Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program - 06/06/19
, Scott E. Gillespie, MS a, David T. Mauger, PhD b, Brenda R. Phillips, MS b, Eugene R. Bleecker, MD c, Elliot Israel, MD d, Deborah A. Meyers, PhD c, Wendy C. Moore, MD e, Ronald L. Sorkness, PhD f, Sally E. Wenzel, MD g, Leonard B. Bacharier, MD h, Mario Castro, MD h, Loren C. Denlinger, MD f, Serpil C. Erzurum, MD i, John V. Fahy, MD j, Benjamin M. Gaston, MD k, Nizar N. Jarjour, MD f, Allyson Larkin, MD g, Bruce D. Levy, MD d, Ngoc P. Ly, MD j, Victor E. Ortega, MD e, Stephen P. Peters, MD e, Wanda Phipatanakul, MD l, Sima Ramratnam, MD f, W. Gerald Teague, MD mAbstract |
Background |
Despite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white patients.
Objective |
We sought to determine associations between black and white patients and asthma-related health care use, accounting for complex relationships.
Methods |
This study was completed as part of the National Heart, Lung, and Blood Institute's Severe Asthma Research Program, a prospective observational cohort. Between November 2012 and February 2015, it enrolled 579 participants 6 years and older with 1 year of observation time and complete data. Inverse probability of treatment weighting was used to balance racial groups with respect to community and family socioeconomic variables and environmental exposure variables. The primary outcome was emergency department (ED) use for asthma. Secondary outcomes included inhaled corticosteroid use, outpatient physician's office visits for asthma, and asthma–related hospitalization.
Results |
Black patients had greater odds of ED use over 1 year (odds ratio, 2.19; 95% CI, 1.43-3.35) but also differed in the majority (>50%) of baseline variables measured. After statistical balancing of the racial groups, the difference between black and white patients with respect to ED use no longer reached the level of significance. Instead, in secondary analyses black patients were less likely to see an outpatient physician for asthma management (adjusted odds ratio, 0.57; 95% CI, 0.38-0.85).
Conclusions |
The disparity in ED use was eliminated after consideration of multiple variables. Social and environmental policies and interventions tailored to black populations with a high burden of asthma are critical to reduction (or elimination) of these disparities.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Asthma control, asthma exacerbation, racial disparities, health care use, propensity scoring, inverse probability of treatment weighting
Abbreviations used : ACT, ED, IPTW, NHLBI, SARP, SMD
Plan
| Supported by National Heart, Lung, and Blood Institute grants to the Severe Asthma Research Program (SARP): U10 HL109086, U10 HL109146, U10 HL109152, U10 HL109164, U10 HL109168, U10 HL109172, U10 HL109250, and U10 HL109257. In addition, this program is supported through the following National Institutes of Health National Center for Advancing Translational Sciences awards: UL1 TR001420 (Wake Forest University), UL1 TR000427 (University of Wisconsin), UL1 TR001102 (Harvard University), and UL1 TR002378 (Emory University). |
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| Disclosure of potential conflict of interest: D. T. Mauger reports nonfinancial support from Merck, Boerhinger Ingleim, GlaxoSmithKline, TEVA, and Vifor outside the submitted work. R. R. Bleecker reports has undertaken clinical trials through his employer, Wake Forest School of Medicine and the University of Arizona, for AstraZeneca, MedImmune, Boehringer Ingelheim, Genentech, Johnson & Johnson (Janssen), Novartis, Regeneron, and Sanofi Genzyme and has also served as a paid consultant for AztraZeneca, MedImmune, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Regeneron, and Sanofi Genzyme outside the submitted work. E. Israel reports personal fees from AstraZeneca, Novartis, Philips Respironics, and Regeneron Pharmaceuticals; personal fees and other support from TEVA Specialty Pharmaceuticals; grants from Genentech; nonfinancial support from Boehringer Ingelheim, GlaxoSmithKline, Merck, Sunovion, and TEVA; grants from Sanofi; personal fees from Bird Rock Bio, Nuvelution Pharmaceuticals, and Vitaeris; grants from Boehringer Ingelheim; nonfinancial support from TEVA Specialty Pharmaceuticals; personal fees from Sanofi Genzyme, Merck, Entrinsic Health Solutions, and GlaxoSmithKline; other support from Vorso; and personal fees from Pneuma Respiratory and 4D Pharma outside the submitted work. W. C. Moore reports consultancy fees from AstraZeneca, Sanofi, and GlaxoSmithKline and is the principal investigator in multicenter clinical trials with sponsors Astrazeneca, GlaxoSmithKline, Pearl Therapeutics, and Sanofi. S. E. Wenzel reports grants and personal fees from AstraZeneca; grants from Beohringer Ingelheim, GlaxoSmithKline and Novartis; grants and personal fees from Sanofi; and personal fees from Pieris and UpToDate outside the submitted work and has a patent null pending. L. B. Bacharier reports personal fees from GlaxoSmithKline, Genentech/Novartis, Merck, DBV Technologies, Teva, Boehringer Ingelheim, Sanofi/Regeneron, Vectura, Circassia, and AstraZeneca outside the submitted work. M. Castro reports personal fees from AstraZeneca, Aviragen, Boehringer Ingelheim, Boston Scientific, Elsevier, Genentech, 4D Pharma, Mallinckrodt, Neutronic, Nuvaira, Teva, Theravance, and VIDA and grants from Boehringer Ingelheim, Chiesi, Genentech, Novartis, Sanofi-Aventis, and Vectura, all outside the submitted work. L. C. Denlinger reports personal fees from AstraZeneca, Sanofi, and GlaxoSmithKline outside the submitted work. S. C. Erzurum reports serving as the Chair of the American Board of Internal Medicine Pulmonary Disease Board outside the submitted work. J. V. Fahy reports consultancy fees from Boehringer Ingelheim, Pieris, Entrinsic Health Solutions, and Sanofi Genzyme and is a named inventor on 3 patents outside the submitted work. N. P. Ly reports grants from Vertex 2017 and personal fees from Gilead 2017 outside the submitted work. W. G. Teague reports salary support from the University of Virginia Ivy Foundation (Endowed Chair); reports grant support from Panera Bread, TEVA Respiratory, AstraZeneca, and Sanofi/Regeneron; serves on advisory boards for Sanofi/Regeneron, TEVA Respiratory, GlaxoSmithKline, Genentech, and Aviragen; serves on speakers' bureaus with personal fees from Genentech/Novartis and TEVA Respiratory (QVAR); and serves on writing committees for the American College of Allergy & Immunology outside the submitted work. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 143 - N° 6
P. 2052-2061 - juin 2019 Retour au numéro
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