A comparison of asthma-related healthcare use between African-Americans and Caucasians belonging to a Health Maintenance Organization (HMO)

The objective of this study was to determine whether racial differences in patterns of asthma care persist in a healthcare environment when financial barriers to health care are minimized. The study cohort consisted of Africa n-American (AA) and Caucasian (C) patients, 18-50 years old, enrolled in a large HMO and hospitalized for asthma in 1993-1995. Baseline and 1-year fol low-up data were collected from the HMO computerized database. Of the 193 p atients in the cohort, 124 (65.3%) were AA and 67 (34.7%) were C. AAs were younger (mean = 36.2, SD = 9.9) than Cs (mean = 39.4, SD = 9.1), had a towe r median household income, and made more asthma-related emergency departmen t (ED) visits (45.2%) than Cs (22.4%) during the 1 year after the initial h ospitalization (alt p values < 0.001). During the same time period, Cs made more asthma-related primary care (70.2%) and allergy/pulmonary visits (38. 8%) than AAs (47.6% and 27%, respectively). Although there were no signific ant racial differences in the rehospitalization rate, AA Medicaid contract patients (32%) had more rehospitalizations for asthma than AA regular contr act patients (15.8%). These differential patterns in the use of asthma-rela ted healthcare in this study indicate that the provision of health insuranc e alone is not sufficient to promote optimal levels of asthma management by all beneficiaries. Asthma education programs targeted for low-income AA pa tients may improve inappropriate healthcare use patterns.