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(Chest. 2006;130:463-471.)
© 2006 American College of Chest Physicians

Health-Care Use Among Puerto Rican and African-American Children With Asthma*

Robyn T. Cohen, MD, MPH; Juan C. Celedón, MD, DrPH, FCCP; Vanessa J. Hinckson, MPH; Clare D. Ramsey, MD, MS; Dorothy B. Wakefield, MA; Scott T. Weiss, MD, MS and Michelle M. Cloutier, MD

* From the Channing Laboratory (Drs. Cohen, Celedón, Ramsey, and Weiss), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Albert Einstein College of Medicine (Ms. Hinckson), Bronx, NY; and the Department of Pediatrics (Ms. Wakefield and Dr. Cloutier), University of Connecticut Health Center, Farmington, CT.

Correspondence to: Robyn T. Cohen, MD, Channing Laboratory, 181 Longwood Ave, Boston, MA 02115; e-mail: robyn.cohen{at}channing.harvard.edu

Abstract

Study objectives: To compare the rates of emergency department (ED) visits, hospitalizations, hospital days, and outpatient clinic visits for asthma among children in two ethnic minority groups that are disproportionately affected by asthma (Puerto Ricans and African Americans).

Study design: This cross-sectional study was part of an asthma intervention program in Hartford, CT, in which 6,554 children were screened for asthma by primary care providers using a parental survey. Medicaid and the supplementary State Children’s Health Insurance Plan data about health-care utilization for asthma were obtained for each child for the 12 months preceding completion of the screening survey.

Results: Among 2,304 children in whom asthma had been diagnosed, Puerto Ricans had more severe asthma than African Americans. In analyses adjusted for asthma severity and other potential confounders, Puerto Rican children had more clinic visits for asthma (rate ratio [RR], 1.31; 95% confidence interval [CI], 1.12 to 1.53) but spent fewer days in the hospital for asthma (RR, 0.36; 95% CI, 0.24 to 0.53) than African-American children. There were no differences in the rates of ED visits or hospitalizations between the two groups.

Conclusions: Puerto Rican children had more severe asthma but were less likely than African-American children to have prolonged hospitalizations for asthma. This finding may be due to the frequent clinic visits for asthma made by Puerto Rican children. Further research is needed to understand the cultural factors that contribute to different approaches to health-care utilization among ethnic minorities.

Key Words: African Americans • asthma • ethnicity • health-care utilization • Puerto Ricans






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