Racial and ethnic differences in childhood asthma treatment in the United States

Health Serv Res. 2013 Dec;48(6 Pt 1):2014-36. doi: 10.1111/1475-6773.12077. Epub 2013 Jun 26.


Objective: To examine racial-ethnic differences in asthma controller medication use among insured U.S. children.

Data sources: Linked nationally representative data from the Medical Expenditure Panel Survey (2005-2008), the 2000 Decennial Census, and the National Health Interview Survey (2004-2007).

Study design: The study quantifies the portion of racial-ethnic differences in children's controller use that are attributable to differences in need, enabling and predisposing characteristics.

Principal findings: Non-Hispanic black and Hispanic children were less likely to use controllers than non-Hispanic white children. Blinder-Oaxaca decomposition results indicated that observable characteristics explain less than 40 percent of the overall differential in controller use between non-Hispanic whites and non-Hispanic blacks. In contrast, observable characteristics explain more than two-thirds (71.3 percent) of the overall non-Hispanic white-Hispanic differential in controller use. For non-Hispanic blacks, a majority of the explained differential in controller use were attributed to enabling characteristics. For Hispanics, a significant portion of the explained differential in controller use was attributed to predisposing characteristics. In addition, a larger portion of the differential in controller use was explained by observable characteristics for publicly insured non-Hispanic black and Hispanic children.

Conclusions: The large observed differences in controller use highlight the continuing challenges of ensuring that all U.S. children have access to quality asthma care.

Keywords: Children; asthma controller medications; decomposition; insurance status; race-ethnicity.

MeSH terms

  • Adolescent
  • African Americans / statistics & numerical data*
  • Age Factors
  • Asthma / ethnology*
  • Child
  • Child, Preschool
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Status
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Infant
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Health / statistics & numerical data*
  • Male
  • Residence Characteristics / statistics & numerical data
  • Sex Factors
  • Socioeconomic Factors
  • United States / epidemiology