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Original Research: ASTHMA |

Race/Ethnicity Differences in the Inpatient Management of Acute Asthma in the United States

Divay Chandra, MD, MSc; Sunday Clark, MPH, ScD; Carlos A. Camargo, Jr, MD, DrPH, FCCP
Author and Funding Information

*From the Department of Epidemiology (Dr. Chandra), Harvard School of Public Health, Boston, MA; the Division of General Internal Medicine (Dr. Clark), University of Pittsburgh, Pittsburgh, PA; and the Department of Emergency Medicine (Dr. Camargo), Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Correspondence to: Carlos A. Camargo, Jr, MD, DrPH, Director, EMNet Coordinating Center, Massachusetts General Hospital, 326 Cambridge St, Suite 410, Boston, MA 02114; e-mail: ccamargo@partners.org


Dr. Camargo has received grant monies from AstraZeneca, Critical Therapeutics, Dey, GlaxoSmithKline, Merck, Novartis, and Respironics, and he has served as consultant/speaker on advisory committees for AstraZeneca, Critical Therapeutics, Dey, GlaxoSmithKline, Merck, Novartis, and Schering-Plough. Drs. Chandra and Clark have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(6):1527-1534. doi:10.1378/chest.08-1812
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Background:  The only published US study on racial/ethnic disparities in inpatient asthma management was performed in 1989–1990 at a single center. The authors reported that black and Hispanic children were provided substandard care at hospital discharge compared to white children. The purpose of the present analysis was to reexamine this important issue in a large multicenter study.

Methods:  A cohort study of 1,232 children and adults hospitalized with a physician diagnosis of acute asthma at 30 hospitals in 22 US states was used.

Results:  The cohort included 562 children (age range, 2 to 17 years; 39% white; 42% black; and 19% Hispanic) and 670 adults (age range, 18 to 54 years; 44% white; 44% black; and 12% Hispanic). There were no significant racial/ethnic differences in the choice of inpatient medications or length of stay among either children or adults. At hospital discharge, Hispanic children were less likely to receive an asthma action plan (37%) compared to white children (60%) or black children (63%; p < 0.001). Multivariate adjustment for eight variables (including socioeconomic status, hospital admissions for asthma in the past year, medication use prior to presentation, physical examination findings, and hospital admission location) attenuated the statistical significance of this association (odds ratio, 0.5; 95% confidence interval, 0.1 to 2.5).

Conclusions:  We did not identify racial/ethnic disparities in the inpatient treatment and outcomes for children or adults with acute asthma. At hospital discharge, Hispanic children were less likely to receive an asthma action plan compared to white or black children, possibly due to language or socioeconomic differences.


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