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Racial and ethnic differences in childhood asthma treatment in the United States
Eric M Sarpong1, G Edward Miller
1Division of Modeling and Simulation, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD.
Insights
Racial-ethnic disparities persist in asthma controller medication use among US children. Differences in need and access to care contribute to lower controller use in Black and Hispanic children compared to White children.
Area of Science:
- Health Services Research
- Pediatric Asthma Management
- Health Disparities
Background:
- Asthma affects millions of children in the U.S., with significant racial-ethnic disparities in prevalence and management.
- Controller medications are crucial for long-term asthma control, yet their utilization varies across different demographic groups.
- Understanding the factors contributing to these disparities is essential for improving asthma care equity.
Purpose of the Study:
- To investigate racial-ethnic differences in asthma controller medication use among insured children in the United States.
- To quantify the extent to which differences in need, enabling, and predisposing characteristics explain these disparities.
- To identify specific factors contributing to lower controller use in non-Hispanic Black and Hispanic children compared to non-Hispanic White children.
Main Methods:
- Utilized linked, nationally representative data from the Medical Expenditure Panel Survey (2005-2008), 2000 Decennial Census, and National Health Interview Survey (2004-2007).
- Employed Blinder-Oaxaca decomposition to analyze racial-ethnic differences in controller medication use.
- Assessed the contribution of observable characteristics (need, enabling, predisposing) to the observed disparities.
Main Results:
- Non-Hispanic Black and Hispanic children were less likely to use asthma controller medications than non-Hispanic White children.
- Observable characteristics explained less than 40% of the controller use gap between non-Hispanic Whites and non-Hispanic Blacks.
- Observable characteristics explained over 71% of the gap between non-Hispanic Whites and Hispanics, with enabling factors for Black children and predisposing factors for Hispanic children being significant.
Conclusions:
- Significant racial-ethnic disparities in asthma controller medication use persist among insured U.S. children.
- Differences in enabling and predisposing characteristics play a substantial role in these disparities, particularly for publicly insured children.
- Addressing these access and utilization challenges is critical to ensuring equitable, high-quality asthma care for all children.
Objective:
To examine racial-ethnic differences in asthma controller medication use among insured U.S. children.
Data Sources:
Linked nationally representative data from the Medical Expenditure Panel Survey (2005-2008), the 2000 Decennial Census, and the National Health Interview Survey (2004-2007).
Study Design:
The study quantifies the portion of racial-ethnic differences in children's controller use that are attributable to differences in need, enabling and predisposing characteristics.
Principal Findings:
Non-Hispanic black and Hispanic children were less likely to use controllers than non-Hispanic white children. Blinder-Oaxaca decomposition results indicated that observable characteristics explain less than 40 percent of the overall differential in controller use between non-Hispanic whites and non-Hispanic blacks. In contrast, observable characteristics explain more than two-thirds (71.3 percent) of the overall non-Hispanic white-Hispanic differential in controller use. For non-Hispanic blacks, a majority of the explained differential in controller use were attributed to enabling characteristics. For Hispanics, a significant portion of the explained differential in controller use was attributed to predisposing characteristics. In addition, a larger portion of the differential in controller use was explained by observable characteristics for publicly insured non-Hispanic black and Hispanic children.
Conclusions:
The large observed differences in controller use highlight the continuing challenges of ensuring that all U.S. children have access to quality asthma care.
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