Race/ethnicity and asthma management among adults presenting to the emergency department

Venkat, Arvind; Hasegawa, Kohei; Basior, Jeanne M.; Crandall, Cameron; Healy, Megan; Inboriboon, Pholaphat Charles; Sullivan, Ashley F.; Camargo, Carlos A.

doi:10.1111/resp.12572

Cited by 13 publications

(8 citation statements)

References 5 publications

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“…6 The study setting, methods of measurement, and collected variables have been reported previously. 7 – 13 Briefly, we recruited EDs by inviting sites that had participated in the earlier MARC study that evaluated ED patients with asthma exacerbation during 1996 to 2001. 5 , 14 , 15 A total of 48 EDs across 23 U.S. states completed the current study.…”

Section: Methodsmentioning

confidence: 99%

Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation

Hasegawa

Stoll

Ahn

et al. 2016

WestJEM

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IntroductionPrevious studies have demonstrated an association of low socioeconomic status with frequent asthma exacerbations. However, there have been no recent multicenter efforts to examine the relationship of insurance status – a proxy for socioeconomic status – with asthma severity and management in adults. The objective is to investigate chronic and acute asthma management disparities by insurance status among adults requiring emergency department (ED) treatment in the United States.MethodsWe conducted a multicenter chart review study (48 EDs in 23 U.S. states) on ED patients, aged 18–54 years, with acute asthma between 2011 and 2012. Each site underwent training (lecture, practice charts, certification) before reviewing randomly selected charts. We categorized patients into three groups based on their primary health insurance: private, public, and no insurance. Outcome measures were chronic asthma severity (as measured by ≥2 ED visits in one-year period) and management prior to the index ED visit, acute asthma management in the ED, and prescription at ED discharge.ResultsThe analytic cohort comprised 1,928 ED patients with acute asthma. Among these, 33% had private insurance, 40% had public insurance, and 27% had no insurance. Compared to patients with private insurance, those with public insurance or no insurance were more likely to have ≥2 ED visits during the preceding year (35%, 49%, and 45%, respectively; p<0.001). Despite the higher chronic severity, those with no insurance were less likely to have guideline-recommended chronic asthma care – i.e., lower use of inhaled corticosteroids (ICS [41%, 41%, and 29%; p<0.001]) and asthma specialist care (9%, 10%, and 4%; p<0.001). By contrast, there were no significant differences in acute asthma management in the ED – e.g., use of systemic corticosteroids (75%, 79%, and 78%; p=0.08) or initiation of ICS at ED discharge (12%, 12%, and 14%; p=0.57) – by insurance status.ConclusionIn this multicenter observational study of ED patients with acute asthma, we found significant discrepancies in chronic asthma severity and management by insurance status. By contrast, there were no differences in acute asthma management among the insurance groups.

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Section: Methodsmentioning

confidence: 99%

Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation

Hasegawa

Stoll

Ahn

et al. 2016

WestJEM

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“…Involving patients in this process may help, and a questionnaire used to identify asthma in early childhood developed in conjunction with parents shows promise in this regard . In addition, engagement with treatment may be dependent on socio‐economic and ethnic factors (rather than simply ethnic background), leading to worse asthma in different ethnic groups not being addressed . Although many socio‐economic factors cannot be altered, obesity is a modifiable ‘lifestyle’ disease, and the influence of obesity on respiratory illness, or bariatric pulmonology is a growth area with significant pulmonary health gains possible if weight loss can be achieved.…”

Section: Asthmamentioning

confidence: 99%

“…4 In addition, engagement with treatment may be dependent on socio-economic and ethnic factors (rather than simply ethnic background), leading to worse asthma in different ethnic groups not being addressed. 6 Although many socio-economic factors cannot be altered, obesity is a modifiable 'lifestyle' disease, and the influence of obesity on respiratory illness, or bariatric pulmonology is a growth area with significant pulmonary health gains possible if weight loss can be achieved. Asthma in the obese is a complex problem with obesity promoting a pro-inflammatory process 7 ; however, evidence of weight loss was published in Respirology following diet and exercise.…”

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confidence: 99%

Year in review 2015: Asthma and chronic obstructive pulmonary disease

et al. 2016

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Asthma continues to cause substantial morbidity and mortality, affecting some 300 million people worldwide, with a large proportion of those poorly controlled.1-3 In the last year, Respirology published a broad-based range of papers focusing on this important disease, ranging from questionnaire studies to molecular biology in mouse models. 4,5 This range of papers emphasizes the breadth of asthma research underway and the role of Respirology in disseminating these advances.

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“…Similarly, Black individuals are more likely to live in areas with greater exposure to hazards such as air pollution, which might increase the prevalence and severity of chronic diseases. 37 38 These differences in neighborhood and home environments and in resources could make it more challenging for Black patients to recover at home and to attend postoperative clinical visits. 39 Our finding that surgical mortality is higher among Black men compared with other subgroups of race and sex is consistent with the finding that Black men have substantially shorter life expectancy at birth compared with other subgroups.…”

Section: Discussionmentioning

confidence: 99%

Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study

Blegen

Gibbons

et al. 2023

BMJ

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ObjectiveTo assess inequities in mortality by race and sex for eight common surgical procedures (elective and non-elective) across specialties in the United States.DesignRetrospective cohort study.SettingUS, 2016-18.Participants1 868 036 Black and White Medicare beneficiaries aged 65-99 years undergoing one of eight common surgeries: repair of abdominal aortic aneurysm, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection.Main outcome measureThe main outcome measure was 30 day mortality, defined as death during hospital admission or within 30 days of the surgical procedure.ResultsPostoperative mortality overall was higher in Black men (1698 deaths, adjusted mortality rate 3.05%, 95% confidence interval 2.85% to 3.24%) compared with White men (21 833 deaths, 2.69%, 2.65% to 2.73%), White women (21 847 deaths, 2.38%, 2.35% to 2.41%), and Black women (1631 deaths, 2.18%, 2.04% to 2.31%), after adjusting for potential confounders. A similar pattern was found for elective surgeries, with Black men showing a higher adjusted mortality (393 deaths, 1.30%, 1.14% to 1.46%) compared with White men (5650 deaths, 0.85%, 0.83% to 0.88%), White women (4615 deaths, 0.82%, 0.80% to 0.84%), and Black women (359 deaths, 0.79%, 0.70% to 0.88%). This 0.45 percentage point difference implies that mortality after elective procedures was 50% higher in Black men compared with White men. For non-elective surgeries, however, mortality did not differ between Black men and White men (1305 deaths, 6.69%, 6.26% to 7.11%; and 16 183 deaths, 7.03%, 6.92% to 7.14%, respectively), although mortality was lower for White women and Black women (17 232 deaths, 6.12%, 6.02% to 6.21%; and 1272 deaths, 5.29%, 4.93% to 5.64%, respectively). These differences in mortality appeared within seven days after surgery and persisted for up to 60 days after surgery.ConclusionsPostoperative mortality overall was higher among Black men compared with White men, White women, and Black women. These findings highlight the need to understand better the unique challenges Black men who require surgery face.

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Race/ethnicity and asthma management among adults presenting to the emergency department

Cited by 13 publications

References 5 publications

Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation

Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation

Year in review 2015: Asthma and chronic obstructive pulmonary disease

Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study

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