Differences in Prevalence, Treatment, and Outcomes of Asthma Among a Diverse Population of Children With Equal Access to Care: Findings From a Study in the Military Health System
PURPOSE OF THE STUDY.
To assess possible racial and ethnic differences in asthma prevalence, treatment patterns, and outcomes among a diverse population of children with equal access to health care.
In the Military Health System (MHS), children 2 to 17 years of age were enrolled throughout 2007 in TRICARE Prime, a voluntary health maintenance organization–type benefit provided by the US Department of Defense. More than 75% of children in the MHS are enrolled in TRICARE Prime.
This was a retrospective cohort analysis. The sponsor parent's race and ethnicity were used as a proxy for the child's race and ethnicity. Outcome measures included the prevalence of diagnosed asthma (using International Classification of Diseases, Ninth Revision [ICD-9] codes), “potentially avoidable” asthma hospitalizations, asthma-related emergency department visits, visits to asthma specialists, and use of asthma medications among children 2 to 4, 5 to 10, and 11 to 17 years of age.
The cohort in the final analysis included 822 900 children aged 2 through 17 years. After adjusting for differences in demographic characteristics and socioeconomic status, black and Hispanic children of all ages were more likely to have an asthma diagnosis than white children (ranging from an odds ratio [OR] of 1.16 [95% confidence interval (CI): 1.09–1.24] to 2.00 [95% CI: 1.93–2.07]). Black children of all ages and Hispanic children aged 5 to 10 years were more likely to have any asthma hospitalization or asthma-related emergency department visit (ranging from an OR of 1.24 [95% CI: 1.1–1.37] to 1.99 [95% CI: 1.37–2.88]) and were less likely to visit a specialist (ranging from an OR of 0.71 [95% CI: 0.61–0.82] to 0.88 [95% CI: 0.79–0.98]) compared with white children. Black children in all age categories were more likely to have filled any prescription for inhaled corticosteroids compared with white children (ranging from an OR of 1.11 [95% CI: 1.02–1.21] to 1.11 [95% CI: 1.04–1.19]).
Despite universal health insurance coverage offered through the MHS, the authors found evidence of racial and ethnic differences in asthma prevalence, treatment, and outcomes.
This study corroborates the presence of racial and ethnic disparities in asthma within a cohort offered universal health care coverage. Black children were not only more likely to be diagnosed with asthma, but they were also found to have poorer control of asthma. It was surprising that black children were also more likely to have filled prescriptions for inhaled steroids compared with white children. The authors suggested that the higher rates of filled prescriptions might be attributed to the higher likelihood of receiving these prescriptions for asthma medications during and after emergency department visits and/or hospitalizations. Actual use and administration of these medications were not evaluated. The study's findings suggest that eliminating racial and ethnic disparities in health care likely requires a multifaceted approach beyond universal health insurance coverage.
- Copyright © 2011 by the American Academy of Pediatrics