Purpose Asthma morbidity and mortality disproportionately affect blacks. Whether these racial disparities are totally explained by differences in access to care, asthma treatment, or socioeconomic status is unknown. Our objectives were (1) to examine whether there are racial disparities in asthma treatment among members of a managed care organization that provides broad access to the full complement of primary to tertiary care services and (2) if racial disparities in treatment exist, to what degree these disparities are associated with asthma severity and health status.
Methods We conducted a cross-sectional study of patients (N = 865, which included 524 white and 154 black patients) who were recruited after hospitalization for asthma. All patients were members of the same large, integrated health care organization. We collected data about preventive and treatment measures for asthma (long-term controller medication use, rescue medication use, monitoring strategies, and educational efforts). We then examined the impact of race on patient-centered outcomes, including asthma severity, asthma-related quality of life, overall health status, and restricted activity due to asthma symptoms. Multivariate analyses were used to examine the associations between race, asthma treatment, and these patient-centered asthma outcomes.
Results Blacks reported increased use of short-acting inhaled β-agonists or nebulizers compared with whites (OR 1.82; 95% CI 1.19-2.79 and OR 1.59; 95% CI 1.11-2.28, respectively). Blacks were more likely to have used their peak flow meters regularly (OR 1.52; 95% CI 1.05-2.21). There were no clear differences in asthma severity, asthma-related quality of life, overall health status, or restricted activity days between blacks and whites after adjusting for individual and area-level socioeconomic status (lowest p value = .16).
Conclusion In a health care setting that provides uniform access to care, black race was associated with some differences in asthma treatment, including increased use of rescue medications. However, despite these differences in asthma treatment, we found no racial disparities in asthma severity, asthma-related quality of life, or overall health status.
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