The Role of Income in Reducing Racial and Ethnic Disparities in Emergency Room and Urgent Care Center Visits for Asthma—United States, 2001–2009

Abstract

Objective. To examine racial/ethnic disparities and associated factors in asthma-related emergency room (ER) and urgent care center (UCC) visits among US adults and determine whether disparities vary across increasing income strata. Methods. We analyzed data from 238,678 adult respondents from the 2001 to 2009 National Health Interview Survey and calculated the weighted annual prevalence of an ER/UCC visit for persons with current asthma. We used logistic regression to calculate adjusted odds ratios (AORs) for asthma-related ER/UCC visits by race/ethnicity and income, adjusting for demographics, socioeconomic, and other health-related factors. Results. The average annual prevalence of asthma-related ER/UCC visits among adults with current asthma was highest for Puerto Ricans (24.8%, 95% confidence interval [CI]: 20.3–29.9) followed by non-Hispanic American Indian/Alaskan Natives (22.1%, 95% CI: 14.4–32.4), non-Hispanic blacks (20.4%, 95% CI: 18.5–22.4), other Hispanics (17.3%, 95% CI: 15.0–19.9), Asians (11.0%, 95% CI: 7.8–15.4), and non-Hispanic whites (10.1%, 95% CI: 9.4–10.9). Puerto Ricans (AOR: 2.01; 95% CI: 1.54–2.62), non-Hispanic blacks (AOR: 1.72; 95% CI: 1.46–2.03), and other Hispanics (AOR: 1.55; 95% CI: 1.25–1.92) with current asthma had significantly higher odds of an asthma-related ER/UCC visit than non-Hispanic whites. Lower socioeconomic status, obesity, and serious psychological distress were also associated with higher odds of asthma-related ER/UCC visits. Puerto Ricans with the lowest income (AOR: 3.52; 95% CI: 2.27–5.47), non-Hispanic American Indian/Alaskan Natives with the highest income (AOR: 5.71; 95% CI: 1.48–22.13), and non-Hispanic blacks in every income stratum had significantly higher odds of asthma-related ER/UCC visits compared to non-Hispanic whites in the highest income stratum. Conclusions. Racial/ethnic disparities in asthma-related ER/UCC visits persist after accounting for income and other socioeconomic factors. Further research is needed to identify modifiable risk factors directly associated to race/ethnicity to decrease the asthma burden on minority populations.

Keywords:

• asthma
• minority health
• emergency medicine
• income
• socioeconomic factors
• disparities
• race
• ethnicity
• emergency room
• urgent care centers

Acknowledgments

The authors wish to acknowledge the following individuals for their service in advising and reviewing this article: Jeanne Moorman, M.S., Cathy Bailey, M.S., David Callahan, M.D., Theresa Harrington, M.D., M.P.H., and T.M., and Hatice Zahran, M.D., M.P.H, Division of Environmental Hazards and Health Effects, CDC.

Declaration of Interest

This work was supported by the Centers for Disease Control and Prevention (CDC). All authors attest that there are no conflicts of interest related to the submission of this manuscript. Mr. H.-Z. Law participated in a research fellowship at CDC sponsored by the CDC Foundation through a grant funded by Pfizer. Mr. E. Oraka is an Oak Ridge Institute for Science and Education Fellow at CDC. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.