Black Patients With Asthma May Fare Worse Regardless of Disease Severity

Patients with asthma who are black appear more likely to visit the emergency department or be hospitalized for the condition than those who are white, even in a managed care setting that provides uniform access to care, according to a report in the September 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Research has shown that black patients with asthma have worse control of their symptoms and higher rates of hospitalization and death than white patients, according to background information in the article.

Reasons may include inadequate access to health care, lower socioeconomic status, genetic or behavioral factors, suboptimal use of asthma control medications, environmental exposures and poor communication or racial bias among health care providers. Previous studies have adjusted for the effects of socioeconomic status and found that racial disparities in asthma outcomes persisted.

Sara E. Erickson, M.D., of the University of California, San Francisco, and colleagues studied 678 patients in one large health plan who were hospitalized for asthma between 2000 and 2004. The patients were interviewed after they were discharged to gather information about their disease and how it affected their lives, their health status and their socioeconomic status. U.S. Census data also was used to gather socioeconomic data from within one block of their home. The patients were followed up for a median (midpoint) of 1.9 years to see if they visited the emergency department or were readmitted to the hospital.

Of the patients included in the study, 524 were white and 154 were black. Although there was no difference between black and white patients in asthma severity, physical health status or controller medication use, blacks were significantly more likely than whites to have had outpatient visits related to their asthma during the study follow-up. Also during this time period, 35.7 percent of black patients compared with 21 percent of white patients visited the emergency department for asthma symptoms and 26.6 percent of blacks vs. 15.3 percent of whites were hospitalized for asthma. These associations remained when the researchers controlled for socioeconomic status and differences in asthma therapy.

“The reasons underlying the racial disparities observed in this study are not clear, although they are likely to be complex,” the authors write. Because knowledge of racial disparities is widespread, clinicians may be more likely to encourage black patients to seek emergency care for their asthma and emergency room physicians maybe more likely to admit blacks, they note. Alternatively, there may be differences in behavior or cultural beliefs about asthma, or in therapies not measured in this study.

“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,” the authors conclude. “These findings suggest that genetic differences may underlie these racial disparities.”(Arch Intern Med. 2007;167(17):1846-1852. Available pre-embargo to the media at www.jamamedia.org.)