Racial Disparities in Hospitalizations, ED Visits Among Medicaid-Enrolled Children With Asthma

Striking racial disparities in hospitalizations and emergency department (ED) visits were identified among Black children with asthma compared with White children enrolled in Medicaid, a study found.

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This comprehensive Medicaid claims-based population study is published in the American Academy of Pediatrics.¹

“Hospitalizations or visits to the ED for asthma are often avoidable with access to high-quality outpatient care,” said lead study author Laura Barrie Smith, PhD, senior research associate, Urban Institute, in a written statement to The American Journal of Managed Care^® (AJMC^®). “Yet this analysis shows that Black Medicaid-enrolled children with asthma were experiencing significantly worse outcomes relative to white Medicaid-enrolled children with asthma as recently as 2019.”

Black children are disproportionately affected by asthma, so the elimination of racial barriers could reduce the number of hospitalizations and ED visits among this patient population. Moreover, nearly half of children with asthma are enrolled in Medicaid, in which proper access to care and management should be provided.

Health disparities in asthma include biological, behavioral, sociocultural, built environment, and health system factors.²

In this study, the researchers aimed to provide new evidence on the racial disparities in asthma hospitalizations and ED visits that negatively affect Medicaid-enrolled children.¹

The researchers used Medicaid claims data from the Transformed Medicaid Statistical Information System, which included a study population of 279,985 children diagnosed with asthma who were continuously enrolled in full-benefit Medicaid from January 1, 2018, to December 31, 2019. Additionally, the study population included children aged 2 to 18 years in the following 10 states: Delaware, Indiana, Michigan, Mississippi, North Carolina, Nevada, New Mexico, Pennsylvania, Texas, and Washington.

The researcher identified asthma hospitalizations and ED visits, as well as estimated the differences for non-Hispanic Black patients and non-Hispanic White patients, adjusting for sex, Medicaid eligibility group, Medicaid plan type, state, and rurality. The key outcome variables included enrollee-level indicators of having 1 or more asthma hospitalization(s) and having 1 or more asthma ED visit(s) during 2019.

The study revealed that in 2019, 1.2% of Black children with asthma had at least 1 hospitalization and 8% had an ED visit compared with 0.5% and 3.4% of White children, respectively. After adjusting for other factors, Black children had twice the rates of White children for hospitalizations (adjusted OR, 2.45; 95% CI, 2.23-2.69) and ED visits (adjusted OR, 2.42; 95% CI, 2.33-2.51).

However, the researchers acknowledged some limitations to the study. Because the researchers only compared Black-White racial disparities, they were unable to assess other racial and ethnic health disparities that are equally important in our understanding of how to eliminate barriers to asthma care. Additionally, the researchers found substantial racial disparities whether the sensitivity analysis was conditioned on a previous diagnosis or not. Furthermore, the analysis was limited to 10 states, so the patterns identified may not be applicable to other geographic regions.

Despite these limitations, the researchers believe the study provides evidence of racial inequities in asthma hospitalizations and ED visits that restrict access to care and proper management within a Medicaid population.

“This new evidence on racial disparities in hospitalizations and ED visits among children with asthma can inform policies and practices to effectively address racial inequities in asthma care within Medicaid programs,” Smith told AJMC. “It will be important to implement solutions that address poor quality care, discriminatory treatment in health care settings, and the structural factors that disproportionately expose Black children to asthma triggers and barriers to accessing care.”

References

1. Smith LB, O’Brien C, Kenney GM, Waidmann TA. Black–white disparities in asthma hospitalizations and ED visits among Medicaid-enrolled children. Hosp Pediatr. Published online May 16, 2024. doi:10.1542/hpeds.2023-007477

2. Perez MF, Coutinho MT. An overview of health disparities in asthma. Yale J Biol Med. 2021;94(3):497-507.