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Racial and ethnic differences in asthma diagnosis among children who wheeze
Lara J Akinbami1, Julia C Rhodes, Marielena Lara
1Infant, Child, and Women's Health Studies Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA. lea8@cdc.gov
Insights
Symptomatic minority children are not underdiagnosed with asthma; they are more likely to receive a diagnosis than non-Hispanic white children, even when accounting for symptom severity. This study challenges previous concerns about asthma diagnosis disparities.
Area of Science:
- Pediatric Health
- Epidemiology
- Health Disparities
Background:
- Racial and ethnic disparities in childhood asthma prevalence are documented.
- Concerns exist regarding potential underdiagnosis of asthma in minority children due to healthcare access barriers.
- It remains unclear if observed prevalence differences reflect true incidence or diagnostic disparities.
Purpose of the Study:
- To investigate racial and ethnic differences in asthma diagnosis among symptomatic children.
- To determine if minority children experience underdiagnosis of asthma compared to non-Hispanic white children.
- Analysis excluded children without reported symptoms, including those with well-controlled asthma.
Main Methods:
- Utilized data from the 1999 National Health Interview Survey, a nationally representative sample.
- Included children aged 3-17 with reported wheezing symptoms in the past year.
- Controlled for demographic factors, socioeconomic status, health insurance, usual source of care, and wheezing severity.
Main Results:
- Among children with wheezing, asthma diagnosis rates were higher for Puerto Rican (83%), non-Hispanic black (71%), and Mexican (65%) children compared to non-Hispanic white children (57%).
- Adjusted relative risk for asthma diagnosis was higher for Puerto Rican (1.43), non-Hispanic black (1.22), and Mexican (1.19) children versus non-Hispanic white children.
- Despite reporting more severe wheezing symptoms, minority children were as or more likely to be diagnosed with asthma.
Conclusions:
- Findings do not support the hypothesis of underdiagnosis of asthma among symptomatic minority children.
- Symptomatic minority children demonstrated a higher likelihood of asthma diagnosis compared to non-Hispanic white children.
- This increased likelihood persisted even after adjusting for greater reported wheezing severity in minority groups.
Background:
Racial and ethnic disparities exist in reported childhood asthma prevalence, but it is unclear if disparities stem from true prevalence differences or a different likelihood of receiving a diagnosis from a health professional. Concern has been raised that asthma may be underdiagnosed, particularly among minority children who have more restricted access to high-quality health care.
Objective:
To examine racial/ethnic differences among currently symptomatic children in acquiring an asthma diagnosis to determine if relative underdiagnosis among minorities exists. Children for whom no symptoms were reported (a group that includes those with well-controlled symptoms) were excluded from the analysis.
Methods:
The 1999 National Health Interview Survey includes a nationally representative sample of children with reported wheezing symptoms. We included children 3 to 17 years old in the study and analyzed racial/ethnic differences in asthma diagnosis, controlling for young age, gender, parental education, single-parent household, central-city residence, region of residence, health insurance, having a usual place of care, and parent-reported severity of wheezing symptoms.
Results:
Among those reported to have wheezed in the past year (n = 946), 83% of Puerto Rican, 71% of non-Hispanic black, and 65% of Mexican children were diagnosed with asthma compared with 57% of non-Hispanic white children. Using non-Hispanic white children as the reference group, the approximate adjusted relative risk for physician diagnosis of asthma given wheezing in the past year was 1.43 (95% confidence interval [CI]: 1.04, 1.63) for Puerto Rican, 1.22 (95% CI: 1.03, 1.37) for non-Hispanic black, and 1.19 (95% CI: 0.94, 1.39) for Mexican children. Minority children were reported to have greater severity of wheezing symptoms. Even after accounting for this increased severity, children in racial and ethnic minority groups were as or more likely to have a reported asthma diagnosis than non-Hispanic white children.
Conclusions:
Our findings do not provide evidence for the hypothesis that symptomatic minority children are underdiagnosed with asthma compared with non-Hispanic white children. To the contrary, among currently symptomatic children, minority children were more likely to be diagnosed than non-Hispanic white children even after accounting for the higher wheezing severity among minority children.
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