Racial inequalities in childhood asthma

doi:10.1016/0277-9536(91)90309-Z

Social Science & Medicine

Volume 32, Issue 7, 1991, Pages 831-836

https://doi.org/10.1016/0277-9536(91)90309-Z Get rights and content

Abstract

Mortality and hospital admission rates for asthma are higher in Maoris and Pacific Islander children than in European children. These ethnic differences are not explained by ethnic differences in asthma prevalence, the characteristics of the disease or admission criteria. There are major ethnic differences in asthma drug management both in the community and at the time of discharge from hospital. In particular Polynesians were less likely to receive prophylactic therapy and this factor probably accounts for ethnic differences in mortality and admissions rates. Possible explanations for the ethnic differences in medical management are discussed.

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Cited by (39)

Quality of hospital care for Māori patients in New Zealand: retrospective cross-sectional assessment
2006, Lancet
Citation Excerpt :
Sizeable Asian and Pacific minority groups also exist; the latter largely being descendants of migrants indigenous to the immediate region of the South Pacific. Although the government has committed to a strategy of enhancing access to primary care and improvements in quality of care for Māori, little information is available on disparities by indigeneity in the quality of treatment.6–8 New Zealand's health-care system is predominantly tax funded, with family doctors managing access to specialist and hospital care.
New Zealand has a substantial indigenous minority—the Māori—that has considerably worse health status than the majority population. We aimed to assess possible disparities in quality of hospital care for Māori with data on preventable adverse events as an indicator of suboptimum treatment.
We undertook a nationally representative cross-sectional survey of admissions to general public hospitals with more than 100 beds providing acute care. A sample of 6579 patients admitted in 1998 to 13 hospitals was selected by stratified systematic list sample. We did a two-stage retrospective assessment of records by structured implicit review. Outcome measures were occurrence, effect, and preventability of adverse events.
Māori accounted for just greater than 15% of admissions and were on average younger, were more likely to be from from deprived areas, had a different case mix, and were in hospital for a shorter stay compared with patients of non-Māori/non-Pacific origin. Overall, after age standardisation, 14% of admissions for Māori were associated with an adverse event, compared with 11% for non-Māori/non-Pacific patients (p=0·01 for difference between groups). For preventable, in-hospital events, this disparity persisted after controlling for age, other sociodemographic factors, and case mix (adjusted odds ratio 1·47; p=0·05). Analysis of potential causal factors showed no markedly or consistently different pattern between the groups.
Despite a predominantly publicly funded hospital system, our findings suggest that hospital care received by Māori is marginally poorer than that received by New Zealand citizens of non-Māori/non-Pacific origin. Although no cause specific to Māori was evident, various policy and system issues can be addressed.
Attendance for general practitioner asthma care by children with moderate to severe asthma in Auckland, New Zealand
2004, Social Science and Medicine
Attendance for general practitioner (GP) care of childhood asthma varies widely in New Zealand (NZ). There is little current research to account for the variations, although groups such as Māori and Pacific peoples have traditionally faced barriers to accessing GP care. This paper aims to describe and account for attendance levels for GP asthma care among 6–9 year-olds with moderate to severe asthma in Auckland, NZ. During 2002, randomly selected schools identified all 6–9 year-olds with possible breathing problems. Completion of a questionnaire by each parent/guardian indicated which children had moderate to severe asthma, and what characteristics influenced their access to GP asthma care. A multilevel, negative binomial regression model (NBRM) was fitted to account for the number of reported GP visits for asthma, with adjustment for clustering within schools.
Twenty-six schools (89.7 percent) identified 931 children with possible breathing problems. Useable questionnaires were returned to schools by 455 children (48.9 percent). Results indicated 209 children with moderate to severe asthma, almost one in every three reportedly making 5 or more GP visits for asthma in the previous year. Māori, Pacific and Asian children were disproportionately represented among these ‘high attendees’. Low attendees (0–2 visits) were mainly NZ Europeans. The NBRM (n=155) showed that expected visits were increased by perceived need, ill–health, asthma severity and, in particular, Māori and Pacific child ethnicity. It may be that Māori and Pacific children no longer face significant barriers to accessing GP asthma care. However, more likely is that barriers apply only to accessing routine, preventative care, leading to poor asthma control, exacerbations requiring acute care, and paradoxically an increase in GP visits. That barriers may increase total numbers of visits challenges the assumption, for all health systems, that access can be defined in terms of barriers that must be overcome to obtain health care.
Asthma and Allergies
2003, Complementary and Alternative Medicine: An Evidence-Based Approach
Variations in hospitalization rates for asthma among Black and minority ethnic communities
1998, Respiratory Medicine
In response to the introduction of ethnic monitoring within the U.K. hospital inpatient data set, this study investigates the variations in secondary healthcare utilization by Black and minority ethnic communities whose cause of admission is related to asthma. The study examines all residents of the West Midlands: over 5 million people, of whom 8·5% are from Black and minority ethnic groups.
A retrospective study of 15 921 asthma-related hospital admissions, from 1 April 1995 to 31 March 1996, was carried out.
Age-standardized admission rates were higher in all Black and minority ethnic groups studied than in the White group. There were elevated rates in Black children aged 5–14 years, and particular differences were observed for Indian and Bangladeshi men and women aged 65 years or over. Emergency admissions to hospital for asthma were strongly associated with patients' socioeconomic background but this was largely observed for Black and minority ethnic groups that also generally experience high levels of deprivation.
The findings support previous studies which suggest that hospital utilization rates for asthma among people from Black and minority ethnic groups are high compared with the White group, despite little evidence in measured prevalence. This study suggests that ethnic background is more important in asthma admissions than deprivation, which raises serious concerns on the appropriateness and quality of asthma care for these patient groups within our society. Future studies need to examine pathways to care, that is the health-seeking behaviour of Black and minority ethnic groups, the type of treatment received at the primary care level and referral patterns to secondary care.
Childhood asthma in New Zealand: The impact of ongoing socioeconomic disadvantage (2010-2019)
2021, New Zealand Medical Journal
Why are those most in need of Sudden Unexplained Infant Death (SUDI) prevention information the least likely to receive it? A comment on unconscious bias and Māori health
2016, New Zealand Medical Journal

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View full text

Racial inequalities in childhood asthma

Abstract

Lancet

International trends in asthma mortality 1970–1985

Chest

International trends in hospital admission rates for asthma

Arch. Dis. Child.

Mortality from asthma: a new epidemic in New Zealand

Br. Med. J.

Trends in hospital admission rates and drug treatment of asthma in New Zealand

NZ Med. J.

Recent trends in asthma mortality, morbidity and management in New Zealand

J. Asthma

Increase in deaths from asthma

Ann. Allergy

Deaths from asthma in New Zealand

Arch. Dis. Child.

Increase in hospitalization for childhood asthma

Arch. Dis. Child.

Seasonal variation and time trends in childhood asthma in England and Wales 1975–1981

Br. Med. J.

Demographic characteristics of asthmatic admissions to hospital

NZ Med. J.

Ethnic differences in prevalence of asthma symptoms and bronchial hyperresponsiveness in New Zealand schoolchildren

Thorax

Why are Polynesian children admitted to hospital for asthma more frequently than European children?

NZ Med. J.