PURPOSE:The only published US study on racial disparities in the inpatient treatment of acute asthma (Finkelstein JA, Pediatrics 1995) was performed at a single-center, and reported that black and Hispanic children were provided substandard inpatient treatment and discharge planning compared to white children. The purpose of the present analysis was to re-examine this important issue in a multicenter study.
METHODS:A cohort-study of 1232 pediatric and adult patients hospitalized for acute asthma at 30 hospitals in 22 US states during 1999–2000.
RESULTS:The cohort included 562 children age 2–17 years (39% white, 42% black, and 19% Hispanic), and 670 adults age 18–54 years (44% white, 44% black, and 12% Hispanic). In terms of inpatient treatment and outcomes, we identified no significant racial/ethnic differences in the medications used or the length-of-stay among children or adults on univariate analysis. At discharge, the only notable differences were in the prescription of asthma action plans and spacers among children. Hispanic children were less likely to receive an asthma action plan (37%) compared to white or black children (60 and 63% respectively, p<0.001). Black children received more prescriptions for inhaled corticosteroids (62%) than white or Hispanic children (53% and 55%, p=0.14) and were also more likely to be prescribed a spacer on discharge (68%) compared to whites or Hispanics (46 and 44%, p<0.001). Multivariate logistic regression was used to further examine the association between race and prescription of asthma action plans among children. After adjusting for 8 potential confounders (including socioeconomic-status, asthma admissions in the past year, medication use prior to presentation, physical examination findings, and admission location) the race/ethnic differences were no longer statistically significant.
CONCLUSION:We did not identify significant racial/ethnic disparities in the inpatient treatment of acute asthma. Hispanic children may have been less likely to receive an asthma action plan at discharge, likely due to socio-economic or language differences.
CLINICAL IMPLICATIONS:Unlike the outpatient setting, there were no racial/ethnic disparities in the inpatient treatment of acute asthma in these US hospitals.
DISCLOSURE:Divay Chandra, University grant monies n/a; Grant monies (from sources other than industry) NIH; Grant monies (from industry related sources) AstraZeneca, Critical Therapeutics, Dey, GlaxoSmithKline, Merck, Novartis, and Respironics.; Shareholder n/a; Employee Massachusetts General Hospital, Brigham & Women’s Hospital; Fiduciary position (of any organization, association, society, etc, other than ACCP n/a; Consultant fee, speaker bureau, advisory committee, etc. AstraZeneca, Critical Therapeutics, Dey, GlaxoSmithKline, Merck, Novartis, and Schering-Plough.; Other n/a; No Product/Research Disclosure Information