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

• Type of Material: Article
• Authors: Anne Fitzpatrick, Emory University; Scott E. Gillespie, Emory University; David T. Mauger, Pennsylvania State University; Brenda R. Phillips, Pennsylvania State University; Eugene R. Bleecker, University of Arizona; Elliot Israel, Harvard Medical School; Deborah A. Meyers, University of Arizona; Wendy C. Moore, Wake Forest University; Ronald L. Sorkness, University of Wisconsin; Sally E. Wenzel, University of Pittsburgh; Leonard B. Bacharier, Washington University; Mario Castro, Washington University; Loren C. Denlinger, University of Wisconsin; Serpil C. Erzurum, Cleveland Clinic; John V. Fahy, University of California San Francisco; Benjamin M. Gaston, Case Western Reserve University; Nizar N. Jarjour, University of Wisconsin; Allyson Larkin, University of Pittsburgh; Bruce D. Levy, Harvard Medical School; Ngoc P. Ly, University of California San Francisco; Victor E. Ortega, Wake Forest University; Stephen P. Peters, Wake Forest University; Wanda Phipatanakul, Harvard Medical School; Sima Ramratnam, University of Wisconsin; W. Gerald Teague, University of Virginia
• Language: English
• Date: 2019-06-01
• Publisher: Mosby-Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 American Academy of Allergy, Asthma & Immunology
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jaci.2018.11.022
• Title of Journal or Parent Work: Journal of Allergy and Clinical Immunology
• Volume: 143
• Issue: 6
• Start Page: 2052
• End Page: 2061
• Grant/Funding Information: In addition, this program is supported through the following National Institutes of Health National Center for Advancing Translational Sciences awards: UL1 TR001420 (Wake Forest University) UL1 TR000427 (University of Wisconsin) UL1 TR001102 (Harvard University) UL1 TR002378 (Emory University); Supported by NHLBI to the Severe Asthma Research Program (SARP): U10 HL109086 U10 HL109146 U10 HL109164 U10 HL109168 U10 HL109172 U10 HL109250 U10 HL109257
• Keywords: Asthma control; health care use; Life Sciences & Biomedicine; Validation; Reliability; Literacy; Immunology; Adherence; asthma exacerbation; Emergency department use; Science & Technology; inverse probability of treatment weighting; Predictors; Age; Allergy; racial disparities; Children; propensity scoring; Outcomes; Quality of life
• Research Categories: Health Sciences, Public Health; Health Sciences, Immunology; Health Sciences, Health Care Management

Abstract

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