This study sought to answer the following questions: compared with white children of similar family income and insurance status, do African-American children (1) visit the Emergency Department (ED) for asthma more often; (2) get hospitalized for asthma more frequently; (3) visit office-based providers for asthma less often; (4) receive fewer outpatient prescriptions for asthma medications; (5) make fewer routine health supervision and immunization visits; and (6) have higher costs for asthma care?

The results indicated that: 1.) African-American children had 70% higher odds of ED visits; 2.) African-American children had 43% higher odds hospitalization than their white counterparts, controlling for age, sex, insurance status, area of residence, and predominant office provider type; 3.) The odds of African-American children making an office visit for asthma were about half those of white children (adjusted OR =0.48; 95% CI, 0.26 to 0.85); 4.) Despite the higher rates in hospitalization, the proportion of children filling prescriptions for asthma medications was similar in the two race groups, as was the average number of prescriptions received among users of this service; and 5.) African-American children had 24% higher total asthma-related payments per capita than white children.

The authors of this study made several critical observations. First, African-American children in the study had 34% higher odds of using theophylline than white children, despite the fact that “published clinical trials have showed increasingly strong evidence to support the use of alternatives to theophylline in the treatment of acute and chronic asthma.” The NIH asthma guidelines discourage use of theophylline in favor of inhaled beta-agonists and anti-inflammatory medications such as steroids and cromolyn. The authors suggests that this “greater use of theophylline among the African-American children in our study may signify that these children were less likely to receive state-of-the-art treatment regimens.” Furthermore, “it is conceivable that the greater asthma burden among the African-American children in our study (as evidenced by ED visits and hospitalizations) should have warranted more aggressive therapy and more frequent use of beta-agonists, steroids, and cromolyn than for white children. Conversely, it is possible that less optimal regimens resulted in more frequent, severe exacerbations leading to ED visits or hospitalizations.”

This study has significant value because the sample population was restricted to the Aid to Families With Dependent Children (AFDC) population, which assured that all subjects had the same insurance status and confined family income to within a narrow range (<65% of the federal poverty level). As the authors state “the fact that utilization differences by ethnicity exist within an AFDC population suggests that these differences are not solely due to differences in health insurance and family income.” They conclude that “race is a marker for other characteristics that determine a child’s utilization pattern. These characteristics might include the patient’s or family’s illness belief systems, compatibility of patient and provider communication styles, cultural attitudes toward health care providers, and institutional racism.”