Minority groups face higher prevalence, more ED visits for asthma

Audrey Urquhart, MPH

Minority children are more likely to have asthma and to need their condition managed in the emergency department (ED), according to a recent report.

Published in the Journal of Asthma, the study sought to identify which racial subgroups have the highest prevalence of asthma and emergency department utilization for the condition. The goal is to use this data to identify possible interventions to prevent asthma exacerbations and reduce disparities across population types.

“We were among the first studies to look at the effect of asthma management in relation to having an ED visit, specifically in terms of preventative medication use, having taken an asthma management course, or having an asthma action plan,” says Audrey Urquhart, MPH, a clinical research coordinator at the Children’s Hospital of Philadelphia (Pennsylvania) PolicyLab and lead author of the report. “Using national level data allowed us to compare across 6 racial/ethnic groups.¹ Puerto Rican children had the highest prevalence of asthma, followed by non-Hispanic black children. Whereas adjustment of asthma management did not significantly affect our results, we found the odds of having an ED visit due to asthma were 1.7 to 2.4 times higher among almost all racial/ethnic minority children, compared with their non-Hispanic white counterparts.”

Minority children have a higher prevalence of asthma than white children, and also used emergency services for their asthma at higher rates, according to the report. Most research previously has focused on white and black populations, but this study investigated other racial groups and sought to answer additional questions about these patients’ asthma management and preventive practices.

Asthma prevalence

The study reviewed data collected between 2013 and 2015 from the National Health Interview Survey. A total of 3336 patients aged between 2 and 17 years-58.7% of them boys-were identified as having asthma. Prevalence was documented by racial subgroup, highlighting disparities in ED visits over a period of 1 year.

The study found that asthma prevalence was highest in Puerto Rican children at 21.2%, followed by 14.5% in non-Hispanic black children, 8.5% in other Hispanic children, 8.2% in non-Hispanic white children, 7.5% in Mexican American children, and 7.1% in other non-Hispanic children. In comparing non-Hispanic white children to the other subgroups, there were significantly higher odds of ED visits for asthma management occurring in most minority subgroups, the report notes. The highest risk for visiting an ED for asthma management was found in Hispanic children, followed by Puerto Rican, Mexican American, and non-Hispanic black children, the report notes. Other non-Hispanic children was the only subgroup that did not have a higher risk than non-Hispanic white children of visiting the ED for asthma.

The study did not take into account environmental factors involved in asthma prevalence or ED visits, and the authors identified this as an area for future study. Additionally, Urquhart notes that the continuing existence of disparities between racial subgroups are multifactorial and likely relate to a complex interplay between medical and social factors.

“Whereas this study did not uncover a specific intervention, our results highlighting these disparities continue to stimulate the need for both clinical research in this area to understand the casual mechanisms and, in parallel, a continued expansion of evidenced-informed policies to mitigate these disparities in children today,” says Urquhart.

Not one thing will fix this problem, she notes, but pediatricians can still help.

“There is no one-sized-fits-all solution for disparities in childhood asthma,” Urquhart says. “I encourage clinicians to continue working to not only treat the physical symptoms of asthma but also collaborate with other healthcare professions to connect children living with chronic illness and who have complex social needs with community-available resources that benefit their health and their family.”