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Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010
Lara J Akinbami1, Jeanne E Moorman2, Alan E Simon3
1Infant, Child and Women's Health Statistics Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md; US Public Health Service, Rockville, Md.
Insights
Racial disparities in childhood asthma exist, but using at-risk rates reveals progress. At-risk analysis shows no disparity in asthma attacks and decreased disparities in emergency department visits and hospitalizations for Black children.
Area of Science:
- Pediatric Health
- Epidemiology
- Health Disparities Research
Background:
- Childhood asthma disparities, particularly in hospitalizations and mortality, are a persistent public health concern.
- Existing research often relies on population-based rates, which may not fully capture the nuances of racial disparities.
- Understanding these disparities is crucial for developing targeted interventions.
Purpose of the Study:
- To analyze trends in racial disparities in childhood asthma outcomes.
- To compare traditional population-based rates with at-risk rates to account for prevalence differences.
- To provide a more accurate assessment of disparities in emergency department visits, hospitalizations, and deaths.
Main Methods:
- Utilized national data from 2001-2010 for Black and White children.
- Calculated estimates of asthma prevalence and key outcomes (ED visits, hospitalizations, deaths).
- Employed weighted loglinear regression and Joinpoint analysis to assess trends and changes in disparities over time.
Main Results:
- Asthma prevalence disparities increased; Black children were twice as likely to have asthma by 2010.
- Population-based rates showed stable or increased disparities in asthma outcomes.
- At-risk rates indicated stable (deaths), decreased (ED visits, hospitalizations), or non-existent (asthma attacks) disparities.
Conclusions:
- At-risk rates offer a critical perspective by adjusting for prevalence differences in asthma outcome disparities.
- Analysis using at-risk rates demonstrates no disparity in asthma attack prevalence among children with asthma.
- Progress has been made in reducing disparities for asthma emergency department visits and hospitalizations when accounting for prevalence.
Background:
Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality.
Objectives:
Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma) to account for prevalence differences between race groups.
Methods:
Estimates of asthma prevalence and outcomes (emergency department [ED] visits, hospitalizations, and deaths) were calculated from national data for 2001 to 2010 for black and white children. Trends were calculated using weighted loglinear regression, and changes in racial disparities over time were assessed using Joinpoint.
Results:
Disparities in asthma prevalence between black and white children increased from 2001 to 2010; at the end of this period, black children were twice as likely as white children to have asthma. Population-based rates showed that disparities in asthma outcomes remained stable (ED visits and hospitalizations) or increased (asthma attack prevalence, deaths). In contrast, analysis with at-risk rates, which account for differences in asthma prevalence, showed that disparities in asthma outcomes remained stable (deaths), decreased (ED visits, hospitalizations), or did not exist (asthma attack prevalence).
Conclusions:
Using at-risk rates to assess racial disparities in asthma outcomes accounts for prevalence differences between black and white children, and adds another perspective to the population-based examination of asthma disparities. An at-risk rate analysis shows that among children with asthma, there is no disparity for asthma attack prevalence and that progress has been made in decreasing disparities in asthma ED visit and hospitalization rates.
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