Disparities in access to asthma medications in U.S. adults aged 50-64 compared to adults 65 and older

Background: Disparities in access to asthma care are well-documented in the youngest and oldest U.S. populations, yet little is known about access disparities in people aged 50-64 years. This rapidly growing age bracket is particularly important because the growing healthcare needs associated with aging are occurring in an era of shrinking employer-sponsored insurance benefits. Research Objective: To compare patterns of racial/ethnic disparities in asthma medication use between adults aged 50-64 years and those 65 years and older. Study Design: For this cross-sectional study, data were extracted from the 2006 and 2007 Medical Expenditure Panel Survey (MEPS). The Andersen Behavioral Model of Health care was used to identify predisposing, enabling and need related independent variables. Self-reported access to asthma care variables, including use of preventive asthma medication and overuse of acute medications, were used as outcome variables. Patient demographics, perceived health status, prescription and health insurance coverage were used in two multiple logistic regression models: (1) daily use (yes/no) of a preventive asthma medication, and (2) overuse (3+) rescue inhalers in last 3 months. All point estimates were weighted to the U.S. non-institutionalized population, and standard errors accounted for the complex survey design. Results: Our final sample comprised of 829 middle-age adults (50-64yrs) and 572 older adults (65 years and over), representing about 8 million and 5.7 million U.S. non-institutionalized asthmatics, respectively. About 36% of the middle-aged asthmatics were currently taking a preventive medication compared to 46% older adult asthmatics. Compared to middle-aged Whites, African American asthmatics were half as likely to be on a preventive asthma medication (Odds Ratio [OR] =0.589, p<0.05). This racial disparity was not observed in older adults (OR=0.89, NS). Racial/ethnic disparities in overuse of rescue inhalers were also observed. Middle-aged Hispanics were significantly more likely to overuse a rescue inhaler compared to near old Whites (OR=1.801, p<0.05). This disparity in overuse was also observed in the older-adult Hispanic population (OR=3.421, p<0.05). Conclusions: These results suggest that racial disparities in access to preventive asthma medications are significantly reduced after age 65. Policies designed to expand insurance benefits to younger asthmatic populations may assist in achieving the Healthy People 2010 goal of reducing disparities.