Race and Sex Differences in Consistency of Care With National Asthma Guidelines in Managed Care Organizations

Krishnan, Jerry A.; Diette, Gregory B.; Skinner, Elizabeth A.; Clark, Becky D.; Steinwachs, Don; Wu, Albert W.

doi:10.1001/archinte.161.13.1660

Cited by 122 publications

(60 citation statements)

References 51 publications

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“…Taken together, these observations suggest a gap in out-of-hospital asthma deaths by race (i.e., black patients were more likely to die of asthma exacerbations out-of-hospital than white patients). Potential explanations include difficulties in accessing adequate healthcare (26), poor preventative management practices (e.g., nonadherence) (27,28), and delays in seeking medical attention (29,30), which are known to be more common among blacks compared with whites in the United States. These considerations suggest that the subset of patients hospitalized for asthma exacerbations may not be representative of all patients with severe and potentially life-threatening exacerbations.…”

Section: Discussionmentioning

confidence: 99%

Mortality in Patients Hospitalized for Asthma Exacerbations in the United States

Krishnan

Diette

Rańd

et al. 2006

Am J Respir Crit Care Med

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193

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Rationale: Hospitalizations for asthma exacerbations are common in the United States, but there are no national estimates of outcomes in this population. It is also not known if race disparities in asthma deaths exist among hospitalized patients. Objectives: To estimate outcomes of patients hospitalized for asthma in the United States and to determine if the risk of death in this population is higher among black patients compared with white patients. Methods: We used the Nationwide Inpatient Sample for 2000. Admissions for asthma exacerbations among patients Ͼ 5 yr of age were included. Mortality was the primary outcome; secondary outcomes were length of stay and total hospital charges. Measurements and Main Results:In-hospital asthma mortality was 0.5% (99% confidence interval [CI], 0.4-0.6), with mean hospital stay of 2.7 d (99% CI, 2.6-2.8 d) and $9,078 (99% CI, $8,300-9,855) in hospital charges. Deaths in this population accounted for about one-third of all asthma deaths reported in the United States. Black patients hospitalized for asthma exacerbations were less likely to die when compared with white patients (0.3 vs. 0.6%; p Ͻ 0.001). However, in multivariable analyses, there were no significant race differences in hospital deaths. Conclusions: Mortality among patients hospitalized for asthma exacerbations accounts for one-third of all deaths from asthma. The higher overall risk of death from asthma in black patients compared with white patients in the United States is not explained by race differences in hospital deaths and therefore is attributable to factors preceding hospitalization.

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Section: Discussionmentioning

confidence: 99%

Mortality in Patients Hospitalized for Asthma Exacerbations in the United States

Krishnan

Diette

Rańd

et al. 2006

Am J Respir Crit Care Med

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193

125

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“…However, this finding also may represent physician bias in the management of patients belonging to different racial/ethnic groups, which has been observed in several prior studies in the adult population. [33][34][35][36] Although adjusted results indicated fewer bacterial diagnoses for African American and Latino patients, compared with non-Hispanic white patients, this did not translate to lower adjusted rates of receiving antibiotics. This may indicate that these groups were more likely to receive antibiotics for inappropriate indications (ie, nonbacterial illnesses).…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Variation in Parent Expectations for Antibiotics: Implications for Public Health Campaigns

et al. 2004

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ABSTRACT. Context. Widespread overuse and inappropriate use of antibiotics are a major public health concern. Little is known about racial/ethnic differences in parents seeking antibiotics for their children's upper respiratory illnesses.Objective. To examine racial/ethnic differences in parent expectations about the need for antibiotics and physician perceptions of those expectations.Design. We conducted a nested, cross-sectional survey of parents who were coming to see their child's pediatrician because of cold symptoms between October 2000 and June 2001. Parents completed a previsit survey that collected information on demographics, their child's illness, and a 15-item previsit expectations inventory that included an item asking how necessary it was for the physician to prescribe antibiotics. Physicians completed a postvisit survey that collected information on diagnosis, treatment, and whether the physician perceived the parent expected an antibiotic. The encounter was the unit of analysis. Multivariate logistic regression analyses were performed to evaluate predictors of dichotomized parental expectations for antibiotics, dichotomized physician perceptions of those expectations, diagnostic patterns, and antibiotic-prescribing patterns.Setting. Twenty-seven community pediatric practices in the Los Angeles, Calif, metropolitan area.Participants. A volunteer sample of 38 pediatricians (participation rate: 64%) and a consecutive sample of 543 parents (participation rate: 83%; ϳ15 participating for each enrolled pediatrician) seeking care for their children's respiratory illnesses. Pediatricians were eligible to participate if they worked in a community-based managed care practice in the Los Angeles area. Parents were eligible to participate if they could speak and read English and presented to participating pediatricians with a child 6 months to 10 years old who had cold symptoms but had not received antibiotics within 2 weeks.Main Outcome Measures. Parental beliefs about the necessity of antibiotics for their child's illness, physician perceptions of parental expectations for antibiotics, bacterial diagnosis rates, and antibiotic-prescribing rates.Results. Forty-three percent of parents believed that antibiotics were definitely necessary, and 27% believed that they were probably necessary for their child's illness. Latino and Asian parents were both 17% more likely to report that antibiotics were either definitely or probably necessary than non-Hispanic white parents. Physicians correctly perceived that Asian parents expected antibiotics more often than non-Hispanic white parents but underestimated the greater expectations of Latino parents for antibiotics. Physicians also correctly perceived that parents of children with ear pain or who were very worried about their child's condition were significantly more likely to expect antibiotics. Physicians were 7% more likely to make a bacterial diagnosis and 21% more likely to prescribe antibiotics when they perceived that antibiotics were expected.Conclusions. Paren...

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“…Recent studies in the physical health sector demonstrated poorer compliance among minority adults in the treatment of HIV (Mehta et al, 1997) and renal disease (Curtin et al, 1999) and among minority children in the treatment of asthma (Krishnan et al, 2001), even after adjusting for factors such as age, education, employment, access to insurance, and symptom frequency (Krishnan et al, 2001). Similarly, adherence may also relate to the ability of consumers and providers to communicate with one another.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Differences in the Use of Psychotropic Medication in High-Risk Children and Adolescents

Leslie

Weckerly

Landsverk

et al. 2003

Journal of the American Academy of Child & Adolescent Psych

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Objectives-To investigate rates of psychotropic medication use by youths served in public service sectors as a function of race/ethnicity.Method-Logistic regression models were used to examine racial/ethnic differences in caregiver report of psychotropic medication use for a random stratified sample of 1,342 children who were served in public service sectors during the second half of fiscal year 1996-97.Results-Race/ethnicity predicted caregiver report of past-year and lifetime psychotropic medication use when all other factors were held constant. Specifically, caregivers of AfricanAmerican and Latino children were less likely to report past-year use compared to white children; caregivers of Latino children and "others" were less likely to report lifetime use. Additional factors predictive of medication use in regression models included younger age, male gender, higher household income, insurance type, active to mental health sector at time of enumeration into the study, impairment and diagnosis of mood, and anxiety or attentional disorder.Conclusions-Racial/ethnic differences in use of psychotropic medication occur in children served in public service sectors and need to be considered in clinical diagnosis and treatment.

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Race and Sex Differences in Consistency of Care With National Asthma Guidelines in Managed Care Organizations

Abstract: Even among patients with health insurance, disparities in asthma care for African Americans compared with whites exist and may contribute to race disparities in outcomes. Women generally reported better asthma care but may benefit from greater use of inhaled corticosteroids.

Cited by 122 publications

References 51 publications

Mortality in Patients Hospitalized for Asthma Exacerbations in the United States

Mortality in Patients Hospitalized for Asthma Exacerbations in the United States

Racial/Ethnic Variation in Parent Expectations for Antibiotics: Implications for Public Health Campaigns

Racial/Ethnic Differences in the Use of Psychotropic Medication in High-Risk Children and Adolescents

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