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Sara E. Erickson, MD; Carlos Iribarren, MD, MPH, PhD; Irina V. Tolstykh, MS; Paul D. Blanc, MD, MSPH; Mark D. Eisner, MD, MPH

Arch Intern Med. 2007;167(17):1846-1852.

Background  Morbidity from asthma disproportionately affects black people. Whether this excess morbidity is fully explained by differences in asthma severity, access to care, or socioeconomic status (SES) is unknown.

Methods  We assessed whether there were racial disparities in asthma management and outcomes in a managed care organization that provides uniform access to health care and then determined to what degree these disparities were explained by differences in SES, asthma severity, and asthma management. We prospectively studied 678 patients from a large, integrated health care delivery system. Patients who had been hospitalized for asthma were interviewed after discharge to ascertain information about asthma history, health status, and SES. Small-area socioeconomic data were ascertained by means of geocoding and linkage to the US Census 2000. Patients were followed up for subsequent emergency department (ED) visits or hospitalizations (median follow-up, 1.9 years).

Results  Black race was associated with a higher risk of ED visits (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.39-2.66) and hospitalizations (HR, 1.89; 95% CI, 1.30-2.76). This finding persisted after adjusting for SES and differences in asthma therapy (adjusted HR for ED visits, 1.73; 95% CI, 1.07-2.81; and adjusted HR for hospitalizations, 2.01; 95% CI, 1.33-3.02).

Conclusions  Even in a health care setting that provides uniform access to care, black race was associated with worse asthma outcomes, including a greater risk of ED visits and hospitalizations. This association was not explained by differences in SES, asthma severity, or asthma therapy. These findings suggest that genetic differences may underlie these racial disparities.

Author Affiliations: Division of Pulmonary and Critical Care Medicine, Department of Medicine (Drs Erickson, Blanc, and Eisner), and Division of Occupational and Environmental Medicine, Department of Medicine (Drs Blanc and Eisner), University of California, San Francisco; and Division of Research, Kaiser Permanente, Oakland, California (Drs Iribarren and Eisner and Ms Tolstykh).

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