Hospitalization or a visit to the emergency department is more likely for black patients with asthma than for white patients, regardless of what the managed care settings are, according to an article published in Archives of Internal Medicine (JAMA/Archives), September 24th issue.
As background information, the authors explain that black patients who suffer from asthma have worse control of their symptoms and are more likely to be hospitalized than white patients. The reasons could be differences in access to good health care, lower socioeconomic status, behavioral, genetic, environmental, poor communication between patient and doctor, and racial bias among doctors. Prior studies had found that even when such variables as socioeconomic status were factored in the racial disparities in asthma outcomes persisted.
Sara E. Erickson, M.D., of the University of California, San Francisco, and team looked at 678 patients from a large health plan who had been hospitalized for asthma during the period 2000-2004. After they had been discharged the patients were interviewed – the aim was to find out about their disease and what impact it had on their lives, health status and socioeconomic status. By drawing on information from the US Census, the researchers were also able to retrieve socioeconomic data from within one block of each patient’s home. To find out how many patients were re-hospitalized or had to visit an emergency room after the interviews, they were followed up for a median of 1.9 years.
Of the 678 patients, 154 were black and 524 were white. Despite there being no difference in asthma severity, physical health status or controller medication use, the black patients were much more likely than the white ones to have had outpatient visits because of their asthma during the follow-up. 35.7% of black patients and 21% of white patients visited the emergency department for asthma symptoms. Hospitalization rates post follow-up were 26.6% for blacks and 15.3% for whites. Even when socioeconomic status and differences in asthma therapy were taken into account, the figures persisted, say the authors.
The researchers wrote “The reasons underlying the racial disparities observed in this study are not clear, although they are likely to be complex.” As knowledge of the racial disparities regarding asthma is widespread, perhaps doctors are more likely to encourage black patients to seek emergency care. Also, for the same reason, maybe emergency room doctors might be more likely to admit (hospitalize) blacks, the authors write.
They conclude “Even in a health care setting that provides uniform access to care; black race was associated with worse asthma outcomes, including a greater risk of emergency department visits and hospitalizations. These findings suggest that genetic differences may underlie these racial disparities.”
Archives of Internal Medicine