Racial and ethnic disparities in asthma medication usage and health-care utilization: data from the National Asthma Survey

Chest. 2009 Oct;136(4):1063-1071. doi: 10.1378/chest.09-0013. Epub 2009 Jun 30.


Background: Despite the availability of effective treatment, minority children continue to experience disproportionate morbidity from asthma. Our objective was to identify and characterize racial and ethnic disparities in health-care utilization and medication usage among US children with asthma in a large multistate asthma survey.

Methods: We analyzed questions from the 2003-2004 four-state sample of the National Asthma Survey to assess symptom control, medication use, and health-care utilization among white, black, and Hispanic children < 18 years old with current asthma who were residing in Alabama, California, Illinois, or Texas.

Results: Of the 1,485 children surveyed, 55% were white, 25% were Hispanic, and 20% were black. Twice as many black children had asthma-related ED visits (39% vs 18%, respectively; p < 0.001) and hospitalizations (12% vs 5%, respectively; p = 0.02) compared with white children. Significantly fewer black and Hispanic children reported using inhaled corticosteroids (ICSs) in the past 3 months (21% and 22%, respectively) compared to white children (33%; p = 0.001). Additionally, 26% of black children and 19% of Hispanic children reported receiving a daily dose of a short-acting beta-agonist compared with 12% of white children (p = 0.001). ED visits were positively correlated with short-acting beta-agonist use and were negatively correlated with ICS use when stratified by race/ethnicity.

Conclusions: Children with asthma in this large, multistate survey showed a dramatic underuse of ICSs. Black and Hispanic children compared with white children had more indicators of poorly controlled asthma, including increased emergency health-care utilization, more daily rescue medication use, and lower use of ICSs, regardless of symptom control.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic beta-Agonists / therapeutic use
  • African Continental Ancestry Group
  • Alabama
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / therapy*
  • California
  • Child
  • Continental Population Groups
  • Emergency Service, Hospital / statistics & numerical data
  • Ethnic Groups
  • European Continental Ancestry Group
  • Health Services / statistics & numerical data*
  • Health Surveys
  • Hispanic Americans
  • Hospitalization / statistics & numerical data
  • Humans
  • Illinois
  • Interviews as Topic


  • Adrenal Cortex Hormones
  • Adrenergic beta-Agonists
  • Anti-Asthmatic Agents