PURPOSE: To examine and explain racial disparities, in comorbid asthma/COPD subjects (defined based on co-occurring diagnoses codes) and compare with patients with asthma alone or COPD alone in a Medicaid population.
METHODS: A retrospective population-based cohort study was conducted using Maryland Medicaid Managed Care patient encounter data (study period 1/1/2001 to 12/31/2003). Patients enrolled were adults aged 40–64 years as of 1/1/2001 with at least 360 days of follow-up from first medical claim (dual eligible excluded). COPD patients were identified based on claims with ICD-9 codes 491.xx, 492.xx, 496.xx, and asthma patients on the basis of ICD-9 code 493.xx in the primary, secondary or tertiary diagnosis field. Charlson Comorbidity Index (CCI) was used to adjust for the severity of comorbidities. We compared healthcare resource utilization and cost-outcomes in African American patients with other patients with COPD, asthma or co-occurring COPD and asthma. Multivariate analyses were conducted using logistic regression models, to predict utilization patterns and costs.
RESULTS: The analysis included 3,072 asthma patients, 3,455 COPD patients, and 2,604 asthma/COPD patients. After controlling for age, gender, cohort allocation, and comorbid conditions, the study found significant differences of healthcare resource utilization by race. African American (AA) patients used 17% fewer medical services, including physician visits, hospitalizations and emergency room visits, than Caucasian patients (OR=0.83, 95% CI: 0.75–0.93). AA patients showed 18% less utilization of outpatient services (OR=0.82, 95% CI: 0.74–0.91) and 15% less utilization of inpatient services than Caucasians (OR=0.85, 95% CI: 0.76–0.94). Overall, Asthma/COPD comorbid group also was more than 5 times likely to have a hospitalization (OR=5.21, CI 4.55–5.97) and to be in the higher 75th percentile costs compared to those in asthma group (OR=5.25, CI 4.59–6.02).
CONCLUSION: The study concludes show that AA adults, in COPD, asthma or comorbid asthma/COPD groups, use fewer medical services and account for lower medical costs than Caucasians.
CLINICAL IMPLICATIONS: Care is needed to address disparities due to race in certain populations as far as COPD is concerned.
DISCLOSURE: Anand Dalal, Employee Anand Dalal is currently employed by GlaxoSmithKline (GSK); Consultant fee, speaker bureau, advisory committee, etc. Fadia Shaya was a consultant at University of MD who received funding from GSK to complete this analysis. Other authors were also funded by GSK.; No Product/Research Disclosure Information