Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleORIGINAL RESEARCH

Racial and Ethnic Disparities in Acute Care Use for Pediatric Asthma

Jorge Kaufmann, Miguel Marino, Jennifer Lucas, Steffani R. Bailey, Sophia Giebultowicz, Jon Puro, David Ezekiel-Herrera, Shakira F. Suglia and John Heintzman
The Annals of Family Medicine March 2022, 20 (2) 116-122; DOI: https://doi.org/10.1370/afm.2771
Jorge Kaufmann
1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: kaufmjor@ohsu.edu
Miguel Marino
1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
2Biostatistics Group, School of Public Health, Oregon Health & Science University–Portland State University, Portland, Oregon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jennifer Lucas
1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Steffani R. Bailey
1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sophia Giebultowicz
3OCHIN, Portland, Oregon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jon Puro
3OCHIN, Portland, Oregon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
David Ezekiel-Herrera
1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Shakira F. Suglia
4Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
John Heintzman
1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
3OCHIN, Portland, Oregon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading

Article Figures & Data

Tables

  • Additional Files
    • View popup
    Table 1.

    Characteristics of Children Aged 3 to 17 Years With Asthma in the ADVANCE Clinical Research Network, 2012-2018

    Racial, Ethnic, and Language Group
    CharacteristicAll (N = 41,276)Non-Hispanic White (n = 10,164)Non-Hispanic Black (n = 10,041)Latine, Prefer English (n = 9,239)Latine, Prefer Spanish (n = 11,832)
    Female, No. (%)17,709 (42.9)4,429 (43.6)4,257 (42.4)4,011 (43.4)5,012 (42.4)
    Age at first visit, mean (SD), y         7.6 (3.7)         8.2 (3.8)         7.6 (3.7)         7.6 (3.7)         6.9 (3.4)
    BMI category, No. (%)a
        Never overweight16,726 (40.5)4,663 (45.9)4,565 (45.5)3,592 (38.9)3,906 (33.0)
        Sometimes overweight10,083 (24.4)2,222 (21.9)2,233 (22.2)2,261 (24.5)3,367 (28.5)
        Always overweight14,467 (35.0)3,279 (32.3)3,243 (32.3)3,386 (36.6)4,559 (38.5)
    Payor type, No. (%)
        Never insured1,122 (2.7)275 (2.7)188 (1.9)264 (2.9)395 (3.3)
        Some private2,423 (5.9)1,140 (11.2)409 (4.1)618 (6.7)256 (2.2)
        Some private and public3,324 (8.1)984 (9.7)659 (6.6)1,003 (10.9)678 (5.7)
    Some public34,407 (83.4)7,765 (76.4)8,785 (87.5)7,354 (79.6)10,503 (88.8)
    Federal poverty level, No. (%)
        Always >138%2,916 (7.1)1,029 (10.1)805 (8.0)620 (6.7)462 (3.9)
        Above and below 138%5,151 (12.5)1,350 (13.3)946 (9.4)930 (10.1)1,925 (16.3)
        Always ≤138%28,103 (68.1)5,973 (58.8)7,072 (70.4)6,437 (69.7)8,621 (72.9)
        Not documented5,106 (12.4)1,812 (17.8)1,218 (12.1)1,252 (13.6)824 (7.0)
    Urbanicity, No. (%)b
        Metropolitan35,401 (85.8)7,507 (73.9)9,619 (95.8)7,174 (77.6)11,101 (93.8)
        Micropolitan4,493 (10.9)1,998 (19.7)183 (1.8)1,705 (18.5)607 (5.1)
        Rural1,382 (3.3)659 (6.5)239 (2.4)360 (3.9)124 (1.0)
    US region, No. (%)
        Northeast4,129 (10.0)228 (2.2)1,449 (14.4)1,163 (12.6)1,289 (10.9)
        South17,515 (42.4)3,819 (37.6)5,293 (52.7)3,677 (39.8)4,726 (39.9)
        Midwest3,819 (9.3)708 (7.0)2,457 (24.5)356 (3.9)298 (2.5)
        West15,813 (38.3)5,409 (53.2)842 (8.4)4,043 (43.8)5,519 (46.6)
    Visits per year, No. (%)
        ≤117,900 (43.4)5,005 (49.2)5,420 (54.0)3,914 (42.4)3,561 (30.1)
        2 or 38,015 (19.4)1,825 (18.0)1,933 (19.3)1,790 (19.4)2,467 (20.9)
        ≥415,361 (37.2)3,334 (32.8)2,688 (26.8)3,535 (38.3)5,804 (49.1)
    Maximum asthma severity, No. (%)c
        Intermittent11,348 (27.5)2,537 (25.0)3,324 (33.1)2,169 (23.5)3,318 (28.0)
        Mild persistent6,541 (15.8)1,193 (11.7)1,780 (17.7)1,691 (18.3)1,877 (15.9)
        Moderate to severe persistent3,583 (8.7)787 (7.7)1,062 (10.6)757 (8.2)977 (8.3)
        Not documented19,804 (48.0)5,647 (55.6)3,875 (38.6)4,622 (50.0)5,660 (47.8)
    Influenza vaccination rate, No. (%)
        <50% annually28,851 (69.9)8,019 (78.9)7,332 (73.0)6,743 (73.0)6,757 (57.1)
        50% to 80% annually8,685 (21.0)1,542 (15.2)1,968 (19.6)1,771 (19.2)3,404 (28.8)
        ≥80% annually3,740 (9.1)603 (5.9)741 (7.4)725 (7.8)1,671 (14.1)
    Pneumococcal vaccination ever, No. (%)26,560 (64.3)5,585 (54.9)6,705 (66.8)5,677 (61.4)8,593 (72.6)
    Smoker, No. (%)
        Never26,905 (65.2)6,136 (60.4)6,048 (60.2)6,010 (65.1)8,711 (73.6)
        Ever969 (2.3)424 (4.2)262 (2.6)163 (1.8)120 (1.0)
        Passive only3,018 (7.3)1,566 (15.4)665 (6.6)408 (4.4)379 (3.2)
        Not documented10,384 (25.2)2,038 (20.1)3,066 (30.5)2,658 (28.8)2,622 (22.2)
    Albuterol prescriptions per year, mean (SD)         0.6 (0.6)         0.5 (0.6)         0.7 (0.7)         0.6 (0.6)         0.7 (0.7)
    Inhaled corticosteroid prescription ever, No. (%)12,267 (29.7)2,860 (28.1)2,944 (29.3)2,411 (26.1)4,052 (34.2)
    • ADVANCE = Accelerating Data Value Across a National Community Health Center; BMI = body mass index; RUCA = rural-urban commuting area; US = United States.

    • Notes: All children had at least 1 year of observation. Data are representative of 345 clinics spanning 18 US states and 4 regions: Northeast (Massachusetts, Rhode Island), South (Florida, Georgia, Maryland, North Carolina), Midwest (Indiana, Kansas, Missouri, Ohio, Wisconsin), and West (Alaska, California, Hawaii, Nevada, New Mexico, Oregon, Washington).

    • ↵a Overweight if BMI >85th percentile. Category reflects all available measures during study period. Biologically implausible values were flagged as more than 8 SDs above or 4 SDs below mean BMI.

    • ↵b RUCA classification code based on 2010 census tract information and patients’ primary clinic zip code.

    • ↵c Maximum asthma severity diagnosed in an ambulatory visit encounter or documented in the patient problem list.

    • View popup
    Table 2.

    Clinic Visits for Asthma Exacerbation Among Children With Asthma Aged 3 to 17 Years (N = 41,276)

    Clinic Visit Outcomes for Asthma Exacerbation
    Outcome and GroupUnadjustedAdjusteda
    VisitsPredicted probability, %bOR (95% CI)Predicted probability, %bOR (95% CI)
    Non-Hispanic White22.4Ref34.3Ref
    Non-Hispanic Black24.91.15 (1.02-1.30)34.10.99 (0.89-1.09)
    Latine, prefer English24.11.10 (1.01-1.20)34.10.99 (0.92-1.06)
    Latine, prefer Spanish27.41.31 (1.20-1.43)36.11.10 (1.02-1.18)
    Visit ratePredicted annual ratecRR (95% CI)Predicted annual ratecRR (95% CI)
    Non-Hispanic White15.1Ref19.3Ref
    Non-Hispanic Black15.31.01 (0.84-1.23)20.01.03 (0.87-1.23)
    Latine, prefer English24.81.65 (0.95-2.86)22.91.18 (0.93-1.51)
    Latine, prefer Spanish18.71.24 (1.03-1.50)17.90.92 (0.80-1.06)
    • OR = odds ratio; RR = rate ratio; Ref = reference.

    • Notes: Visits to community health center ambulatory clinics only. Values in bold denote statistically significant results (P <.05).

    • ↵a Adjusted for age, sex, body mass index, insurance type, federal poverty level, urbanicity, US region, documented asthma severity, number of yearly visits, albuterol and inhaled corticosteroid prescriptions, influenza and pneumococcal vaccinations, and tobacco smoke exposure.

    • ↵b Predicted probability of ever having a visit with a clinic-coded asthma exacerbation; adjusted results are averaged over covariates.

    • ↵c Predicted annual rate of visits with clinic-coded asthma exacerbation per 100 person-years; adjusted results are averaged over covariates.

    • View popup
    Table 3.

    Asthma-Related ED Visits Among Children With Asthma Aged 3 to 17 Years Receiving Oregon-Medicaid (N = 6,555)

    Asthma-Related ED Visit Outcomes
    Outcome and GroupUnadjustedAdjusteda
    VisitsPredicted probability, %bOR (95% CI)Predicted probability, %bOR (95% CI)
    Non-Hispanic White9.5Ref9.9Ref
    Non-Hispanic Black13.31.47 (1.06-2.04)13.31.40 (1.04-1.89)
    Latine, prefer English10.01.07 (0.84-1.36)10.81.10 (0.85-1.43)
    Latine, prefer Spanish9.40.99 (0.78-1.27)9.90.99 (0.77-1.28)
    Visit ratePredicted annual ratecRR (95% CI)Predicted annual ratecRR (95% CI)
    Non-Hispanic White5.4Ref5.9Ref
    Non-Hispanic Black9.91.84 (1.39-2.44)8.81.49 (1.09-2.04)
    Latine, prefer English5.51.02 (0.75-1.39)5.30.90 (0.67-1.21)
    Latine, prefer Spanish5.41.00 (0.77-1.31)5.40.92 (0.68-1.24)
    • ED = emergency department; OR = odds ratio; RR = rate ratio; Ref = reference.

    • Note: Values in bold denote statistically significant results (P < .05).

    • ↵a Adjusted for age, sex, body mass index, federal poverty level, urbanicity, documented asthma severity, number of yearly visits, albuterol and inhaled corticosteroid prescriptions, influenza and pneumococcal vaccinations, and tobacco smoke exposure.

    • ↵b Predicted probability of ever having had an asthma-related ED visit; adjusted results are averaged over covariates.

    • ↵c Predicted annual rate of asthma-related ED visits per 100 person-years; adjusted results are averaged over covariates.

Additional Files

  • Tables
  • SUPPLEMENTAL MATERIALS IN PDF FILE BELOW

    • KaufmannSupp.pdf -

      Supplemental Table 1. Characteristics of Oregon-Medicaid-recipient children age 3-17 years with asthma having had a minimum of one year observation time in the ADVANCE Clinical Research Network, 2012-2018. 

      Supplemental Table 2. Asthma exacerbation outcomes among Oregon-Medicaid recipient children (age 3-17) with asthma, at community health center ambulatory visits (AV), for children having had at least 1 AV in the ADVANCE Clinical Research Network, 2012-2018. 

      Supplemental Table 3. Asthma-related hospital inpatient admission outcomes for Oregon-Medicaid recipient children with asthma age 3-17, having had at least 1 community health center visit in the ADVANCE Clinical Research Network, 2012-2018 (N = 6,555). 


  • VISUAL ABSTRACT IN PNG FILE BELOW

    • Kauffman_visual_abstract.png -

      How do patterns of health visits vary by demographics and facility type for children with asthma?

      A new study analyzes the likelihood of use of community health centers, emergency departments, and inpatient admissions by race/ethnicity, compared to White children.

PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 20 (2)
The Annals of Family Medicine: 20 (2)
Vol. 20, Issue 2
1 Mar 2022
  • Table of Contents
  • Index by author
  • Plain Language Article Summaries
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Racial and Ethnic Disparities in Acute Care Use for Pediatric Asthma
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
1 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Racial and Ethnic Disparities in Acute Care Use for Pediatric Asthma
Jorge Kaufmann, Miguel Marino, Jennifer Lucas, Steffani R. Bailey, Sophia Giebultowicz, Jon Puro, David Ezekiel-Herrera, Shakira F. Suglia, John Heintzman
The Annals of Family Medicine Mar 2022, 20 (2) 116-122; DOI: 10.1370/afm.2771

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Racial and Ethnic Disparities in Acute Care Use for Pediatric Asthma
Jorge Kaufmann, Miguel Marino, Jennifer Lucas, Steffani R. Bailey, Sophia Giebultowicz, Jon Puro, David Ezekiel-Herrera, Shakira F. Suglia, John Heintzman
The Annals of Family Medicine Mar 2022, 20 (2) 116-122; DOI: 10.1370/afm.2771
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Patient and Health Care Professional Perspectives on Stigma in Integrated Behavioral Health: Barriers and Recommendations
  • Evaluation of the Oral Health Knowledge Network’s Impact on Pediatric Clinicians and Patient Care
  • Study What You Do: Developing a Psychotherapy Tracking Database in a Large-Scale Integrated Behavioral Health Service
Show more Original Research

Similar Articles

Subjects

  • Domains of illness & health:
    • Chronic illness
  • Person groups:
    • Children's health
  • Methods:
    • Quantitative methods
  • Other research types:
    • Health services
  • Core values of primary care:
    • Access
  • Other topics:
    • Disparities in health and health care

Keywords

  • asthma
  • community health center
  • health care utilization
  • pediatric asthma
  • racial/ethnic disparities
  • health disparity, minority and vulnerable populations
  • primary care
  • practice-based research
  • child health

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Multimedia
  • Supplements
  • Online First
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2023 Annals of Family Medicine