TY - JOUR
T1 - Urban minority children with asthma
T2 - Substantial morbidity, compromised quality and access to specialists, and the importance of poverty and specialty care
AU - Flores, Glenn
AU - Snowden-Bridon, Christina
AU - Torres, Sylvia
AU - Perez, Ruth
AU - Walter, Tim
AU - Brotanek, Jane
AU - Lin, Hua
AU - Tomany-Korman, Sandy
N1 - Funding Information:
The authors thank the following individuals for their assistance with this study: Laurie Smrz, Rhonda Durst, Rebecca Schultz de Parra, Jacqueline Gonzales, Martha Stevens, Duke Wagner, Amanda Schultz, John Meurer, Jennifer Cohen, Kevin Kelly, Marc Gorelick, Joseph Lee, and John Whit-comb. They are grateful to Anne Beal at the Commonwealth Fund and Brian Austin in the Improving Chronic Illness Care Program of the Robert Wood Johnson Foundation for their continuous support and assistance.
Funding Information:
Funded by grants to G.F. from the Commonwealth Fund and the Improving Chronic Illness Care program of the Robert Wood Johnson Foundation.
PY - 2009/5
Y1 - 2009/5
N2 - Background. Asthma disproportionately affects minorities, but not enough is known about morbidity and specialist access in asthmatic minority children. Objective. To examine asthma morbidity and access to specialty care in urban minority children. Methods. A consecutive series was recruited in 2004-2007 of urban minority children 2 to 18 years old seen for asthma in four emergency departments (EDs) or admitted to a children's hospital. Outcomes assessed included asthma symptom and attack frequency; missed school and parental work; asthma ED visits and hospitalizations; severity of illness; and asthma specialty care. Results. Of 648 children assessed, 220 were eligible. The mean age was 7 years; 68% were poor, 83% had Medicaid, 84% were African-American, and 16% were Latino. Sixty-eight percent of children were not in excellent/very good health, 73% had persistent asthma (moderate/severe = 52%), and only 44% had asthma care plans. The mean number of asthma attacks in the past year was 12, and of monthly daytime and nighttime asthma symptoms, is 12 and 12, respectively. The mean annual number of asthma doctor visits was 6; of ED asthma visits, 3; hospitalizations, 1; missed school days, 7; and missed parent work days, 6. Eighty-three percent of children have no asthma specialist, and 62% use EDs as the usual asthma care source. Poor children were less likely than the non-poor to have asthma specialists (13 vs. 26%; p 0.03). African-Americans were more likely than Latinos to use EDs for usual asthma care (68% vs. 44%; p 0.01). In multivariable analyses, poverty was associated with greater odds and having an asthma care plan with lower odds of an asthma attack in the past year; poverty also was associated with half the odds of having an asthma specialist. African-American children were significantly more likely to report the ED as the usual source of asthma care, and having an asthma specialist and male gender were associated with greater odds of having an asthma care plan. Conclusions. Urban minority children with asthma average 1 asthma symptom daily, 1 exacerbation monthly, and 7 missed school days, 6 missed parental work days, 3 ED visits, and 1 hospitalization yearly; most receive their usual asthma care in EDs and have no asthma care plan or asthma specialist. Urban minority asthmatic children need interventions to reduce morbidity and improve access to specialists and asthma care plans, especially among the poor and African-Americans.
AB - Background. Asthma disproportionately affects minorities, but not enough is known about morbidity and specialist access in asthmatic minority children. Objective. To examine asthma morbidity and access to specialty care in urban minority children. Methods. A consecutive series was recruited in 2004-2007 of urban minority children 2 to 18 years old seen for asthma in four emergency departments (EDs) or admitted to a children's hospital. Outcomes assessed included asthma symptom and attack frequency; missed school and parental work; asthma ED visits and hospitalizations; severity of illness; and asthma specialty care. Results. Of 648 children assessed, 220 were eligible. The mean age was 7 years; 68% were poor, 83% had Medicaid, 84% were African-American, and 16% were Latino. Sixty-eight percent of children were not in excellent/very good health, 73% had persistent asthma (moderate/severe = 52%), and only 44% had asthma care plans. The mean number of asthma attacks in the past year was 12, and of monthly daytime and nighttime asthma symptoms, is 12 and 12, respectively. The mean annual number of asthma doctor visits was 6; of ED asthma visits, 3; hospitalizations, 1; missed school days, 7; and missed parent work days, 6. Eighty-three percent of children have no asthma specialist, and 62% use EDs as the usual asthma care source. Poor children were less likely than the non-poor to have asthma specialists (13 vs. 26%; p 0.03). African-Americans were more likely than Latinos to use EDs for usual asthma care (68% vs. 44%; p 0.01). In multivariable analyses, poverty was associated with greater odds and having an asthma care plan with lower odds of an asthma attack in the past year; poverty also was associated with half the odds of having an asthma specialist. African-American children were significantly more likely to report the ED as the usual source of asthma care, and having an asthma specialist and male gender were associated with greater odds of having an asthma care plan. Conclusions. Urban minority children with asthma average 1 asthma symptom daily, 1 exacerbation monthly, and 7 missed school days, 6 missed parental work days, 3 ED visits, and 1 hospitalization yearly; most receive their usual asthma care in EDs and have no asthma care plan or asthma specialist. Urban minority asthmatic children need interventions to reduce morbidity and improve access to specialists and asthma care plans, especially among the poor and African-Americans.
KW - African-Americans
KW - Asthma
KW - Children
KW - Hispanic Americans
KW - Minority groups
KW - Specialties
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U2 - 10.1080/02770900802712971
DO - 10.1080/02770900802712971
M3 - Article
C2 - 19484676
AN - SCOPUS:67649814195
SN - 0277-0903
VL - 46
SP - 392
EP - 398
JO - Journal of Asthma
JF - Journal of Asthma
IS - 4
ER -