Chest
Volume 136, Issue 2, August 2009, Pages 405-411
Journal home page for Chest

Original Research
COPD
Burden of COPD, Asthma, and Concomitant COPD and Asthma Among Adults: Racial Disparities in a Medicaid Population

https://doi.org/10.1378/chest.08-2304Get rights and content

Background

Asthma and COPD are characterized by substantial racial disparities in morbidity and mortality. We hypothesized that because African-American patients with these conditions experience greater mortality and morbidity than their white counterparts, they would use more health-care resources when no difference in health insurance exists.

Methods

A retrospective, population-based cohort study was conducted using Maryland Medicaid Managed Care patient encounter data. We compared health services utilization and cost outcomes in both African-American and white patients with COPD, asthma, or coexisting COPD and asthma.

Results

The study population consisted of 9,131 patients with COPD, asthma, or both conditions. Of the total population, 52% were African American (n = 4,723), and 44% were white (n = 4,021); all other races were combined into the “unknown race” category to account for the remaining 4% (n = 387). After controlling for age, gender, cohort allocation, and comorbidities, we found that African-American adults with COPD, asthma, or coexisting COPD and asthma actually used fewer medical services and accounted for lower medical costs than white adults.

Conclusions

Lower health services utilization and medical costs among African-American patients with COPD and asthma may provide a possible explanation for the racial disparities in outcomes of patients with these conditions.

Section snippets

Design

This study used a retrospective patient encounters database, and the study period was 36 months, from January 1, 2001, to December 31, 2003. The study population was selected from the larger (> 400,000) pool of all Maryland Medicaid Managed Care beneficiaries. The race variable was drawn directly from encounter files in Medicaid data. African-American patients accounted for about half of the study population, with female beneficiaries constituting > 60%, and beneficiaries ≥ 17 years of age

Results

Table 1 shows the demographic characteristics of the three study cohorts. The total study population consisted of 9,131 patients with COPD, asthma, or both conditions. Of the total population, 52% were African American (n = 4,723), and 44% were white (n = 4,021); all other races were combined into an “unknown race” category to account for the remaining 4% of the population (n = 387).

The three cohorts were balanced with regard to the number of patients with a study condition, as follows: asthma,

Discussion

COPD and asthma present a number of medical, public health, and economic concerns for patients, physicians, and insurers as well as for the community, which often shares the impact of the disease. This study compared health services utilization and cost outcomes in Maryland Medicaid Managed Care adult beneficiaries with COPD, asthma, or coexisting COPD and asthma. We found significant differences by race in health services utilization. Contrary to our expectations across all three study

Acknowledgments

Author contributions: All authors participated in the study conception, design, analysis, interpretation of results, and revision of the manuscript, and approved the final version of the manuscript.

Financial/nonfinancial disclosures: The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The views expressed in this article are those of the authors and do

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Funding/Support: This research was supported by National Heart, Lung, and Blood Institute Grant HL07441 (S.L.S.).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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