Urban Minority Children with Asthma: Substantial Morbidity, Compromised Access to Specialists, and the Importance of Poverty and Specialty Care

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 2004-07 of urban minority children 2–18 years old seen for asthma in 4 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. 220 of 648 children assessed were eligible. The mean child age was 7 years; 68% are poor, 81%, African-American (AA), and 19%, Latino (L). 17% of parents are married and living with spouses, 64%, high-school graduates, and 45%, unemployed. 68% of children are not in excellent/very good health, 76% have persistent asthma (moderate/severe=55%), 92% have primary care providers, 83% have Medicaid, and 3% are uninsured. The mean annual number of asthma attacks in the past year was 12, and of monthly daytime and nighttime asthma symptoms is 13 and 12, respectively. The mean annual number of asthma doctor visits is 6; of ED asthma visits, 3; hospitalizations, 1; missed school days, 9; and missed parent work days, 8. 78% of children have no asthma specialist, and 64% use EDs as the usual asthma care source; only 2% are not receiving asthma medications. Poor children are less likely than the non-poor to have asthma specialists (13 vs. 26%; p<.03). Children with no asthma specialist average more annual asthma attacks (14 vs. 7; p<.01) but fewer ED visits (3 vs. 4.5; p<.03). AAs are more likely than Ls to use EDs for usual asthma care (68% vs. 44%; p<.01). In multivariate analyses, poverty and having no asthma specialist are each associated with 1 additional asthma attack in the past year; the poor have greater odds of no asthma specialist (OR, 2.4; 95% CI, 1.1-4.9), and AAs have higher odds of EDs as the usual asthma care source (OR, 2.7; 95% CI, 1.3-5.6).

Conclusions. Urban minority children with asthma average 1 asthma symptom daily, 1 exacerbation monthly, and 9 missed school days, 8 missed parental work days, 3 ED visits, and 1 hospitalization yearly; most receive their usual asthma care in EDs and have no asthma specialist. Urban minority asthmatic children need interventions to reduce morbidity and improve access to specialists, especially among the poor and African-Americans.