Asthma Care Quality, Language, and Ethnicity in a Multi-State Network of Low-income Children

John Heintzman, MD, MPH; Jorge Kaufmann, ND, MS; Jennifer Lucas, PhD; Shakira Suglia, PhD; Arvin Garg, MD; Jon Puro, MS; Sophia Giebultowicz, MA; David Ezekiel-Herrera, MS; Andrew Bazemore, MD; Miguel Marino, PhD


J Am Board Fam Med. 2020;33(5):707-715. 

In This Article

Abstract and Introduction


Introduction: Prior research has documented disparities in asthma outcomes between Latino children and non-Hispanic whites, but little research directly examines the care provided to Latino children over time in clinical settings.

Methods: We utilized an electronic health record–based dataset to study basic asthma care utilization (timely diagnosis documentation and medication prescription) between Latino (Spanish preferring and English preferring) and Non-Hispanic white children over a 13-year study period.

Results: In our study population (n = 37,614), Latino children were more likely to have Medicaid, be low income, and be obese than non-Hispanic white children. Latinos (Spanish preferring and English preferring) had lower odds than non-Hispanic whites of having their asthma recorded on their problem list on the first day the diagnosis was noted (odds ratio [OR] = 0.83; 95% CI, 0.77 to 0.89 Spanish preferring; OR = 0.93; 95% CI, 0.87 to 0.99 English preferring). Spanish-preferring Latinos had higher odds of ever receiving a prescription for albuterol (OR = 1.96; 95% CI, 1.52 to 2.52), inhaled corticosteroids (OR = 1.45; 95% CI, 1.01 to 2.09), or oral steroids (OR = 1.48; 95% CI, 1.07 to 2.04) than non-Hispanic whites. Among those with any prescription, Spanish-preferring Latinos had higher rates of albuterol prescriptions compared with non-Hispanic whites (adjusted rate ratio [aRR] = 1.0; 95% CI, 1.01 to 1.13).

Conclusions: In a multi-state network of clinics, Latino children were less likely to have their asthma entered on their problem list the first day it was noted than non-Hispanic white children, but otherwise did not receive inferior care to non-Hispanic white children in other measures. Further research can examine other parts of the asthma care continuum to better understand asthma disparities.


Approximately 8% of children in the United States have asthma.[1] Prior studies have demonstrated persistent disparities in the asthma care utilized by Latino children compared with non-Hispanic white children,[2–12] in areas of medication use,[2,3,6,8,9] asthma self-management,[4] and overall access to care.[7,10–12] Asthma has longstanding national standards to guide disease management,[13] including documentation of asthma as a chronic condition in the medical chart (including its severity)[13–15] and appropriate prescription of medications (eg, bronchodilators and inhaled and oral corticosteroids) to match disease severity.[13] Understanding disparities in the primary care environment (where these guidelines are implemented) is crucial; however, existing studies have produced conflicting findings. Studies using some surveys have found that Latino patients are less likely to have inhaled corticosteroids prescribed,[3,6,8] while a study using another demonstrated no significant differences in these medication prescriptions.[16] Surveys have shown limitations when used to measure health care services received over time.[17–21] Since many low-income children receive their asthma care in community health centers (CHCs),[22] examining a CHC population is essential to understanding asthma care for this particular demographic. Our objective was to use a multi-state (n = 21) electronic health record (EHR)–based data set that serves a network of CHCs, containing greater than 37,000 children with asthma, to study differences in basic asthma care utilization (timely diagnosis documentation and medication prescription) between Latino and Non-Hispanic white children over a thirteen-year study period. We hypothesized that Latino children would have less frequent documentation of asthma—including severity—on their problem list, and lower medication prescriptions overall compared with non-Hispanic white children with asthma.