This retrospective cohort study of an inner-city, hospital-based comprehensive care system sought to determine patterns of care among inner-city patients with asthma. The investigators hypothesized “that patients who do not receive regular care from a primary care provider are more likely to be hospitalized for asthma, and that age, race, and gender are important predictors of hospitalization for asthma.”

The results indicate that the “incidence rates for scheduled, urgent, and pharmacy refill visits were less for African-American compared with white patients.” Analysis of unadjusted rates showed that African-Americans had 180 scheduled visits, 102 urgent visits, and 138 prescription refill visits per 100 py compared with 240, 132, and 187, respectively, for white patients. Age- and gender-adjusted rates, revealed a similar pattern: African-Americans had consistently lower rates of overall outpatient and urgent visits. However, a reverse trend was found for ED visits by African-American males: “African-American males had a significantly higher rate than that of white males.” The crude rate difference per 100 py was 2.0 (95% CI: -0.6, 4.9) and the age adjusted difference was 4.2 (95% CI: 1.7, 6.6). African-American males between 5-19 years of age had the highest rate of ED visits. Higher rates of asthma-specific hospitalizations were also observed among African-Americans. Specifically, the rates were “highest for African-American males compared with other race and gender strata: crude rate difference per 100 py for females was 1.5 (CI: -0.3, 3.4); for males the corresponding rate was 8.0 (CI: 5.6, 10.3); the age adjusted rates were 0.8 (CI: -0.8,2.3) for females and 7.4 (CI: 5.2, 9.7) for males. Despite these higher rates of hospitalizations and ED visits (evidence of worse morbidity among black patients), “prescription refill rate was lower for African-American female and male patients.” One-hundred sixty-four African-American women versus 227 white women had prescription refill visits (age-adjusted difference per 100py -52 (CI: -61, -44)), and 107 African American men versus 119 white men had prescription refill visits (respective rate -18 (CI: -26, -10)).

The finding that “patients at increased risk of hospitalization for asthma, namely African-American adolescent males, have fewer outpatient visits accompanied by a higher emergency department visit rate for asthma and more asthma-specific hospitalizations suggests that access to appropriate use of medical care for asthma may be lacking among such patients.” According to these investigators, targeted interventions should include “increasing access to routine care, channeling patients away from the emergency department, active intervention among the highest risk patients, and patient (or parent) and practitioner education.”

Although half of the study population had no insurance coverage, among the insured there was no statistical difference in the proportion of African-American and white patients covered by commercially available insurance. Furthermore, “African-American patients were more likely to have Medicaid (33% versus 18%, p<0.0001) whereas white patients more likely received hospital’s indigent care program or lacked insurance coverage (58% versus 47%, p<0.0001).”
Thus, financial barriers to care cannot fully account for the racial differences in resource utilization, specifically rates of outpatient visits and prescription drug use.