This article has been expanded with additional reporting.
A new Oregon Health & Science University study has found that non-Hispanic Black children are more likely to receive asthma care in emergency departments, a finding that underscores longstanding health disparities.
The first-of-its-kind study is based upon health data of more than 41,000 children in 18 states from 2012 to 2018. Of those, 6,555 were enrolled in the Oregon Health Plan. That same study found Spanish-speaking Latino/a/x children are more likely to receive preventative asthma care at community health clinics.
The findings come as Oregon is in the midst of overhauling its health care system, including the Medicaid-funded Oregon Health Plan that serves 1.4 million people, while proposing changes intended to address disparities in health care.
The study’s findings include the following:
- Non-Hispanic Black children were more likely than white children to receive asthma care at emergency departments. However, the researchers aren’t sure if this is due to a heightened need for emergency-level care, or the lack of access to primary care.
- Meanwhile, Spanish-speaking Latino/a/x children are more likely than white children to receive acute asthma care in community health centers. The local, federally supported clinics provide care regardless of a patient’s ability to pay.
- The impact of poverty could well be driving the results for Black children. Among Black children enrolled in the Oregon Health Plan, 73% always lived below 138% of the federal poverty level, also the cutoff point for enrollment in the health program for low-income Oregonians. Other groups ranged from 54% to 58%.
The predicted annual rate of non-Hispanic White children visiting the emergency departments with asthma-related was 5.9%. Meanwhile, the rate for non-Hispanic Black children was 8.8%.
The study noted that incomes can make it harder to get care for chronic disease, and “Stressors of financial instability, together with lower primary care use, could lead to escalations of asthma symptoms that require hospital-based care.”
Jorge Kaufmann, the study’s first author and an OHSU biostatistician, noted that asthma standards of care require at least two visits a year for prevention and care management. “With not having those necessary, preventive care visits, they're likely not getting a lot of the preventive care such as inhalers,” Kaufmann said.
Kaufmann said asthma is incurable but manageable with the right preventative care. That’s significant because the study measures asthma exacerbation, such as attacks and flare ups. Other preventative and primary care is closely linked.
“Here we have a group of children that's more likely to use the emergency department for these flare ups, and they're also the least likely to be getting vaccines for the flu or pneumonia, and also not as likely to get the preventive inhalers … That can prevent flare ups from getting to that scary point where someone needs to seek emergency care,” Kaufmann said.
For the researchers, the project showed that Black children were less likely to get asthma care at community health centers compared to Latino/a/x children. Researchers didn’t expect that trendline to emerge.
“We still do need to understand why these utilization differences are happening, specifically for these health centers that are making it more affordable,” Kauffmann said. “What are the social factors that are affecting this care utilization?”
Earlier this year, the Legislature approved a pilot program that puts mobile health units in two separate communities. House Bill 4052 will send teams of health care workers into areas where access to basic primary health care services is lacking and hold events with services such as checkups and preventative screenings.
Efforts like that could help, Kauffmann said.
“Certainly, if it has to do with actually getting to the clinic, in terms of transportation or a family member or taking time off or something like that, then mobile clinics could probably have a good impact,” he said.
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.