Racial and Socioeconomic Disparities in Pediatric Asthma Emergency Care

Year 2024, Volume: 10 Issue: 20, 95 - 102, 31.10.2024

Serdar Aydın , Camran Caldwell

https://doi.org/10.48121/jihsam.1476440

Abstract

The aim of this paper is to build a model to compare the relative impact of race and ethnicity and insurance type on pediatric Emergency Department utilization for asthma. A binary logistic regression model using relevant variables from 2022 NHIS survey data was conducted to compare asthma ED visit odds ratios of racial and ethnic minorities and publicly insured children. The results suggest that insurance type has slightly greater influence over asthma ED visits than race and ethnicity. Publicly insured children had the highest unadjusted odds ratio (1.88 [CI 95% 1.09-3.24)]) followed by Non-Hispanic Black children (1.80 [0.92-3.52]) and Hispanic children (1.51 [0.80-2.86]). The data are possibly biased toward exclusion of well-controlled asthmatics that may affect the resulting odds ratios. More socioeconomic variables would provide a more complete analysis. The paper has direct implications for health service providers and policymakers. Providers are encouraged to provide equitable, culturally competent care to asthmatics and policymakers are encouraged to embrace policies that promote better access for Medicaid beneficiaries, improved air quality and housing conditions for low-income children, and better racial representation in the provider workforce. The paper collates many existing sources of research on asthma disparities as a backdrop for examination of recent survey data pertaining to differences in asthma ED utilization between populations. It supports existing theories and work being done to mitigate poor asthma outcomes in children that are exacerbated by biological and systemic factors.

Keywords

Health services, Quality management, Emergency Department, Asthma

References

• Arroyo, A. J. C., Chee, C. P., Camargo, C. A., Jr, & Wang, N. E. (2018). Where do children die from asthma? National data from 2003 to 2015. The journal of allergy and clinical immunology, 6(3), 1034–1036. https://doi.org/10.1016/j.jaip.2017.08.032
• Bearison, D. J., Minian, N., & Granowetter, L. (2002). Medical management of asthma and folk medicine in a Hispanic community. Journal of pediatric psychology 27(4), 385–392. https://doi.org/10.1093/jpepsy/27.4.385
• Burchard, E. G., Avila, P. C., Nazario, S., Casal, J., Torres, A. Rodriguez-Santana J. R., Toscano, M., Senter Silvia, J., Alioto, M., Salazar, M., Gomez, I., Fagan, J. K., Salas, J., Lilly, C., Matallana, H., Ziv, E., Castro, R., Selman, M., Chapela, R. … & Silverman, E. K. (2003). Lower bronchodilator responsiveness in Puerto Rican than in Mexican Subjects with asthma. American journal of respiratory and critical care medicine 169(3), 386-392. https://doi.org/10.1164/rccm.200309-1293OC
• Camargo Jr, C. A., Rachelefsky, G., & Schatz, M. (2009). Managing asthma exacerbations in the emergency department: summary of the National Asthma Education and Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations. Proceedings of the American Thoracic Society, 6(4), 357-366. https://doi.org/10.1513/pats.P09ST2
• Canino, G., McQuaid, E. L., & Rand, C. S. (2009). Addressing asthma health disparities: a multilevel challenge. Journal of allergy and clinical immunology, 123(6), 1209-1217. https://doi.org/10.1016/j.jaci.2009.02.043 Friedman, B., & Basu, J. (2001). Health insurance, primary care, and preventable hospitalization of children in a large state. American journal of managed care, 7(5), 473-488.
• Fritz, G. K., McQuaid, E. L., Kopel, S. J., Seifer, R., Klein, R. B., Mitchell, D. K., Esteban, C. A., Rodriguez-Santana, J., Colon, A., Alvarez, M., & Canino, G. (2010). Ethnic differences in perception of lung function: a factor in pediatric asthma disparities? American journal of respiratory and critical care medicine, 182(1), 12-18. https://doi.org/10.1164/rccm.200906-0836OC
• George, M., Birck, K., Hufford, D. J., Jemmott, L. S., & Weaver, T. E. (2006). Beliefs about asthma and complementary and alternative medicine in low-income inner-city African-American adults. Journal of general internal medicine, 21(12), 1317-1324. https://doi.org/10.1111/j.1525-1497.2006.00624.x
• Gould, W., Peterson, E. L., Karungi, G., Zoratti, A., Gaggin, J., Toma, G., Yan, S., Levin, A. M., Yang, J. J., Wells, K., Wang, M., Burke, R. R., Beckman, K., Popadic, D., Land, S. J., Kumar, R., Seibold, M. A., Lanfear, D. E., Burchard, E. G., & Williams, L. K. (2010). Factors predicting inhaled corticosteroid responsiveness in African American patients with asthma. Journal of allergy and clinical immunology, 126(6), 1131-1138. https://doi.org/10.1016/j.jaci.2010.08.002
• Hasegawa, K., Stoll, S. J., Ahn, J., Kysia, R. F., Sullivan, A. F., Camargo Jr., C. A. (2016). Association of insurance status with severity and management in ED patients with asthma exacerbation. Western journal of emergency medicine: integrating emergency care with population health, 17(1), 22-27. https://doi.org/10.5811/westjem.2015.11.28715
• Hughes, H. K., Matsui, E. C., Tschudy, M. M., Pollack, C. E., & Keet, C. A. (2017). Pediatric asthma health disparities: race, hardship, housing, and asthma in a national survey. Academic pediatrics, 17(2), 127-134. https://doi.org/10.1016/j.acap.2016.11.011
• Kaufmann, J., Marino, M., Lucas, J., Bailey, S. R., Giebultowicz, S., Puro, J., Ezekiel-Herrera, D., Suglia, S. F., & Heintzman, J. (2022). The annals of family medicine, 20(2), 116-122. https://doi.org/10.1370/afm.2771
• Koinis-Mitchell, D., McQuaid, E. L., Seifer, R., Kopel, S. J., Esteban, C., Canino, G., Garcia-Coll, C., Klein, R., & Fritz, G. K. (2007). Multiple urban and asthma-related risks and their association with asthma morbidity in children, Journal of pediatric psychology 32(5), 582–595. https://doi.org/10.1093/jpepsy/jsl050
• Lakupoch, K., Manuyakorn, W., Preutthipan, A., & Kamalaporn, H. (2018). The effectiveness of newly developed written asthma action plan in improvement of asthma outcome in children. Asian Pacific journal of allergy and immunology, 36(2), 88-92.
• Lee, M. O., Sivasankar, S., Pokrajac, N., Smith, C., & Lumba-Brown, A. (2020). Emergency department treatment of asthma in children: a review. Journal of the American college of emergency physicians, 1(6), 1552–1561. https://doi.org/10.1002/emp2.12224
• Mansour, M. E., Lanphear, B. P., & DeWitt, T. G. (2000). Barriers to asthma care in urban children: parent perspectives. Pediatrics 106(3), 512-519. https://doi.org/10.1542/peds.106.3.512
• McQuaid, E. L., Kopel, S. J., Klein, R. B., & Fritz, G. K. (2003). Medication adherence in pediatric asthma: reasoning, responsibility, and behavior. Journal of pediatric psychology, 28(5), 323-333. https://doi.org/10.1093/jpepsy/jsg022
• McQuaid, E. L., Mitchell, D. K., Walders, N., Nassau, J. H., Kopel, S. J., Klein, R. B., Wamboldt, M. Z., & Fritz, G. K. (2007). Pediatric asthma morbidity: the importance of symptom perception and family response to symptoms. Journal of pediatric psychology, 32(2), 167-177. https://doi.org/10.1093/jpepsy/jsj112
• Mitchell, S. J., Bilderback, A. L. & Okelo, S. O. (2016). Racial disparities in asthma morbidity among pediatric patients seeking asthma specialist care. Academic pediatrics 16(1), 64-67. https://doi.org/10.1016/j.acap.2015.06.010
• Nath, J. B. & Hsia, R. Y. (2015) Children’s emergency department use for asthma, 2001-2010. Emergency department 15(2), 225-230. https://doi.org/10.1016/j.acap.2014.10.011
• Piehl, M. D., Clemens, C. J., & Joines, J. D. (2000). Narrowing the gap: decreasing emergency department use by children enrolled in the Medicaid program by improving access to primary care. Archives of pediatrics & adolescent medicine, 154(8), 791-795. https://doi.org/10.1001/archpedi.154.8.791
• Rand, C. S., Butz, A. M., Kolodner, K., Huss, K., Eggleston, P., & Malveaux, F. (2000). Emergency department visits by urban African American children with asthma. Journal of allergy and clinical immunology, 105(1), 83-90. https://doi.org/10.1016/S0091-6749(00)90182-9
• Saha, S., Komaromy, M., Koepsell, T. D., & Bindman, A. B. (1999). Patient-physician racial concordance and the perceived quality and use of health care. Archives of internal medicine, 159(9), 997-1004. https://doi.org/10.1001/archinte.159.9.997
• Shields, A. E. (2007). Trends in private insurance, Medicaid/State Children's Health Insurance Program, and the health-care safety net. Chest, 132(5), 818S-830S. https://doi.org/10.1378/chest.07-1903
• Van Cleave, J., & Davis, M. M. (2008). Preventive care utilization among children with and without special health care needs: associations with unmet need. Ambulatory pediatrics, 8(5), 305-311. https://doi.org/10.1016/j.ambp.2008.04.003
• Wells, K. E., Cajigal, S., Peterson, E. L., Ahmedani, B. K., Kumar, R., Lanfear, D. E., Burchard, E.G., & Williams, L. K. (2016). Assessing differences in inhaled corticosteroid response by self-reported race-ethnicity and genetic ancestry among asthmatic subjects. Journal of allergy and clinical immunology, 137(5), 1364-1369. https://doi.org/10.1016/j.jaci.2015.12.1334
• Williams, D. R., Sternthal, M., & Wright, R. J. (2009). Social determinants: taking the social context of asthma seriously. Pediatrics, 123 Suppl 3(Suppl 3), S174–S184. https://doi.org/10.1542/peds.2008-2233H