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Race and Sex Differences in Consistency of Care With National Asthma Guidelines in Managed Care Organizations
Jerry A. Krishnan, MD;
Gregory B. Diette, MD, MHS;
Elizabeth A. Skinner, MSW;
Becky D. Clark;
Don Steinwachs, PhD;
Albert W. Wu, MD, MPH
Arch Intern Med. 2001;161:1660-1668.
Background In the United States, morbidity from asthma disproportionately affects
African Americans and women. Although inadequate care contributes to overall
asthma morbidity, less is known about differences in asthma care by race and
sex.
Subjects and Methods To examine the relationships of race and sex with asthma care, we analyzed
responses to questionnaires administered to adults enrolled in 16 managed
care organizations participating in the Outcomes Management System Asthma
Study between September and December 1993. Indicators of care consistent with
National Asthma Education and Prevention Program (1991) recommendations were
assessed. Of a random sample of 8640 patients asked to participate, 6612 (77%)
completed the survey. This study focused on 5062 (14% African American, 72%
women) patients with at least moderate asthma symptom severity.
Results Fewer African Americans than whites reported care consistent with recommendations
for medication use (eg, daily inhaled corticosteroid use, 34.9% vs 54.4%; P = .001), self-management education (eg, action plan,
42.0% vs 53.8%; P = .001), avoiding triggers (37.6%
vs 53.6%; P = .001), and specialist care (28.3% vs
41.0%; P = .001). Differences in asthma care by sex
were smaller and tended to favor women except for daily inhaled corticosteroid
use (women vs men: 49.6% vs 58.3%; P = .001) and
having specialist care (37.7% vs 43.1%; P = .001).
Similar race and sex differences were observed after adjusting for age, education,
employment, and symptom frequency.
Conclusions 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.
From the Divisions of Pulmonary and Critical Care Medicine (Drs Krishnan
and Diette) and General Medicine (Dr Wu), Department of Medicine, The Johns
Hopkins School of Medicine, and Departments of Epidemiology (Dr Diette) and
Health Policy and Management (Mss Skinner and Clark and Drs Steinwachs and
Wu), The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.
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