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Original Research: ASTHMA |

Racial and Ethnic Disparities in Asthma Medication Usage and Health-Care Utilization: Data From the National Asthma Survey

Deidre Crocker, MD; Clive Brown, MBBS, MPH; Ronald Moolenaar, MD, MPH; Jeanne Moorman, MS; Cathy Bailey, MS; David Mannino, MD, MPH, FCCP; Fernando Holguin, MD, MPH
Author and Funding Information

Affiliations: From the Air Pollution and Respiratory Health Branch (Dr. Crocker, Ms. Moorman, and Ms. Bailey), the Division of Global Migration and Quarantine (Dr. Brown), and the Division of Global Public Health Capacity Development (Dr. Moolenaar), Centers for Disease Control and Prevention, Atlanta GA; the Division of Pulmonary and Critical Care Medicine (Dr. Mannino), University of Kentucky, Lexington KY; and the Department of Medicine (Dr. Holguin), University of Pittsburgh, Pittsburgh, PA.

Correspondence to: Deidre Crocker, MD, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-58, Chamblee, GA 30341; e-mail: dvj4@cdc.gov


This study was funded by Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA.

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(4):1063-1071. doi:10.1378/chest.09-0013
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Background:  Despite the availability of effective treatment, minority children continue to experience disproportionate morbidity from asthma. Our objective was to identify and characterize racial and ethnic disparities in health-care utilization and medication usage among US children with asthma in a large multistate asthma survey.

Methods:  We analyzed questions from the 2003–2004 four-state sample of the National Asthma Survey to assess symptom control, medication use, and health-care utilization among white, black, and Hispanic children < 18 years old with current asthma who were residing in Alabama, California, Illinois, or Texas.

Results:  Of the 1,485 children surveyed, 55% were white, 25% were Hispanic, and 20% were black. Twice as many black children had asthma-related ED visits (39% vs 18%, respectively; p < 0.001) and hospitalizations (12% vs 5%, respectively; p = 0.02) compared with white children. Significantly fewer black and Hispanic children reported using inhaled corticosteroids (ICSs) in the past 3 months (21% and 22%, respectively) compared to white children (33%; p = 0.001). Additionally, 26% of black children and 19% of Hispanic children reported receiving a daily dose of a short-acting β-agonist compared with 12% of white children (p = 0.001). ED visits were positively correlated with short-acting β-agonist use and were negatively correlated with ICS use when stratified by race/ethnicity.

Conclusions:  Children with asthma in this large, multistate survey showed a dramatic underuse of ICSs. Black and Hispanic children compared with white children had more indicators of poorly controlled asthma, including increased emergency health-care utilization, more daily rescue medication use, and lower use of ICSs, regardless of symptom control.

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