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Paula Lozano, MD, MPH; Frederick A. Connell, MD, MPH; Thomas D. Koepsell, MD, MPH

JAMA. 1995;274(6):469-473.

Abstract
Objective.
—To determine whether African-American children with asthma use more emergency department (ED) and inpatient medical services and fewer preventive services than white children with similar insurance coverage and family income.

Design.
—Historical cohort study using Medicaid claims data.

Setting.
—Aid to Families With Dependent Children enrollees aged 3 through 17 years in the Seattle-Tacoma, Wash, metropolitan area.

Patients.
—All 576 African-American children and 1369 white children receiving services for asthma between June 1988 and December 1992.

Main Outcome Measures.
—Utilization of asthma services (ED, inpatient, office visits, and pharmacy) and well-child services and associated Medicaid reimbursements.

Results.
—African-American children were more likely than white children to make ED visits or to be hospitalized for asthma; adjusted odds ratios (ORs) were 1.70 (95% confidence interval [CI], 1.34 to 2.15) and 1.42 (95% CI, 1.03 to 1.96), respectively. African-American children were less likely to have made an office visit for asthma; the adjusted OR was 0.48 (95% CI, 0.26 to 0.85). The two groups were similarly likely to have filled a prescription for an asthma medication and to have made a well-child visit. Per capita payments for asthma services were 24% higher for African-American children: $436 vs $350 per child-year.

Conclusions.
—Higher use of ED and inpatient services for asthma among African-American children using Medicaid (compared with white children) cannot be fully explained by poverty or inadequate health insurance. Furthermore, these children appear to make disproportionately few office visits for asthma, suggesting suboptimal use of preventive services for asthma. In contrast, the comparable use of well-child visits in the two groups suggests the problem may not be in access to care in general, but there may be specific problems in the successful management of chronic diseases such as asthma among African-American children.

(JAMA. 1995;274:469-473)

Author Affiliations
From the Department of Pediatrics (Dr Lozano) and the Robert Wood Johnson Clinical Scholars Program (Drs Lozano and Koepsell), University of Washington School of Medicine; the Departments of Health Services (Drs Connell and Koepsell) and Epidemiology (Dr Koepsell), University of Washington School of Public Health and Community Medicine; and the Center for Health Studies, Group Health Cooperative of Puget Sound (Dr Lozano), Seattle, Wash.

Footnotes
The views expressed herein are those of the authors and are not necessarily those of the Robert Wood Johnson Foundation.

Reprint requests to Center for Health Studies, Group Health Cooperative of Puget Sound, 1730 Minor Ave, Suite 1600, Seattle, WA 98101 (Dr Lozano).

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