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Racial and Ethnic Disparities in Acute Care Use for Pediatric Asthma
Jorge Kaufmann1, Miguel Marino2,3, Jennifer Lucas2
1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon kaufmjor@ohsu.edu.
Insights
Asthma care disparities persist among children. Spanish-preferring Latine children visited clinics more for exacerbations, while Black children had higher emergency department (ED) use, indicating unequal healthcare access.
Area of Science:
- Pediatric Health
- Health Disparities
- Asthma Management
Background:
- Previous research indicates higher asthma-related emergency department (ED) use among Black and Latine populations.
- Understanding healthcare utilization patterns across different settings (outpatient, ED, inpatient) for pediatric asthma exacerbations is crucial.
- Correlations between acute care use and routine outpatient services require further investigation.
Purpose of the Study:
- To quantify racial, ethnic, and language-based disparities in pediatric acute asthma care.
- To analyze differences in healthcare use across outpatient, ED, and inpatient settings for asthma exacerbations.
- To examine the relationship between acute care utilization and routine outpatient service use in community health centers.
Main Methods:
- An observational study analyzed electronic health records from US community health centers (2012-2018).
- Compared non-Hispanic Black, English-preferring Latine, Spanish-preferring Latine, and non-Hispanic White children (3-17 years) for clinic-coded asthma exacerbations.
- Evaluated asthma-related ED use and inpatient admissions in a subsample of Oregon-Medicaid recipients using regression analyses.
Main Results:
- Spanish-preferring Latine children showed higher odds of clinic visits for asthma exacerbation compared to non-Hispanic White peers (OR=1.10).
- Non-Hispanic Black children had higher odds and rates of asthma-related ED use than non-Hispanic White peers (OR=1.40, RR=1.49) in a Medicaid subsample.
- No significant differences in asthma-related inpatient admissions were observed across groups.
Conclusions:
- This study reveals distinct patterns in clinic and ED acute-care utilization for pediatric asthma among non-Hispanic Black and Spanish-preferring Latine children compared to non-Hispanic White children.
- Non-Hispanic Black children utilized clinics less but had higher ED use, while Spanish-preferring Latine children had higher clinic utilization, including for acute exacerbations.
- Addressing disparities in clinic-based care is essential for mitigating unequal asthma outcomes.
Purpose:
Previous work has shown that asthma-related emergency department (ED) use is greatest among Black and Latine populations, but it is unknown whether health care use for exacerbations differs across settings (outpatient, ED, inpatient) and correlates with use of routine outpatient services. We aimed to measure disparities by race, ethnicity, and language in pediatric acute asthma care using data from US primary care community health centers.
Methods:
In an observational study using electronic health records from community health centers in 18 states, we compared non-Hispanic Black, English-preferring Latine, Spanish-preferring Latine, and non-Hispanic White children aged 3 to 17 years on visits for clinic-coded asthma exacerbations (2012-2018). We further evaluated asthma-related ED use and inpatient admissions in a subsample of Oregon-Medicaid recipients. Covariate-adjusted odds ratios (ORs) and rate ratios (RRs) were derived using logistic or negative binomial regression analysis with generalized estimating equations.
Results:
Among 41,276 children with asthma, Spanish-preferring Latine children had higher odds of clinic visits for asthma exacerbation than non-Hispanic White peers (OR = 1.10; 95% CI, 1.02-1.18). Among the subsample of 6,555 children insured under Oregon-Medicaid, non-Hispanic Black children had higher odds and rates of asthma-related ED use than non-Hispanic White peers (OR = 1.40; 95% CI, 1.04-1.89 and RR = 1.49; 95% CI, 1.09-2.04, respectively). We observed no differences between groups in asthma-related inpatient admissions.
Conclusions:
This study is the first to show that patterns of clinic and ED acute-care use differ for non-Hispanic Black and Spanish-preferring Latine children when compared with non-Hispanic White peers. Non-Hispanic Black children had lower use of clinics, whereas Spanish-preferring Latine children had higher use, including for acute exacerbations. These patterns of clinic use were accompanied by higher ED use among Black children. Ensuring adequate care in clinics may be important in mitigating disparities in asthma outcomes.VISUAL ABSTRACT.
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