Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010

Abstract

Background: Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality.

Objectives: Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma) to account for prevalence differences between race groups.

Methods: Estimates of asthma prevalence and outcomes (emergency department [ED] visits, hospitalizations, and deaths) were calculated from national data for 2001 to 2010 for black and white children. Trends were calculated using weighted loglinear regression, and changes in racial disparities over time were assessed using Joinpoint.

Results: Disparities in asthma prevalence between black and white children increased from 2001 to 2010; at the end of this period, black children were twice as likely as white children to have asthma. Population-based rates showed that disparities in asthma outcomes remained stable (ED visits and hospitalizations) or increased (asthma attack prevalence, deaths). In contrast, analysis with at-risk rates, which account for differences in asthma prevalence, showed that disparities in asthma outcomes remained stable (deaths), decreased (ED visits, hospitalizations), or did not exist (asthma attack prevalence).

Conclusions: Using at-risk rates to assess racial disparities in asthma outcomes accounts for prevalence differences between black and white children, and adds another perspective to the population-based examination of asthma disparities. An at-risk rate analysis shows that among children with asthma, there is no disparity for asthma attack prevalence and that progress has been made in decreasing disparities in asthma ED visit and hospitalization rates.

Keywords: Asthma; child; disparities; emergency room; epidemiology; hospitalization; mortality; prevalence; race.

Published by Elsevier Inc.

Figures

Figure 1

Current asthma prevalence and average annual percent change (APC) among children ages 0-17 years Source: National Health Interview Survey, CDC/NCHS *Average annual percentage change is significantly different than zero

Figure 2

Population-based rates and at risk rates for asthma attack prevalence, and average annual percent change (APC) among children 0-17 years Source: National Health Interview Survey *Annual percentage change is significantly different than zero † The combined APC for black and white children was 1.0%

Figure 3

Population-based rates and at risk rates for asthma emergency department visits, and average annual percent change (APC) among children 0-17 years Source: National Hospital Ambulatory Medical Care Survey † The combined APC for black and white children was 0.3%

Figure 4

Population-based rates and at risk rates for asthma hospitalizations, and average annual percent change (APC) among children 0-17 years Source: National Hospital Discharge Survey *Annual percentage change is significantly different than zero † The combined APC for black and white children was 6.8%

Figure 5

Population-based rates and at risk rates for asthma deaths, and average annual percent change (APC) among children 0-17 years Source: National Vital Statistics System *Annual percentage change is significantly different than zero † The combined APC for black and white children was −3.5%

Figure 6

Black/white rate ratios for population-based rates (PBR) and at-risk rates (ARR) of asthma outcomes among children 0-17 years, 2010 Source: National Health Interview Survey, National Hospital Ambulatory Medical Care Survey, National Hospital Discharge Survey, National Vital Statistics System Note: The dotted line at the value of 1.0 denotes no black/white disparity in outcome rate