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A higher Asthma Medication Ratio (AMR) predicts a decrease in ED visits among African American and Hispanic children
Yonsu Kim1, Katrina Miller Parrish2, Matthew Pirritano2
1University of Nevada, Las Vegas, NV, USA.
Insights
Increased controller medication use, measured by the Asthma Medication Ratio (AMR), significantly reduced emergency department visits for Black and Hispanic children with persistent asthma. This suggests improved medication adherence can help lessen asthma-related healthcare disparities.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Health Disparities
Background:
- African American and Hispanic children experience higher rates of asthma-related emergency department (ED) visits and hospitalizations.
- Suboptimal asthma management may contribute to these disparities and increase healthcare costs.
- The association between race/ethnicity, controller medication use, and healthcare utilization for asthma is not well understood.
Purpose of the Study:
- To investigate if the Asthma Medication Ratio (AMR) predicts asthma-related healthcare utilization across different racial and ethnic groups.
- To determine if higher AMR values are associated with decreased hospital-based care utilization in children with persistent asthma.
Main Methods:
- A cohort of 4,584 children (ages 5-11) with persistent asthma in Los Angeles, covered by Medi-Cal, was analyzed.
- Asthma Medication Ratios (AMR) were calculated using HEDIS criteria based on 2018 pharmacy claims.
- Healthcare utilization (hospitalizations, ED visits, outpatient visits) in 2019 was examined in relation to AMR values from the previous year.
Main Results:
- African American children had the lowest average AMR (0.401) and the highest rates of ED visits and hospitalizations.
- A higher AMR (>0.5) was significantly associated with a decrease in ED visits within 12 months for African American (OR=0.551) and Hispanic (OR=0.613) children.
- No significant association was found between AMR and asthma-related hospitalizations across racial/ethnic groups.
Conclusions:
- Increased adherence to controller asthma medications, as indicated by a higher AMR, is linked to reduced ED visits among minority children.
- Promoting controller medication use and caregiver adherence may be key strategies to mitigate asthma disparities in healthcare utilization.
- Further research is needed to explore the association between AMR and hospitalizations.
Introduction:
Higher rates of ED visits and hospitalizations for asthma among African American and Hispanic children may indicate suboptimal management of asthma, leading to a greater financial burden of healthcare. It is not well known if an association of race/ethnicity with controller medication and hospital-based care utilization exists.
Objective:
This study examines whether the Asthma Medication Ratio (AMR) predicts healthcare utilization for asthma by race/ethnicity.
Methods:
4,584 Medi-Cal children (Ages 5-11) with persistent asthma in Los Angeles were identified and their AMRs (2018) were calculated based on the HEDIS criteria. Healthcare utilization data were used, including hospitalizations, ED visits, and pharmacy claims to examine whether a higher AMR predicts decreases in healthcare utilization by race/ethnicity in the subsequent 3,6, and 12 months (2019).
Results:
The average AMR was lowest among African American children (0.401). In the subsequent 12 months, they were highest in ED visits (0.249) and hospitalizations (0.121), but lowest in outpatient visits (0.793). The results of logistic regression showed that a higher value of AMR (>0.5) contributed to decreases in ED visits in the subsequent 12 months only among African Americans (OR = 0.551, 95% CI 0.364-0.832) and Hispanics (OR = 0.613, 95% CI 0.489-0.770). No association between AMR and hospitalizations was found.
Conclusions:
Our findings indicate that increased use of controller medication contributes to a decrease in ED visits among African American and Hispanic children with persistent asthma. Increased use of controller medications and caregiver's efforts for medication adherence may contribute to a reduction in asthma disparities.
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