The study is the first to gather information directly from parents to evaluate racial and ethnic differences in children’s asthma status and management. And the findings may have wider implications: asthma is a "sentinel condition" for monitoring quality of health care delivery, the authors note, because it is a common chronic illness with clear guidelines for care.
Led by Tracy Lieu, associate professor of ambulatory care and prevention at Harvard Pilgrim Health Care and Harvard Medical School, the researchers conducted phone interviews with parents of children age 2 to 16 with asthma who were insured by Medicaid programs. The children received care from one of five health plans: Harvard Pilgrim and the Neighborhood Health Plan in Massachusetts; Group Health Cooperative in Washington state; and Kaiser Permanente and Partnership Healthplan in California. Co-authors of the study, published in the May issue of the journal Pediatrics, are at Kaiser and the Group Health Cooperative’s Center for Health Studies in Seattle.
Of the 1,658 children studied, 38 percent were black, 19 percent Latino, and 31 percent white. The researchers adjusted the data to separate the effects of race or ethnicity from the effects of family income, family size, and number of adults in the family.
The results show that black children had worse asthma on average than white or Latino children. On the American Academy of Pediatrics asthma rating scale of 0 to 100 for physical health, black children scored six points lower than white or Latino children after score adjustment. Latino children had fewer symptom-days than white or black children but were rated by parents as having more severe symptoms. Lower income, larger family size, and having only a single adult in the family were also associated with worse asthma.
Both black and Latino children were less likely than white children to use daily inhaled anti-inflammatory medications that can help prevent asthma flare-ups. However, among children with persistent asthmaæabout two thirds of the total groupæonly 33 percent of whites were using the drugs, compared with 28 percent of blacks and 22 percent of Latinos.
"These findings underscore that this is not just a problem for minorities," said Lieu. "It’s a problem for all children with asthma."
Racial and ethnic disparities exist throughout the health care system for many medical problems, she noted. "Our findings are similar to what has been observed in adultsænot only in asthma, but in many other settings from cancer screening to kidney transplants to surgery for heart conditions," she said. "What’s unique about our study is that all the children had Medicaid, and all were in similar systems of care. That means the disparities cannot be explained by differences in financial access to health care systems."
Instead, Lieu said, "Emerging ideas about these disparities and how to reduce them focus on communication and on understanding cultural beliefs about health and illness."
The study was funded by the Agency for Healthcare Research and Quality, the American Association of Health Plans Foundation, and the Maternal and Child Health Bureau.
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Beth Israel Deaconess Medical Center, Judge Baker Children's Center, Boston VA Medical Center, Massachusetts Eye and Ear Infirmary, Brigham and Women's Hospital, Massachusetts General Hospital, Cambridge Hospital, Massachusetts Mental Health Center, Center for Blood Research, McLean Hospital, Children's Hospital , Mount Auburn Hospital, Dana-Farber Cancer Institute, Schepens Eye Research Institute, Harvard Pilgrim Health Care, Spaulding Rehabilitation Hospital, Joslin Diabetes Center
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PEDIATRICS