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PEDIATRICS Vol. 109 No. 1 January 2002, pp. e1

ELECTRONIC ARTICLE

Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

Alexander N. Ortega, PhD*,{ddagger}, Peter J. Gergen, MD{ddagger}, A. David Paltiel, PhD*, Howard Bauchner, MD{ddagger},§, Kathleen D. Belanger, PhD* and Brian P. Leaderer, PhD*

* Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
{ddagger} Agency for Healthcare Research and Quality, Center for Primary Care Research, Rockville, Maryland
§ Departments of Pediatrics and Social and Behavioral Sciences, Boston University Schools of Medicine and Public Health, Boston, Massachusetts

--> Objective. To understand the importance of source of care and other factors that influence differences in asthma medication use by race and Hispanic ethnicity.

Methods. The Childhood Asthma Severity Study provided 12-month, retrospective, parent-reported questionnaire data on a monthly basis for children ages <=12 years in a community sample of 1002 children and their families from Connecticut and Massachusetts. Medications considered included cromolyn, ß2-agonist, inhaled steroids, anticholinergics, theophylline, and systemic steroids. Information was available on demographics, insurance status, symptom severity, primary care contact, and provider practice types.

Results. Black and Hispanic children received fewer ß2-agonists, and Hispanic children received fewer inhaled steroids than white children after adjusting for patients’ race, age, gender, insurance status, symptom severity, number of primary care visits for asthma, number of urgent visits to the regular provider, family income, maternal education, and site of care. When multivariate analyses were restricted to patients in private practice, the significant association between Hispanic ethnicity and low inhaled steroid use persisted, whereas differences in ß2-agonist use by race and ethnicity changed little but became nonsignificant.

Conclusion. Even within private practices, patients’ race and ethnicity are associated with clinician nonadherence to national guidelines. Programs to eliminate these disparities will need both to focus on site of care and to intervene at the provider and patient levels to be successful.

Key Words: asthma • child • practice • guidelines • health insurance • Hispanic Americans

Abbreviations: HMO, health maintenance organization • CHAS, Childhood Asthma Severity Study

Received for publication Jun 29, 2001; Accepted Aug 14, 2001.