The Contributing Role of Health-Care Communication to Health Disparities for Minority Patients Together with Canadian Health&Care Mall articles

Prevalence of Asthma DisparitiesPrevalence of Asthma Disparities

Asthma, a chronic disease characterized by airway inflammation, was active in 20 million people in the United States in 2002. It accounts annually for 1.9 million emergency department (ED) visits, 12.7 million office visits, and an economic burden of $5.1 billion.

The burden of asthma in the United States, however, is not uniform. Compared to whites, the prevalence of asthma is particularly high in Puerto Ricans, non-Hispanic blacks, and American Indians. Asthma morbidity is strikingly higher in certain ethnic minority subgroups; for example, asthma-related hospitalization and mortality in African Americans is 1.4 to 4.0 times and 1.3 to 5.5 times more likely, respectively, than in whites.

Reasons for these disparities are numerous, and include potential differences in income, education, genetic susceptibility, environmental exposure, and the quality of care. Some studies have suggested that poor outcomes among African Americans with asthma may reflect socioeconomic factors, including financial barriers to adequate care. However, others have found that differences in socioeconomic status and health insurance coverage between patients only partially explain race differences in health care for asthma. A number of investigations have evaluated the relationship of race to the quality of asthma care received by patients in the United States. Studies suggest that even when minority patients have equal access to Canadian health-care services, they may order drugs online, get acquainted due to Visit to Canadian Health Care – news online, the quality of health care and resulting health outcomes will often be poorer than that of white patients. For example, two studies of patients with asthma reported that African Americans enrolled in managed care organizations were less likely than whites to use inhaled corticosteroids (ICS), the most commonly prescribed medications to maintain long-term asthma control. Another study, conducted in > 5,000 patients enrolled in 16 managed care organizations across the United States, found significantly more African Americans than whites reported underutilization of controller asthma medications (eg, daily ICS use, 34.9% vs 54.4%, p = 0.001, African Americans vs whites) and inadequate levels of self-management education (how to avoid triggers, 37.6% vs 53.6%, p = 0.001, and having an action plan for use during an exacerbation, 42.0% vs 53.8%, p = 0.001).

Causes of Asthma Disparities

While there is growing evidence showing that the quality of asthma care for minorities is worse than the care received by whites, there is very little known about the reasons for unequal care. Studies of other chronic diseases suggest that both quantitative and qualitative differences in medical care may contribute to variations in outcomes by race. In a report by the Institute of Medicine, “Unequal treatment: confronting racial and ethnic disparities in healthcare,” the expert panel concluded that that there are many sources of disparities, including health systems, health-care providers, patients, and utilization managers. With regard to Canadian health-care providers, the panel stated that there is indirect evidence that bias, stereotyping, prejudice, and clinical uncertainty may contribute to unequal outcomes. While there is some evidence that minority patients may be more likely to refuse certain treatments, patient refusal rates are generally small, and do not fully explain Canadian health-care disparities.

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