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Improving medication use may be the key to reducing racial disparities in children's asthma problems

Black and Hispanic children with asthma end up hospitalized or in the emergency department due to poorly controlled asthma far more often than white children with the condition. Researchers have been trying to sort out whether these racial/ethnic disparities are due to differences in asthma care, insurance status, or sociodemographic factors.

A recent study shows that the disparity may simply reflect a difference in use of preventive medications for asthma. Despite having worse asthma than white children (based on number of symptom days, school days missed, and health status scores), black and Hispanic children with similar insurance and sociodemographic characteristics were 31 percent and 42 percent less likely, respectively, to be using inhaled antiinflammatory medication (including inhaled steroids) to prevent the beginning or worsening of an asthma episode.

This suggests that nonfinancial barriers—such as differences in health beliefs and concepts of disease, fears about steroids, or communication barriers (including language) between doctors and patients—may play an important role in suboptimal medication use. Most other asthma care processes, including specialist use, preventive visits, and home management practices (for example, no pets or smoking at home), were equal or better for minority children studied. Increasing the use of preventive medications would be a natural focus for reducing racial disparities in asthma burden, concludes Tracy A. Lieu, M.D., M.P.H., of Harvard Medical School.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS09935), Dr. Lieu and her colleagues analyzed data on Medicaid-insured children with asthma in five managed care organizations in California, Washington, and Massachusetts. They also interviewed the parents to gauge children's asthma status to evaluate racial/ethnic variations in processes of asthma care.

See "Racial/ethnic variation in asthma status and management practices among children in managed Medicaid," by Dr. Lieu, Paula Lozano, M.D., M.P.H., Jonathan A. Finkelstein, M.D., M.P.H., and others, in the May 2002 Pediatrics 109(5), pp. 857-865.

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