Asthma's alarming rise is hitting minority groups especially hard. Robyn Cohen, MD, a pulmonary attending physician at Children's Hospital Boston, has found differences in health care utilization between two groups—African-Americans and Puerto Ricans—that may have implications for primary care providers.
Dr. Cohen and her colleagues analyzed data from more than 6,500 low-income
children in Hartford, Conn., more than 2,900 (45 percent) of whom were diagnosed with the disease. The Puerto Rican children had worse asthma than their African-American peers, and made almost 30 percent more clinic visits for asthma, but the African-American children spent three times more days in the hospital for asthma-related symptoms.
The findings, reported in Chest in August, beg for explanation. "Do Puerto
Rican children get more care early in their illness? Are we not making all families feel comfortable about coming to the clinic? Are we not teaching families to
recognize asthma symptoms? We don't know the answers to these questions," Dr.
Elizabeth Woods, MD, director of Children's Community Asthma Initiative, speculates that cultural factors may influence families' willingness to have their children take medications
preventively. Overall, only 18 percent of the children with persistent asthma filled prescriptions for preventive
medications, but Puerto Rican families were more likely than African-American families to do so. "We need to help people understand why it's important to take medication before they're sick," Dr. Woods says.
The patterns seen in this study may not apply to all Hispanics, Cohen adds, as substantial differences in asthma outcomes have been noted between Puerto Ricans and Mexican-Americans, for example.