 |
The 130th Annual Meeting of APHA |
|
The 130th Annual Meeting of APHA |
Joshua M Thorpe, MPH, UNC-Chapel Hill, Beard Hall, CB#7360, Chapel Hill, NC 27599, 919-928-8757, thorpej@unc.edu and Carolyn Kalinowski, MPH, Dept. of Psychiatry, UNC-Chapel Hill, Beard Hall, CB#7360, Chapel Hill, NC 27514.
Background: As AHRQ has stated, asthma is an "ambulatory care-sensitive condition (office-based or outpatient visits)” for which emergency room (ER)/hospitalizations can be avoided through appropriate non-hospital care. If primary care providers fail to follow asthma treatment guidelines, patients may require otherwise avoidable hospitalizations or ER care. Practice guidelines suggest that pharmaceuticals are the essential therapeutic component in asthma management, and that all levels of asthma severity receive at least one prescription medication (i.e. fast-acting beta 2 –agonist).
Research Objective: This study tested the following hypotheses: 1) race/ethnicity is associated with the likelihood of receiving one or more prescribed asthma medications, independent of access to ambulatory care for asthma; 2) race/ethnicity is associated with hospitalization and ER utilization for asthma care, independent of access to ambulatory care and number prescribed medications for asthma.
Study Design: Data were extracted from the 1997 Medical Expenditure Panel Survey (MEPS). A total of 1,592 self-reported asthmatics were identified. Patient demographics, health status (measures of perceived impact of asthma on daily life), insurance coverage, and family income were used in a logistic regression model to explain the probability of receiving one or more prescribed asthma medications. As an indicator of general access to health services, the number of ambulatory visits for asthma was included in the unrestricted model. A second logistic regression model, using the same covariates with number of prescribed asthma medications, explained the probability of receiving ER or hospital services.
Principal Findings: Race/ethnicity differences were identified in likelihood of receiving asthma any asthma medications, even after controlling for general access to ambulatory healthcare services such that Blacks and Hispanics, respectively, were 49% and 41% less likely than whites (Blacks: 95% CIOR, 0.33, 0.80. Hispanics: 95% CIOR, 0.36, 0.97). Race/ethnicity differences were also identified in likelihood of receiving ER or hospital services, even after controlling for general access to ambulatory healthcare services and prescribed asthma medications such that Blacks were 2.8 times more likely than whites have an ER visit or hospitalization for asthma (95% CIOR, 0.33, 1.49, 5.11).
Conclusions: Both black and Hispanic asthmatics are less likely to receive at least one asthma medication compared to whites; independent of ambulatory visits for their asthma. Blacks are more likely to require emergency treatment or hospital care for their asthma compared to whites; independent of both ambulatory visits for asthma and number of prescribed asthma medications. Better information about specific classes of asthma medications and adherence to medications is essential to understanding these identified disparities.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.