Race May Play A Role In Children's Asthma Care

Children in this country suffer from asthma more than any other chronic illness, and new research finds African American children with the condition have a greater risk than others of experiencing severe symptoms that escalate into an emergency.

Previous research has shown that in comparison with white and Hispanic children, African Americans have a higher rate of asthma, are hospitalized more and face more disability due to the condition. Because of this, "we suspected they might also exhibit relatively more severe asthma symptoms at the time of hospitalization," said Yu Bai, a doctoral candidate at Pennsylvania State University.

Bai and his colleagues analyzed the records of 7,726 white, African American and Hispanic children up to age 19 who were admitted to Pennsylvania hospitals in 2001 for asthma symptoms. The researchers then examined how the physician reported the severity of the children's condition and ranked them either as "emergency" or "non-emergency" admissions.

Ninety percent of the African American children had an emergency asthma condition compared with 60 percent of white and 64 percent of Hispanic children. In all, African-American children were more than twice as likely to have severe asthma symptoms as whites.

The study appears in the February issue of the Journal of Health Care for the Poor and Underserved.

Bai and colleagues found that children on Medicaid had the most severe symptoms at admission compared with those who had private insurance and two-thirds of African-American children had Medicaid or other public insurance.

Other studies have shown that children on Medicaid have less access to primary care for asthma and are less likely to be prescribed the proper medication, according to the authors.

Bai said there's a need for improvement: "Providing greater resources to the Medicaid program would allow for more comprehensive provision of services that would help children and their families manage asthma including case management services, provision of medically necessary equipment and supplies and referrals to asthma specialists when needed."

Barbara Tilley, Ph.D., chair of the department of biometry and epidemiology at the Medical University of South Carolina in Charleston, said the authors' results were "consistent with other studies that indicate an increased burden of asthma for African American children whether or not they are on Medicaid." She agreed there is a need for improvement in delivery of care for all children on Medicaid with asthma.

Bai Y, Hillemeier MM, Lengerich EJ. Racial/ethnic disparities in symptom severity among children hospitalized with asthma. Journal of Health Care for the Poor and Underserved 18(1), 2007.

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