Racial and Ethnic Differences in Asthma Diagnosis Among Children Who Wheeze

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Purpose of the Study. To determine if racial and ethnic differences in documented pediatric asthma prevalence relate to true prevalence differences or a different probability of receiving the diagnosis. Study Population. The study population was 3- to 17-year-old children of non-Hispanic white, non-Hispanic black, Puerto Rican, and Mexican ethnicity taken from a continuous survey administered by the National Center for Health Statistics. Methods. The results for children aged 3 to 17 years in the 1999 National Health Interview Survey were analyzed for those with reported wheezing. Asthma diagnosis was evaluated for racial and ethnic differences while controlling for age, gender, parental education, single-parent household, residence, insurance, health care, and parent-reported severity of symptoms. Results. Among those reported to have wheezed in the past year (n = 946), 83% of Puerto Rican, 71% of non-Hispanic black, and 65% of Mexican children were diagnosed with asthma compared with 57% of non-Hispanic white children. Using non-Hispanic white children as the reference group, the approximate adjusted relative risk for physician diagnosis of asthma given wheezing in the past year was 1.43 (95% confidence interval [CI]: 1.04–1.63) for Puerto Rican, 1.22 (95% CI: 1.03–1.37) for non-Hispanic black, and 1.19 (95% CI: 0.94–1.39) for Mexican children. Minority children were reported to have greater severity of wheezing symptoms. Even after accounting for this increased severity, children in racial and ethnic minority groups were as or more likely to have a reported asthma diagnosis than non-Hispanic white children. Conclusions. These findings do not support the hypothesis that symptomatic minority children are underdiagnosed with asthma compared with non-Hispanic white children. To the contrary, among currently symptomatic children, minority children were more likely to be diagnosed than non-Hispanic white children even after accounting for the higher wheezing severity among minority children. Reviewer Comments. This study suggests that minority children with wheezing severity measured by National Health Interview Survey guidelines are not underdiagnosed. These results suggest that public health endeavors should be directed toward better management and control.