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Original Research: COPD |

Burden of COPD, Asthma, and Concomitant COPD and Asthma Among Adults: Racial Disparities in a Medicaid Population

Fadia T. Shaya, PhD, MPH; Mark S. Maneval, BS Pharm; Confidence M. Gbarayor, MPH; Kyongsei Sohn, PhD, MBA; Anand A. Dalal, PhD, MBA; Dongyi Du, MSc; Steven M. Scharf, MD, PhD
Author and Funding Information

From the Department of Pharmaceutical Health Services Research (Drs. Shaya and Sohn, Mr. Maneval, Ms. Gbarayor, and Mr. Du), University of Maryland School of Pharmacy, Baltimore, MD; GlaxoSmithKline (Dr. Dalal), Research Triangle Park, NC; and the Sleep Disorders Center (Dr. Scharf), University of Maryland School of Medicine, Baltimore, MD.

Fadia T. Shaya, PhD, MPH, Associate Professor, Associate Director, Center on Drugs and Public Policy, University of Maryland School of Pharmacy, University of Maryland School of Medicine, Epidemiology and Preventive Medicine, 220 Arch St, Twelfth Floor, Baltimore, MD 21201; e-mail: fshaya@rx.umaryland.edu


This research was supported by National Heart, Lung, and Blood Institute Grant HL07441 (S.L.S.).

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;136(2):405-411. doi:10.1378/chest.08-2304
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Background:  Asthma and COPD are characterized by substantial racial disparities in morbidity and mortality. We hypothesized that because African-American patients with these conditions experience greater mortality and morbidity than their white counterparts, they would use more health-care resources when no difference in health insurance exists.

Methods:  A retrospective, population-based cohort study was conducted using Maryland Medicaid Managed Care patient encounter data. We compared health services utilization and cost outcomes in both African-American and white patients with COPD, asthma, or coexisting COPD and asthma.

Results:  The study population consisted of 9,131 patients with COPD, asthma, or both conditions. Of the total population, 52% were African American (n = 4,723), and 44% were white (n = 4,021); all other races were combined into the “unknown race” category to account for the remaining 4% (n = 387). After controlling for age, gender, cohort allocation, and comorbidities, we found that African-American adults with COPD, asthma, or coexisting COPD and asthma actually used fewer medical services and accounted for lower medical costs than white adults.

Conclusions:  Lower health services utilization and medical costs among African-American patients with COPD and asthma may provide a possible explanation for the racial disparities in outcomes of patients with these conditions.

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