The widening black/white gap in asthma hospitalizations and mortality

doi:10.1016/j.jaci.2005.11.047

Journal of Allergy and Clinical Immunology

Volume 117, Issue 2, February 2006, Pages 351-358

https://doi.org/10.1016/j.jaci.2005.11.047 Get rights and content

Background

Large racial differences in asthma morbidity and mortality have prompted research on new interventions, public awareness, and health policy efforts in the past decade.

Objective

We sought to characterize recent trends in US asthma hospitalization and mortality for black and white children and adults during the period from 1980 through 2002.

Methods

We conducted a successive representative national cohort study of US residents ages 5 to 34 years using data from the National Hospital Discharge Survey and the US vital statistics system. Outcome measures included black/white (B/W) asthma hospitalization and mortality rates, rate ratios, and rate differences.

Results

For asthma hospitalizations from 1980 through 2002, children ages 5 to 18 years had a 50% increase in the B/W rate ratio, and the rate difference increased from 22.8 to 28.3 hospitalizations per 10,000 population. For young adults ages 19 to 34 years, the B/W rate ratio increased from 2.3 to 2.8, and the rate difference decreased from 9.6 to 7.9 hospitalizations per 10,000 population. For asthma mortality from 1980 through 2001, children ages 5 to 19 years had a large increase in the B/W rate ratio from 4.5 to 5.6 and in the rate difference from 5.6 to 8.1 deaths per 1,000,000 population. There did not appear to be a significant change in the B/W differences for adults ages 20 to 34 years.

Conclusions

For children, there have been notable increases in asthma B/W differences in hospitalizations and mortality since 1980, whereas for adults the increase has been smaller. National efforts to improve asthma care over the past decade do not appear to have reduced this B/W gap. When treating children with asthma, it is important to consider the racial-ethnic factors that might lead to avoidable hospitalizations and premature mortality.

Section snippets

Study population

This study examines national reports of hospitalizations (hospital discharges) and deaths (mortality data) that occurred among US residents ages 5 to 34 years between January 1, 1980, and December 31, 2002. Hospitalization data were stratified into data on children (ages 5-18 years) and data on adults (ages 19-34 years). Mortality data were also stratified into data on children (ages 5-19 years) and data on adults (ages 20-34 years). These age groups were used to minimize misclassification of

Asthma hospitalizations

During the 1980 through 2002 time period, there was an average annual 438,700 ± 11,400 hospitalizations, averaging 20 ± 0.5 hospital discharges per 10,000 population. The national trends for asthma hospitalizations for black and white individuals ages 5 to 34 years are shown in Fig 1. Table I presents the actual number of discharges per 10,000 population for each time period, along with B/W rate ratios and rate differences. The rate of hospitalizations for white subjects decreased from 9.0 to

Discussion

From this analysis, it appears that B/W differences in asthma hospitalizations and mortality in the United States for children and young adults have either remained stable or increased during the 1980 through 2002 time period. For children ages 5 to 18 years, these differences have increased for both hospitalization and mortality. For young adults, there appears to be a smaller increase in B/W differences for hospitalizations and mortality.

With the B/W differences increasing more for children

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View all citing articles on Scopus

: Supported by Health Resources and Services Administration (HRSA) training grant #T32HS00078-07.

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Health care education, delivery, and qualityThe widening black/white gap in asthma hospitalizations and mortality

Background

Objective

Methods

Results

Conclusions

Section snippets

Study population

Asthma hospitalizations

Discussion

Chest

J Allergy Clin Immunol

Patient Education and Counseling

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

J Pediatr Health Care

Paediatr Respir Rev

J Pediatr

National Healthcare Disparities Report

Unequal treatment: confronting racial and ethnic disparities in health care

J Natl Med Assoc

Children's health care in the first national healthcare quality report and national healthcare disparities report

Med Care

Current estimates from the National Health Interview Survey, 1995

Vital Health Stat 10

Surveillance for asthma—United States, 1960-1995

MMWR CDC Surveill Summ

Recent Trends in asthma hospitalization and mortality in the United States

J Asthma

Asthma prevalence and control characteristics by race/ethnicity—United States, 2002

MMWR Morb Mortal Wkly Rep

Deaths: final data for 2000

Changing patterns of asthma mortality. Identifying target populations at high risk

JAMA

Effect of racial and socioeconomic factors on asthma mortality in Chicago

Chest

Reduction in resource utilization by an asthma outreach program

Arch Pediatr Adolesc Med

Does quality of care affect rates of hospitalization for childhood asthma?

Pediatrics

National Asthma Education Program. Expert Panel on the Management of Asthma. Executive summary: guidelines for the diagnosis and management of asthma: National Asthma Education Program: expert panel report

Health care education, delivery, and quality
The widening black/white gap in asthma hospitalizations and mortality