence of asthma and the disparity in asthma related ED visits among minority children exemplify the need for further research in understanding the mechanisms underlying the continuing existence of these health imbalances,” noted the authors.
Funding and Conflicts of Interest Disclosures:
There was no funding information provided.
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Urquhart A, Clarke P. US racial/ethnic disparities in childhood asthma emergent health care use: National Health Interview Survey, 2013–2015 [published online, April 8, 2019]. J Asthma. doi:10.1080/02770903.2019.1590588