Racial, ethnic disparities persist in pediatric acute care use for asthma

A new study highlights different patterns of clinic and ED acute care use for asthma among non-Hispanic Black and bilingual Latino children compared with non-Hispanic white children.

Non-Hispanic Black children with asthma had lower clinic use but higher ED use, and bilingual Latino children had a higher clinic use for acute, chronic and preventive care, compared with non-Hispanic white children with asthma, researchers reported in Annals of Family Medicine.

The observational study evaluated electronic health records of 41,276 children with asthma (mean age, 7.6 years; 42.9% girls) from community health centers in 18 U.S. states. Researchers compared visits for clinic-coded asthma exacerbations from 2012 to 2018 among non-Hispanic Black (n = 10,041), English-preferring Latino (n = 9,239), Spanish-preferring Latino (n = 11,832) and non-Hispanic white children (n = 10,164) aged 3 to 17 years. In a subsample of 6,555 children insured under Oregon-Medicaid, researchers assessed asthma-related ED use and inpatient admissions.

Non-Hispanic Black children had the highest proportion of moderate to severe asthma (10.6%) as well as fewer yearly community health center visits. Fifty-four percent had fewer than two annual visits.

Compared with non-Hispanic white children with asthma, Spanish-preferring Latino children had higher odds of clinic visits for asthma exacerbations in the adjusted regression model (OR = 1.1; 95% CI, 1.02-1.18) and the Oregon-Medicaid subsample (OR = 1.36; 95% CI, 1.17-1.58).

Non-Hispanic Black children with asthma had higher odds (OR = 1.4; 95% CI, 1.04-1.89) and higher yearly rates (RR = 1.49; 95% CI, 1.09-2.04) of asthma-related ED use compared with non-Hispanic white children.

Researchers observed no differences between racial and ethnic groups for asthma-related inpatient hospital admissions with an overall probability of less than 5% for all groups and an estimated rate of one to two admissions per 100 person-years.

“Our discovery suggests that the community health center delivery model may be more effective at mitigating disparities in some situations and groups than others,” Jorge Kaufmann, MD, MS, with the department of family medicine at Oregon Health and Science University, Portland, said in a related press release.

According to Kaufmann, further research may focus on features of the community health center delivery approach that could be improved or expanded to reach all populations in need of care.

“The findings from this research underscore the multifaceted nature of minority health and health disparities, “Eliseo J. Pérez-Stable, MD, director of the National Institute on Minority Health and Health Disparities, said in the release. “There are multiple social factors and levels of influence that can impact health behavior within a population with the same diagnosis and these must be explored to better understand and address health disparities.”

Reference:

• Scientists find racial and ethnic disparities in use of pediatric acute asthma care. Published March 29, 2022. Accessed March 30, 2022.