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ICD Code: 493. Asthma



ICD Code: 493. Article Review
Title: Stewart KA et al; "Differences in Prevalence, Treatment, and Outcomes of Asthma Among a Diverse Population of Children with Equal Access to Care." Archives of Pediatrics and Adolescent Medicine; V.164; 8/10; p720     DOI:10.1001/archpediatrics.2010.100
      STUDY DESIGN: The authors' primary research question was whether similar access to medical care through the Military Health System (MHS) among a diverse U.S. population minimized racial and ethnic differences in prevalence of diagnosed asthma, treatment, and outcomes observed in previous studies. They conducted a retrospective cohort analysis of children continuously enrolled throughout 2007 in TRICARE Prime, a voluntary health maintenance organization-type benefit option in which military treatment facilities are intended to be the principal source of care. More than 75% of children in the MHS are enrolled in Prime and about 60% are dependents of active duty personnel. The final analysis cohort includes 822,900 children aged 2 through 17 years. For analyses of asthma care and asthma-related outcomes, the authors identified the subsample of 59,266 children with at least 1 inpatient or 2 outpatient claims with a diagnosis for asthma.
      DIFFERENCES BY RACE/ETHNICITY IN MILITARY CHILDREN: The prevalence of asthma was reported as follows in Hispanics, non-Hispanic blacks, and non-Hispanic whites, respectively: all ages, 8.0%, 9.6%, 6.3%; ages 2-4 years, 8.5%, 11.2%, 7.0%; ages 5-10 years, 9.2%, 11.4%, 7.0%; ages 11-17 years, 6.2%, 7.3%, 5.4%. The prevalence of asthma varied significantly by race and ethnicity, with black children more likely to be diagnosed with asthma than either Hispanic or white children (9.6% vs 8.0% and 6.3%, respectively. After adjusting for differences in demographic characteristics, military-related characteristics, and comorbidity, black and Hispanic children in all age groups were significantly more likely to have an asthma diagnosis than white children. Black children in all age groups and Hispanic children aged 5 to 10 years were significantly more likely to have any asthma-related potentially avoidable hospitalizations and emergency department visits and significantly less likely to visit a specialist 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. Black children aged 5 to 10 years were also significantly more likely than white children to fill any asthma-related prescription, while Hispanic children aged 11 to 17 years were significantly less likely to have a prescription filled.
      DISCUSSION: Despite universal health insurance coverage and access to military treatment facilities, the authors found evidence of racial and ethnic differences in asthma prevalence and outcomes after adjusting for differences in demographic characteristics and socioeconomic status. Compared with white children in the MHS, the prevalence of asthma among black and Hispanic children was significantly higher and their outcomes were often worse. The findings suggest that eliminating racial and ethnic disparities in health care likely requires a multifaceted approach beyond universal health insurance coverage.

Search Criteria: Text - Archives of Pediatrics and Adolescent Medicine; V.164; 8/10; p720