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Findings From a Study in the Military Health System

Kate A. Stewart, PhD; Patricia C. Higgins, PhD; Catherine G. McLaughlin, PhD; Thomas V. Williams, PhD; Elder Granger, MD; Thomas W. Croghan, MD

Arch Pediatr Adolesc Med. 2010;164(8):720-726. Published online June 7, 2010. doi:10.1001/archpediatrics.2010.100

Objective  To assess racial and ethnic differences in asthma prevalence, treatment patterns, and outcomes among a diverse population of children with equal access to health care.

Design  Retrospective cohort analysis.

Setting  The Military Health System.

Participants  A total of 822 900 children aged 2 through 17 years continuously enrolled throughout 2007 in TRICARE Prime, a health maintenance organization–type benefit provided by the Department of Defense.

Main Outcome Measures  Prevalence of diagnosed asthma, potentially avoidable asthma hospitalizations, asthma-related emergency department visits, visits to asthma specialists, and use of asthma medications among children aged 2 to 4, 5 to 10, and 11 to 17 years.

Results  Black and Hispanic children in all age groups were significantly more likely to have an asthma diagnosis than white children (ranging from odds ratio [OR] = 1.16; 95% confidence interval [CI], 1.09-1.24; to OR = 2.00; 95% CI, 1.93-2.07). Black children in all age groups and Hispanic children aged 5 to 10 years were significantly more likely to have any potentially avoidable asthma hospitalizations and asthma-related emergency department visits (ranging from OR = 1.24; 95% CI, 1.11-1.37; to OR = 1.99; 95% CI, 1.37-2.88) and were significantly less likely to visit a specialist (ranging from OR = 0.71; 95% CI, 0.61-0.82; to OR = 0.88; 95% CI, 0.79-0.98) compared with white children. Black children in all age categories were significantly more likely to have filled any prescriptions for inhaled corticosteroids compared with white children (ranging from OR = 1.11; 95% CI, 1.02-1.21; to OR = 1.11; 95% CI, 1.04-1.19).

Conclusions  Despite universal health insurance coverage, we found evidence of racial and ethnic differences in asthma prevalence, treatment, and outcomes.

Author Affiliations: Mathematica Policy Research, Inc (Drs Stewart, Higgins, and Croghan) and Departments of Medicine and Psychiatry, Georgetown University School of Medicine (Dr Croghan), Washington, DC; Mathematica Policy Research, Inc, Ann Arbor, Michigan (Dr McLaughlin); and Center for Health Care Management Studies, TRICARE Management Activity, Falls Church, Virginia (Drs Williams and Granger). Dr Stewart is now at Mathematica Policy Research, Inc, Chicago, Illinois. Dr Granger has now retired.

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