Equal access to health care did not eliminate racial disparities among pediatric asthma patients

Despite coverage by the same health insurance program, black and Hispanic children were significantly less likely than white children to visit specialists for asthma and often experienced poorer disease-related outcomes.

Mathematica Policy Research Inc. researchers and others conducted a retrospective cohort study of children enrolled in TRICARE Prime — a health maintenance organization-type benefit program offered by the Department of Defense — during 2007 to evaluate racial/ethnic disparities in asthma prevalence, treatment and outcomes among pediatric asthma patients.

“Because the Military Health System (MHS) provides comprehensive health insurance to a racially and ethnically diverse population of beneficiaries, studying disparities in health care treatments and outcomes among this population could add significantly to our understanding of the potential effect of universal coverage on reducing disparities in health care,” the researchers noted.

The study looked at 822,900 children aged 2 to 17 years and included those children who had at least one medical claim during the year. For their analysis, the researchers assessed outcome measures — including prevalence of asthma; potentially avoidable asthma hospitalizations; asthma-related ED visits; visits to asthma specialists; and use of asthma medications — in the context of three age groups: 2 to 4 years, 5 to 10 years and 11 to 17 years.

Results indicated higher rates of asthma diagnosis among black (9.6%) and Hispanic (8.0%) children in all age groups when compared with white children (6.3%). Black children in all age groups and Hispanic children aged 5 to 10 years were also more likely to experience potentially avoidable asthma-related hospitalizations and ED visits. These children, however, were also less likely than white children to visit a specialist for their condition.

Data showed that black children also had a higher likelihood of filling prescriptions for inhaled corticosteroids. The researchers noted, however, that the higher rate of asthma-related hospitalizations and ED visits among black children may have been responsible for the increased number of prescriptions in this population. Additionally, because their treatments were less likely to be managed by specialists, these data could indicate that the medication may not have been used properly.

“Our study provides critical information about the presence of racial and ethnic disparities among a diverse population of children enrolled in a national health insurance system,” the researchers wrote. “Our findings suggest that eliminating racial and ethnic disparities in health care likely requires a multifaceted approach beyond universal health insurance coverage.”

Stewart KA. Arch Pediatr Adolesc Med. 2010;doi:10.1001/archpediatrics.2010.100.