-Delays in care can lead to more severe disease
African-American children with asthma get much-needed specialty exams, care and treatment at more advanced stages of the disease than their Caucasian counterparts, according to research led by investigators at Johns Hopkins Children’s Center.
The findings, presented May 16 at the annual American Thoracic Society meeting, highlight lingering disparities in access to specialized care that research has shown can lead to sub-optimal treatment and worse outcomes.
The study, which involved 117 African-American and 156 Caucasian children referred to Hopkins Children’s to see an asthma specialist, underscores the need to find out just why African- American patients with asthma get to the specialist later than Caucasian children. In addition to regular primary care, children with asthma need regular check-ups with a pediatric pulmonary specialist who oversees their treatment and monitors their disease.
“Seeing a specialist in time could mean the difference between mild and severe disease, and delays in care can lead to serious complications and long-term illness,” says lead investigator Sande Okelo, M.D., a pediatric pulmonary specialist at Hopkins Children’s.
“The most critical questions now are ‘Why is this happening? and ‘What can we do about it?’”Okelo says. “We need to identify and eliminate any barriers that prevent African-American children from receiving timely care by a specialist.”
By the time they got to see a specialist, African-American children in the study had experienced more negative effects from asthma overall, marked by worse pulmonary function. Indeed, the Caucasian children in the study had 97 percent of their expected age-appropriate lung function, compared with African-American children, who had 79 percent of their expected lung function. Such differences could contribute to the other negative effects observed in the study.
In the few months leading up to their visit, more African-American children ended up in the emergency department (31 percent) than their Caucasian counterparts (16 percent) and were hospitalized (64 percent vs. 41 percent), and were more likely to have spent time in intensive care (16 percent vs. 6 percent) than Caucasian children. Over their lifetime, African-American children also had more hospitalizations (average of 2.2 vs. 1.0) and visits to the intensive care unit for severe asthma attacks (average of 1.8 vs. 1.1).
Asthma is the most common pediatric chronic illness, affecting 6.5 million children in the United States, according to the Centers for Disease Control and Prevention
Other researchers involved in the study included Michelle Eakin, Andrew Bilderback, Kristin Riekert and Cynthia Rand, all of Hopkins.
The research was funded by the National Heart Lung and Blood Institute of the National Institutes of Health.