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Published on: June 4, 2017
Racial differences in emergency department use persist despite allergist visits and prescriptions filled for
C L Joseph1, S L Havstad, D R Ownby
1Henry Ford Health System, Detroit, MI 48202-3450, USA.
Insights
African-American children disproportionately use emergency departments for asthma care. Even after adjustments, this disparity persists, suggesting undertreated asthma may be a key factor.
Area of Science:
- Pediatric Asthma Care
- Health Disparities Research
- Emergency Medicine
Background:
- African-American children exhibit higher emergency department (ED) utilization for asthma care compared to Caucasian children.
- Understanding the drivers of these disparities is crucial for equitable healthcare delivery.
Purpose of the Study:
- To investigate racial disparities in emergency department (ED) utilization for asthma care among children.
- To adjust for factors including anti-inflammatory medication use, type of initial asthma visit, and demographic variables.
Main Methods:
- A cohort of 4- to 11-year-old managed care enrollees with an index asthma visit was prospectively observed for 12 months.
- Asthma-related encounters and prescription drug claims data were analyzed to assess ED utilization patterns.
Main Results:
- African-American race was significantly associated with increased ED visits for asthma (RR=1.8).
- This association remained significant after adjusting for visit type, medication use, and demographics (adjusted RR=1.6).
- African-American children with non-specialist visits showed lower anti-inflammatory medication use (RR=0.5) and higher hospitalization rates post-ED visit (RR=10.2).
Conclusions:
- Racial disparities in emergency department (ED) asthma care utilization persist among children, even after statistical adjustments.
- These findings suggest that uncontrolled or undertreated asthma, particularly among African-American children not receiving specialty care, may drive ED overuse.
Background:
African-American children use the emergency department (ED) for asthma care more than their Caucasian counterparts.
Objective:
We sought to compare ED utilization for asthma care by race, adjusting for prescriptions filled for antiinflammatory medications, type of index visit (specialist vs nonspecialist), and demographic variables.
Methods:
An index asthma visit was identified for a cohort of managed care enrollees aged 4 to 11 years. Information on asthma encounters and drug claims data was evaluated during a prospective observation period of 12 months.
Results:
African-American race was associated with one or more ED visits during the observation period (relative risk [RR] = 1.8, 95% CI = 1.3 to 2.5, p < 0.01). After adjusting for index visit type, prescriptions filled, and selected demographic variables, African-American race remained associated with post-index ED utilization (adjusted RR = 1.6, 95% CI = 1.0 to 2.4, p = 0.05). Additional findings included an inverse relationship between African-American race and antiinflammatory medications among children with nonspecialist index visits (RR = 0.5, 95% CI = 0.3 to 0.9, p = 0.02) and a positive relationship between African-American race and hospitalization after an ED visit for asthma care (RR = 10.2, 95% CI = 1.4 to 74.8, p < 0.01).
Conclusion:
African-American children were more likely to use ED asthma care even after adjusting for the type of index visit, prescriptions filled for antiinflammatory medications, and selected demographic variables. Racial differences in ED utilization for asthma care could be caused by a higher prevalence of uncontrolled or undertreated disease among African-American children not receiving specialty care.
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