Laird Harrison

March 04, 2017

UPDATED March 7, 2017 // ATLANTA — Black children die from asthma at a higher rate than white and Hispanic children, whether at home, as a hospital inpatient, or in an emergency department, researchers say.

"It suggests there are other factors that may be influencing the disparity," said Anna Chen Arroyo, MD, from Brigham and Women's Hospital in Boston.

Previous studies have documented the disparity in rates of death from asthma by ethnicity. Dr Arroyo and her colleagues were hoping to home in on reasons for this disparity by analyzing the settings where deaths occur. They reasoned that the setting of a child's death could reveal something about the care the child received during an acute asthma attack.

Children who died outside the hospital might not have received any medical treatment, and if they died in the emergency room, they might have received care too late, she explained.

Dying after being admitted to the hospital, in contrast, could mean the child received all possible care.

Dr Arroyo presented the finding here at the American Academy of Allergy, Asthma and Immunology 2017 Annual Meeting.

These are pretty startling data and might indicate the need to improve asthma education for providers.

The researchers identified all children younger than 19 years with asthma as the underlying cause of death from the National Center for Health Statistics Mortality Multiple Cause-of-Death public use data for 2003 to 2014. They then examined place of death — out of hospital (home or dead on arrival), outpatient (emergency department or clinic), inpatient — and the age, sex, race, and ethnicity of this cohort.

Of the 2571 deaths identified, 14% were out-of-hospital deaths, 51% were outpatient deaths, and 30% were inpatient deaths. There were declines in outpatient deaths for white patients and in out-of-hospital deaths for black and Hispanic patients. There was an increase in inpatient deaths for all ethnic groups.

The results indicate that all patients received at least some medical care or intervention, Dr Arroyo reported, which "suggests some improvement in access to care."

However, black children were six times more likely to die from asthma than Hispanic or white children — a disparity that persisted throughout the study period. And in all settings, black children accounted for a significantly higher proportion of deaths than white children (P < .05).

Table. Asthma Deaths in Children by Ethnicity and Setting


Setting
Black (% of Deaths) White (% of Deaths) Hispanic (% of Deaths) P Value
Outpatient 59 24 12 .05
Out of hospital 50 35 10 .05
Inpatient 50 30 14 .05

"These are pretty startling data and might indicate the need to improve asthma education for providers," said Mary Beth Fasano, MD, from the University of Iowa in Iowa City.

"They are discouraging data as we look to try to decrease asthma mortality," she told Medscape Medical News.

Dr Arroyo and Dr Fasano have disclosed no relevant financial relationships.

American Academy of Allergy, Asthma & Immunology (AAAAI) 2017 Annual Meeting: Abstract 283. Presented March 4, 2017.

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