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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Vydané v:	Journal of allergy and clinical immunology Ročník 143; číslo 6; s. 2052 - 2061
Hlavní autori:	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
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Elsevier Inc 01.06.2019 Elsevier Limited
Predmet:	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
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Abstract	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]
AbstractList	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. 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] BackgroundDespite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white patients.ObjectiveWe sought to determine associations between black and white patients and asthma-related health care use, accounting for complex relationships.MethodsThis 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.ResultsBlack 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).ConclusionsThe 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. Despite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white patients.BACKGROUNDDespite 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.OBJECTIVEWe 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.METHODSThis 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).RESULTSBlack 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.CONCLUSIONSThe 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.
Author	Wenzel, Sally E. Fahy, John V. Castro, Mario Larkin, Allyson Ly, Ngoc P. Moore, Wendy C. Phipatanakul, Wanda Bacharier, Leonard B. Sorkness, Ronald L. Jarjour, Nizar N. Ortega, Victor E. Phillips, Brenda R. Teague, W. Gerald Fitzpatrick, Anne M. Mauger, David T. Levy, Bruce D. Gaston, Benjamin M. Meyers, Deborah A. Israel, Elliot Peters, Stephen P. Erzurum, Serpil C. Bleecker, Eugene R. Ramratnam, Sima Gillespie, Scott E. Denlinger, Loren C.
Author_xml	– sequence: 1 givenname: Anne M. surname: Fitzpatrick fullname: Fitzpatrick, Anne M. email: anne.fitzpatrick@emory.edu organization: Emory University, Department of Pediatrics, Atlanta, Ga – sequence: 2 givenname: Scott E. surname: Gillespie fullname: Gillespie, Scott E. organization: Emory University, Department of Pediatrics, Atlanta, Ga – sequence: 3 givenname: David T. surname: Mauger fullname: Mauger, David T. organization: Pennsylvania State University, Department of Public Health Sciences, Hershey, Pa – sequence: 4 givenname: Brenda R. surname: Phillips fullname: Phillips, Brenda R. organization: Pennsylvania State University, Department of Public Health Sciences, Hershey, Pa – sequence: 5 givenname: Eugene R. surname: Bleecker fullname: Bleecker, Eugene R. organization: University of Arizona, Department of Medicine, Tucson, Ariz – sequence: 6 givenname: Elliot surname: Israel fullname: Israel, Elliot organization: Brigham and Women's Hospital, Harvard Medical School, Department of Medicine, Boston, Mass – sequence: 7 givenname: Deborah A. surname: Meyers fullname: Meyers, Deborah A. organization: University of Arizona, Department of Medicine, Tucson, Ariz – sequence: 8 givenname: Wendy C. surname: Moore fullname: Moore, Wendy C. organization: Wake Forest University, Department of Medicine, Winston-Salem, NC – sequence: 9 givenname: Ronald L. surname: Sorkness fullname: Sorkness, Ronald L. organization: University of Wisconsin, Department of Medicine, Madison – sequence: 10 givenname: Sally E. surname: Wenzel fullname: Wenzel, Sally E. organization: University of Pittsburgh, Department of Medicine, Pittsburgh, Pa – sequence: 11 givenname: Leonard B. surname: Bacharier fullname: Bacharier, Leonard B. organization: Washington University, Departments of Medicine and Pediatrics, St Louis, Mo – sequence: 12 givenname: Mario surname: Castro fullname: Castro, Mario organization: Washington University, Departments of Medicine and Pediatrics, St Louis, Mo – sequence: 13 givenname: Loren C. surname: Denlinger fullname: Denlinger, Loren C. organization: University of Wisconsin, Department of Medicine, Madison – sequence: 14 givenname: Serpil C. surname: Erzurum fullname: Erzurum, Serpil C. organization: Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio – sequence: 15 givenname: John V. surname: Fahy fullname: Fahy, John V. organization: University of California, San Francisco, Departments of Medicine and Pediatrics, Calif – sequence: 16 givenname: Benjamin M. surname: Gaston fullname: Gaston, Benjamin M. organization: Case Western Reserve University, Department of Pediatrics, Cleveland, Ohio – sequence: 17 givenname: Nizar N. surname: Jarjour fullname: Jarjour, Nizar N. organization: University of Wisconsin, Department of Medicine, Madison – sequence: 18 givenname: Allyson surname: Larkin fullname: Larkin, Allyson organization: University of Pittsburgh, Department of Medicine, Pittsburgh, Pa – sequence: 19 givenname: Bruce D. surname: Levy fullname: Levy, Bruce D. organization: Brigham and Women's Hospital, Harvard Medical School, Department of Medicine, Boston, Mass – sequence: 20 givenname: Ngoc P. surname: Ly fullname: Ly, Ngoc P. organization: University of California, San Francisco, Departments of Medicine and Pediatrics, Calif – sequence: 21 givenname: Victor E. surname: Ortega fullname: Ortega, Victor E. organization: Wake Forest University, Department of Medicine, Winston-Salem, NC – sequence: 22 givenname: Stephen P. surname: Peters fullname: Peters, Stephen P. organization: Wake Forest University, Department of Medicine, Winston-Salem, NC – sequence: 23 givenname: Wanda surname: Phipatanakul fullname: Phipatanakul, Wanda organization: Boston Children's Hospital, Harvard Medical School, Department of Pediatrics, Boston, Mass – sequence: 24 givenname: Sima surname: Ramratnam fullname: Ramratnam, Sima organization: University of Wisconsin, Department of Medicine, Madison – sequence: 25 givenname: W. Gerald surname: Teague fullname: Teague, W. Gerald organization: University of Virginia, Department of Pediatrics, Charlottesville, Va
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Keywords	racial disparities ACT inverse probability of treatment weighting Asthma control health care use NHLBI propensity scoring IPTW asthma exacerbation SARP SMD ED
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PublicationDate	June 2019 2019-06-00 2019-Jun 20190601
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Snippet	Despite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white... BackgroundDespite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared...
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SubjectTerms	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
Title	Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program
URI	https://www.clinicalkey.com/#!/content/1-s2.0-S0091674918317329 https://dx.doi.org/10.1016/j.jaci.2018.11.022 https://www.ncbi.nlm.nih.gov/pubmed/30635198 https://www.proquest.com/docview/2235007820 https://www.proquest.com/docview/2179356987
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