Chest

Chest

Volume 124, Issue 3, September 2003, Pages 803-812
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Clinical Investigations
ASTHMA
Acute Asthma Among Adults Presenting to the Emergency Department: The Role of Race/Ethnicity and Socioeconomic Status

https://doi.org/10.1378/chest.124.3.803Get rights and content

Objectives:

To investigate racial/ethnic differences in acute asthma among adults presenting to the emergency department (ED), and to determine whether observed differences are attributable to socioeconomic status (SES).

Design:

Prospective cohort studies performed during 1996 to 1998 by the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers provided 24-h coverage for a median duration of 2 weeks per year. Adults with acute asthma were interviewed in the ED and by telephone 2 weeks after hospital discharge.

Participants:

Sixty-four North American EDs.

Results:

A total of 1,847 patients were enrolled into the study. Black and Hispanic asthma patients had a history of more hospitalizations than did whites (ever-hospitalized patients: black, 66%; Hispanic, 63%; white, 54%; p < 0.001; patients hospitalized in the past year: black, 31%; Hispanic, 33%; white, 25%; p < 0.05) and more frequent ED use (median use in past year: black, three visits; Hispanic, three visits; white, one visit; p < 0.001). The mean initial peak expiratory flow rate (PEFR) was lower in blacks and Hispanics (black, 47%; Hispanic, 47%; white, 52%; p < 0.001). For most factors, ED management did not differ based on race/ethnicity. After accounting for several confounding variables, blacks and Hispanics were twice as likely to be admitted to the hospital. Blacks and Hispanics also were more likely to report continued severe symptoms 2 weeks after hospital discharge (blacks, 24%; Hispanic, 31%; white, 19%; p < 0.01). After adjusting for sociodemographic factors, the race/ethnicity differences in initial PEFR and posthospital discharge symptoms were markedly reduced.

Conclusion:

Despite significant racial/ethnic differences in chronic asthma severity, initial PEFR at ED presentation, and posthospital discharge outcome, ED management during the index visit was fairly similar for all racial groups. SES appears to account for most of the observed acute asthma differences, although hospital admission rates were higher among black and Hispanic patients after adjustment for confounding factors. Despite asthma treatment advances, race/ethnicity-based deficiencies persist. Health-care providers and policymakers might specifically target the ED as a place to initiate interventions designed to reduce race-based disparities in health.

Section snippets

Materials and Methods

We analyzed data from three prospective cohort studies performed from 1996 to 1998 as part of the MARC (http://healthcare.partners.org/marc). The purpose of the MARC was to try to define the characteristics of patients presenting to the ED for acute asthma, to describe their management and outcome, and to follow their course after hospital discharge. Using a standardized protocol, researchers at 64 EDs in 21 US states and 4 Canadian provinces provided 24-h coverage for a median duration of 2

Results

Among the eligible patients, 588 refused study entry, were missed, or were not enrolled for another reason, and 1,847 were enrolled into the study. Three patients were excluded because race/ethnicity data were missing. Patients identified as Asian or “other” race/ethnicity (44 patients) were excluded, since the purpose of the study was to investigate blacks and Hispanics. Patients who were enrolled did not differ from those who were not enrolled according to demographic factors, available

Discussion

It is widely recognized that black and Hispanic asthma patients receive substandard outpatient care, visit the ED more frequently, and are hospitalized at greater rates than are whites.8,9,10,11,12,13,14,15,16,17,18,48 However, little is known about whether racial/ethnic differences exist during the course and treatment of exacerbations while in the ED or whether racial/ethnic differences exist in relapse and outcome after discharge from the ED. Because we prospectively enrolled patients during

Emergency Medicine Network Steering Committee

Edwin D. Boudreaux, PhD; Barry E. Brenner, MD, PhD; Carlos A. Camargo, Jr, MD (Chair); Rita K. Cydulka, MD; Theodore J. Gaeta, DO, MPH; and Michael S. Radeos, MD, MPH.

Emergency Medicine Network Coordinating Center

Keith Brinkley, MA; Carlos A. Camargo, Jr, MD (Director); Sunday Clark, MPH; Jennifer A. Emond, MS; Jessica L. Hohrmann, MPH; Sunghye Kim, MD (all at Massachusetts General Hospital, Boston, MA).

Principal Investigators at the 64 Participating Sites

F.C. Baker, III (Maine Medical Center, Portland, ME); J.M. Basior (Buffalo General Hospital, Buffalo, NY); C.A. Bethel (Mercy Hospital,

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail:[email protected]).

    Dr. Camargo is supported by grant HL-63841 from the National Institutes of Health (Bethesda, MD). The Multicenter Airway Research Collaboration was supported by grant HL-63253 from the National Institutes of Health, and by unrestricted grants from GlaxoSmithKline Inc (Research Triangle Park, NC) and Monaghan Medical Corporation (Syracuse, NY).

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    Copyright © 2003 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.