Medication Use Among Children With Asthma in East Harlem

Diaz, Theresa; Sturm, Toni; Matte, Thomas; Bindra, Monisha; Lawler, Katherine; Findley, Sally E.; Maylahn, Chris

doi:10.1542/peds.105.6.1188

Cited by 112 publications

(75 citation statements)

References 26 publications

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“…For example, a study by Warman et al 10 that measured antiinflammatory drug use among inner-city children with persistent asthma found that only 39% were receiving daily antiinflammatory treatment. A similar study by Diaz et al 11 found that 39% of children with severe asthma were using antiinflammatory medications. However, it was difficult to derive a reasonably bounded estimate for ICS usage rates because of the heterogeneity of the studies.…”

Section: Discussionmentioning

confidence: 75%

Quality of Care for Childhood Asthma: Estimating Impact and Implications

et al. 2009

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We conducted a review of 164 relevant publications to consolidate the evidence on gaps in the quality of asthma care, the impact of those gaps, and the costs and benefits of closing those gaps. Researchers used a wide variety of definitions for measures of quality asthma care, clinical and utilization end points, and disease severity. Gaps in care were most evident for pharmacologic treatment, particularly the underuse of inhaled corticosteroids, with median usage rates of 40%; however, in studies with large proportions of black subjects, the inhaled corticosteroid usage rate was only 32%, compared with 51% for nonminority populations. Studies on outcomes focused on emergency department visits, hospital admissions, and missed school days. Because only 6 studies included information on the costs of improving asthma care, no consensus estimates of the cost/benefit ratio for better asthma care could be derived. There was insufficient evidence in the literature for assessment of the impact of gaps in care and the costs of closing those gaps. More economic evaluations of the impact of gaps in asthma care and of interventions to improve asthma control are needed. Future research on gaps in asthma care and their impact must use standardized definitions for key variables such as disease severity and care utilization to allow comparisons across studies and building of an evidence base that is convincing for policy makers and purchasers of care. Pediatrics 2009; 123:S199-S204 I N 2002, Ͼ30 million US individuals reported having been diagnosed as having asthma, including 122 per 1000 children (which made asthma the most common chronic disease among children) and 106 per 1000 adults. The prevalence of the disease remains at historically high levels. 1 In 2004, the total estimated annual costs of treating asthma were approximately $16.1 billion, of which $11.5 billion were direct costs. 2 Prescription drugs accounted for the largest single component of these direct costs ($5 billion), and hospital care represented one third of the $11.5 billion. 2 Although recent advances in pharmacotherapy have made asthma a highly treatable disease, research suggests that treatment often falls short of recommended care; according to a 2001 study, 3 74% of children with moderate/ severe asthma in a national sample did not receive adequate treatment. Despite their higher prevalence of disease, minority children are less likely than nonminority children to receive adequate treatment. 4 Two Rand studies showed that only 43% of adult patients and only 44% of children who used a rescue inhaler Ն3 times per day were given maintenance treatment. 5,6 Recognition by policy makers, providers, and the public of the discrepancies between recommended care and care that is actually received has led to initiatives to improve the quality of asthma care, such as the Healthy People 2010 initiative. 7 Although the quality of asthma care, treatment options, and the effects of the disease have been addressed extensively by the research community, ther...

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Section: Discussionmentioning

confidence: 75%

Quality of Care for Childhood Asthma: Estimating Impact and Implications

et al. 2009

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“…64 Puerto Ricans are among the racial/ethnic groups most widely affected by asthma in the USA. 24,[65][66][67][68][69][70][71][72][73][74] We hypothesized that specific building-level characteristics-presence of pests and building type and conditions-were associated with levels of indoor allergens.…”

Section: Asthma and Indoor Allergensmentioning

confidence: 99%

Are Building-Level Characteristics Associated with Indoor Allergens in the Household?

et al. 2011

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Building-level characteristics are structural factors largely beyond the control of those who live in them. We explored whether building-level characteristics and indoor allergens in the household are related. We examined the relationship between building-level characteristics and indoor allergens: dust mite, cat, cockroach, and mouse. Building-level characteristics measured were presence of pests (seeing cockroaches and rodents), building type (public housing, buildings zoned commercially and residentially, and building size), and building condition (building age and violations). Allergen cutpoints were used for categorical analyses and defined as follows: dust mite: 90.25 μg/g; cat: 91 μg/g; cockroach: 91 U/g; mouse: 91.6 μg/g. In fully adjusted linear analyses, neither dust mite nor cat allergen were statistically significantly associated with any building-level characteristics. Cockroach allergen was associated with the presence of cockroaches (2.07; 95% CI, 1.23, 3.49) and living in public housing (2.14; 95% CI, 1.07, 4.31). Mouse allergen was associated with the presence of rodents (1.70; 95% CI, 1.29, 2.23), and building size: living in a low-rise (G8 floors; 0.60; 95% CI, 0.42, 0.87) or high-rise (8+floors; 0.50; 95% CI, 0.29, 0.88; compared with house/duplex). In fully adjusted logistic analyses, cat allergen was statistically significantly associated with living in a high-rise (6.29; 95% CI, 1.51, 26.21; compared with a house/duplex). Mouse allergen was associated with living in public housing (6.20; 95% CI, 1.01, 37.95) and building size: living in a low-rise (0.16; 95% CI, 0.05, 0.52) or high-rise (0.06; 95% CI, 0.01, 0.50; compared with a house/duplex). Issues concerning building size and public housing may be particularly critical factors in reducing asthma morbidity. We suggest that future research explore the possible improvement of these factors through changes to building code and violations adherence, design standards, and incentives for landlords.

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“…16 -20 For example, studies have documented that minority children are more frequent users of reliever medications such as short-acting ␤-agonists and not control therapies such as inhaled antiinflammatory medications. [17][18][19][20] In addition, data from the National Health and Nutrition Examination Survey III, a survey of the US population, reported that young, poor, and Spanish-speaking children were at high risk for inadequate asthma therapy. 21 A cross-sectional study of inner-city children who were from Washington, DC, and Baltimore, Maryland, and had at least mild persistent asthma found that these children were high nebulizer users of ␤-agonists but low users of inhaled steroids.…”

mentioning

confidence: 99%

Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

et al. 2002

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ABSTRACT. Objective. To understand the importance of source of care and other factors that influence differences in asthma medication use by race and Hispanic ethnicity.Methods. The Childhood Asthma Severity Study provided 12-month, retrospective, parent-reported questionnaire data on a monthly basis for children ages <12 years in a community sample of 1002 children and their families from Connecticut and Massachusetts. Medications considered included cromolyn, ␤2-agonist, inhaled steroids, anticholinergics, theophylline, and systemic steroids. Information was available on demographics, insurance status, symptom severity, primary care contact, and provider practice types.Results. Black and Hispanic children received fewer ␤2-agonists, and Hispanic children received fewer inhaled steroids than white children after adjusting for patients' race, age, gender, insurance status, symptom severity, number of primary care visits for asthma, number of urgent visits to the regular provider, family income, maternal education, and site of care. When multivariate analyses were restricted to patients in private practice, the significant association between Hispanic ethnicity and low inhaled steroid use persisted, whereas differences in ␤2-agonist use by race and ethnicity changed little but became nonsignificant.Conclusion. Even within private practices, patients' race and ethnicity are associated with clinician nonadherence to national guidelines. Programs to eliminate these disparities will need both to focus on site of care and to intervene at the provider and patient levels to be successful. Pediatrics 2002;109(1). URL: http://www. pediatrics.org/cgi/content/full/109/1/e1; asthma, child, practice guidelines, health insurance, Hispanic Americans.

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Medication Use Among Children With Asthma in East Harlem

Cited by 112 publications

References 26 publications

Quality of Care for Childhood Asthma: Estimating Impact and Implications

Quality of Care for Childhood Asthma: Estimating Impact and Implications

Are Building-Level Characteristics Associated with Indoor Allergens in the Household?

Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

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