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

Disclosures

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

In This Article

Results

Descriptive statistics for the study population and by ethnicity/language groups are included in Table 1. Of note, Latino patients (Spanish and English speaking) had a higher prevalence of Medicaid insurance, a higher proportion of individuals under 138% of the federal poverty level, and a higher proportion of obese individuals than non-Hispanic white children. Spanish-speaking children had a slightly higher proportion of Medicaid insurance, and non-Hispanic white children had a higher proportion of private insurance. Additional descriptive statistics, by cohort, of the subpopulation of patients with a visit after October 1, 2015 (our denominator for those who could have ICD-10 documentation of asthma severity) is included in Appendix Table 1. Appendix Table 2 compares the characteristics of patients with a visit after October 1, 2015, to those without a visit after that date.

Figure 1 demonstrates our findings related to the documentation of asthma as a chronic condition. Latino patients (Spanish 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 for Spanish preferring; OR = 0.93; 95% CI, 0.87 to 0.99 for English preferring). If it was not diagnosed on the first day, however, Spanish-preferring Latino patients had their asthma diagnosis recorded sooner than non-Hispanic white children (HR = 1.13; 95% CI, 1.03 to 1.24). English-speaking Latino patients showed similar time to problem list documentation as non-Hispanic white children (HR = 1.05; 95% CI, 0.98 to 1.14). There was no difference between ethnicity/language groups in EHR problem list documentation of asthma severity (OR = 0.95; 95% CI, 0.87 to 1.05 for Spanish-preferring Latinos; OR = 0.99; 95% CI, 0.92 to 1.06 for English-preferring Latinos).

Figure 1.

Measures of problem list documentation outcomes among children (ages 3 to 17 years) with asthma comparing Latino English-preferring and Latino Spanish-preferring to non-Hispanic whites across 21 US states, 2005 to 2017.

Unadjusted prescription rates of the 3 ethnicity/language groups are shown in Table 2. Generally, children in our study population had similar unadjusted annual rates of common asthma medications.

Figure 2 demonstrates the adjusted relative odds of ever having received a prescription of albuterol or inhaled or oral steroids. Spanish-preferring Latino patients had significantly higher odds of ever receiving a prescription for albuterol than non-Hispanic white children (OR = 1.96; 95% CI, 1.52 to 2.52). Similarly, Spanish-preferring Latino patients had higher odds of ever having received a prescription for corticosteroids (OR = 1.45; 95% CI, 1.01 to 2.09) and oral steroids (OR = 1.48; 95% CI, 1.07 to 2.04) compared with non-Hispanic white children. This association for corticosteroids and oral steroids was also observed among children with mild-persistent asthma when stratified by asthma severity. We observed no differences in the odds of receiving any corticosteroids or oral steroids prescription between Spanish-preferring Latinos and non-Hispanic white children with moderate to severe persistent asthma. Comparing English-preferring Latino patients to non-Hispanic white patients, we saw similar odds of prescriptions of albuterol, or inhaled or oral steroids, overall and by level of severity.

Figure 2.

Estimates of relative odds of ever receiving specific prescription medications comparing Latino English-preferring and Latino Spanish-preferring to non-Hispanic white children across 21 US states, 2005 to 2017. For corticosteroid inhalers and oral steroids outcomes, we report odds ratios overall (among all patients with persistent asthma) and stratified by maximum level of persistent asthma denoted by parentheses.

Figure 3 displays, among children with a prescription during the study period, the adjusted rate ratios (aRRs) of common asthma prescriptions by our defined ethnicity/language groups. Of note, Spanish-preferring Latino children had higher rates of albuterol prescriptions compared with non-Hispanic whites (RR = 1.07; 95% CI, 1.01 to 1.13). Overall, Spanish-preferring Latinos and non-Hispanic white children had similar prescription rates of inhaled corticosteroid and oral steroid. However, among the sample of patients with mild persistent asthma severity, we observed that Spanish-preferring patients receive higher rates of inhaled corticosteroid (RR = 1.18; 95% CI, 1.04 to 1.34), but lower rates of oral steroids (RR = 0.73; 95% CI, 0.55 to 0.98) compared with non-Hispanic white children with asthma. There were no other differences in common asthma prescription rate between English-preferring Latinos and non-Hispanic whites.

Figure 3.

Among patients who were prescribed a medication, estimates of relative rates of specific prescription medications comparing Latino English-preferring and Latino Spanish-preferring to non-Hispanic whites across 21 US states, 2005 to 2017. For corticosteroid inhalers and oral steroids outcomes, we report odds ratios overall (among patients with persistent-asthma) and stratified by maximum level of persistent asthma denoted by parentheses.

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