Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program

Despite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white patients. We sought to determine associations between black and white patients and asthma-related health care use, accounting for complex re...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology Vol. 143; no. 6; pp. 2052 - 2061
Main Authors: Fitzpatrick, Anne M., Gillespie, Scott E., Mauger, David T., Phillips, Brenda R., Bleecker, Eugene R., Israel, Elliot, Meyers, Deborah A., Moore, Wendy C., Sorkness, Ronald L., Wenzel, Sally E., Bacharier, Leonard B., Castro, Mario, Denlinger, Loren C., Erzurum, Serpil C., Fahy, John V., Gaston, Benjamin M., Jarjour, Nizar N., Larkin, Allyson, Levy, Bruce D., Ly, Ngoc P., Ortega, Victor E., Peters, Stephen P., Phipatanakul, Wanda, Ramratnam, Sima, Teague, W. Gerald
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.06.2019
Elsevier Limited
Subjects:
Age
Asthma
Asthma control
asthma exacerbation
Corticosteroids
Environmental policy
Family medical history
health care use
Hospitalization
inverse probability of treatment weighting
Nitric oxide
Patients
propensity scoring
Quality of life
Questionnaires
racial disparities
United States > US
racial disparities
ACT
inverse probability of treatment weighting
Asthma control
health care use
NHLBI
propensity scoring
IPTW
asthma exacerbation
SARP
SMD
ED
ISSN:0091-6749, 1097-6825, 1097-6825
Online Access:Get full text
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Summary:Despite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white patients. We sought to determine associations between black and white patients and asthma-related health care use, accounting for complex relationships. This study was completed as part of the National Heart, Lung, and Blood Institute's Severe Asthma Research Program, a prospective observational cohort. Between November 2012 and February 2015, it enrolled 579 participants 6 years and older with 1 year of observation time and complete data. Inverse probability of treatment weighting was used to balance racial groups with respect to community and family socioeconomic variables and environmental exposure variables. The primary outcome was emergency department (ED) use for asthma. Secondary outcomes included inhaled corticosteroid use, outpatient physician's office visits for asthma, and asthma–related hospitalization. Black patients had greater odds of ED use over 1 year (odds ratio, 2.19; 95% CI, 1.43-3.35) but also differed in the majority (>50%) of baseline variables measured. After statistical balancing of the racial groups, the difference between black and white patients with respect to ED use no longer reached the level of significance. Instead, in secondary analyses black patients were less likely to see an outpatient physician for asthma management (adjusted odds ratio, 0.57; 95% CI, 0.38-0.85). The disparity in ED use was eliminated after consideration of multiple variables. Social and environmental policies and interventions tailored to black populations with a high burden of asthma are critical to reduction (or elimination) of these disparities. [Display omitted]
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ISSN:0091-6749
1097-6825
1097-6825
DOI:10.1016/j.jaci.2018.11.022