IMPACT OF RACE ON LONG-TERM ASTHMA CONTROL IN CHILDREN

Abstract

SESSION TITLE: Pediatric Asthma SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 01:30 PM - 02:30 PM PURPOSE: Asthma control in minorities such as African American and Hispanic children is considered more difficult. The aim of this study was to document racial disparities (if any) in asthma control among children whose asthma is managed per NAEPP (EPR-3) guidelines. METHODS: This was a three-year prospective cohort study. After IRB approval, children referred by primary care physicians with the diagnosis of uncontrolled asthma were enrolled in our pediatric asthma center since 2011, and were provided asthma care as per NAEPP guidelines. At each visit (3-6 months), families completed asthma questionnaires including acute care need, symptom control, and Asthma Control Test (ACT). Results were compared between ethnic groups (Caucasians and African Americans/Hispanics) over time. The distribution of scores was measured by mean, standard deviation, median, and interquartile range depending upon the normality of the data. Poisson Mixed Effects Model was used to evaluate change in asthma indicators over 6 month increments. Alpha level of significance was ≤ 0.05. RESULTS: The sample included 395 children, ages 2-17 years [median 6 (3, 9)], and were 61% male. Caucasians 262 (69%), African American 91(24%) and Hispanic children 27 (7%) were including in this study. Acute care need (hospital admissions, emergency department visits, urgent care visits, school days missed and number of days/month requiring albuterol and days/month with wheezing improved significantly (p<0.0001 for all) when data from baseline (initial visit) were compared to data at 6 month follow up respectively and improvement persisted for three year follow-up period ACT scores improved significantly between the baseline (first visit) and 3 month follow-up visit (16.9 ±5.7 and 20 ±5.2 respectively, p<0.05) and improvement persisted throughout three-year follow up. Data was compared using race (Caucasians vs. African Americans/Hispanics) as covariate. Compared to Caucasians, minority children had slightly more acute care need, number of days/month with wheezing and low ACT at baseline, but differences were not statistically significant. Both groups improved significantly from baseline and improvements persisted throughout three year follow up. Race was not a significant covariate (p=0.90) in overall asthma improvement over time. There was significantly better rate of improvement in minority children compared to Caucasians over time in hospital admissions (p=0.01), missed school days (p=0.009), and number of days/month with wheezing (p=0.02). CONCLUSIONS: Better asthma control can be achieved in children by managing their asthma as per NAEPP (EPR-3) guidelines. Once asthma guidelines are followed, race was not a significant factor in overall asthma improvement over time. CLINICAL IMPLICATIONS: Following guidelines improves asthma care and once guidelines are followed, race is not a significant factor in asthma control. DISCLOSURES: No relevant relationships by Anne May, source=Web Response no disclosure on file for Karen McCoy; No relevant relationships by Christopher Nemastil, source=Web Response No relevant relationships by Judy Pitts, source=Web Response No relevant relationships by Ann Salvator, source=Web Response No relevant relationships by Shahid Sheikh, source=Web Response No relevant relationships by Lisa Ulrich, source=Web Response