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Racial/Ethnic Variation in Emergency Department Care for Children With Asthma

Zook, Heather G. MA*†; Payne, Nathaniel R. MD, MHSA*‡; Puumala, Susan E. PhD§∥; Ziegler, Katherine M. MPH§¶; Kharbanda, Anupam B. MD, MSc#

doi: 10.1097/PEC.0000000000001282
Original Articles

Objective To assess the variation between racial/ethnic groups in emergency department (ED) treatment of asthma for pediatric patients.

Methods This study was a cross-sectional analysis of pediatric (2–18 years) asthma visits among 6 EDs in the Upper Midwest between June 2011 and May 2012. We used mixed-effects logistic regression to assess the odds of receiving steroids, radiology tests, and returning to the ED within 30 days. We conducted a subanalysis of asthma visits where patients received at least 1 albuterol treatment in the ED.

Results The sample included 2909 asthma visits by 1755 patients who were discharged home from the ED. After adjusting for demographics, insurance type, and triage score, African American (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 1.40–2.26) and Hispanic (aOR, 1.64; 95% CI, 1.22–2.22) patients had higher odds of receiving steroids compared with whites. African Americans (aOR, 0.58; 95% CI, 0.46–0.74) also had lower odds of radiological testing compared with whites. Asians had the lowest odds of 30-day ED revisits (aOR, 0.26; 95% CI, 0.08–0.84), with no other significant differences detected between racial/ethnic groups. Subgroup analyses of asthma patients who received albuterol revealed similar results, with American Indians showing lower odds of radiological testing as well (aOR, 0.47; 95% CI, 0.22–1.01).

Conclusions In this study, children from racial/ethnic minority groups had higher odds of steroid administration and lower odds of radiological testing compared with white children. The underlying reasons for these differences are likely multifactorial, including varying levels of disease severity, health literacy, and access to care.

From the *Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota;

Department of Evaluation, Professional Data Analysts, Inc;

Department of Quality and Safety, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN;

§Population Health, Sanford Research;

Department of Pediatrics, Sanford School of Medicine at the University of South Dakota, Sioux Falls, SD;

Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO; and

#Department of Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.

Disclosure: The authors declare no conflict of interest.

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award No. U54MD008164. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Reprints: Anupam B. Kharbanda, MD, MSc, Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Ave South, Minneapolis, MN 55404 (e-mail:

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