Black children at significantly higher risk of asthma death regardless of setting
ATLANTA — Black children were six times more likely to die from asthma than either white or Hispanic children, regardless of whether death occurred in the hospital, the emergency department or clinics, or at home, according to data presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology.
“It has been known for some time that black minority children are hospitalized more and die more from asthma compared to white children,” Anna Chen Arroyo, MD, MPH, from Brigham and Women’s Hospital, said during a press conference.
“As significant efforts have been spent on reducing pediatric asthma health disparities, we were interested in looking at where children die: out of the hospital, in the emergency room or clinics, or in the hospital,” Arroyo said. “Where a child dies reflects the amount of acute medical interventions provided to the child prior to death, and suggests areas where we can focus future efforts and interventions.”
Arroyo and colleagues examined the National Center for Health Statistics Mortality Multiple Cause-of-Death public use data provided from 2003 to 2014 to determine locations of pediatric asthma death. Locations were categorized into three sections: out-of-hospital (home or dead on arrival), outpatient (emergency department or clinic) and inpatient.
The researchers analyzed records of children aged less than 19 years (n=2,571) who had asthma reported as the underlying cause of death, with additional examination of patient age, sex, race and ethnicity. The researchers compared differences with the Marascuilo procedure, and calculated the rates with bridged–race population estimates.
According to study findings, the annual mortality rate for black children (9.29 per 1,000,000 persons) was six times higher compared to Hispanic (1.54 per 1,000,000) and white children (1.28 per 1,000,000). An outpatient setting was listed more frequently as place of death (51%) than out-of-hospital (14%) and inpatient deaths (30%). Outpatient asthma deaths were more common among black children (59%) vs. white (24%) and Hispanic children (12%), while out-of-hospital asthma deaths were also disproportionately more common in black children (50%) compared to white (35%) and Hispanic children (10%).
“Unfortunately, we found that black children continue to die at a rate six to seven times higher than white or Hispanic children which did not significantly decrease over the study period,” Arroyo said. “When we looked at differences in the location of death across different racial and ethnic groups, we found that there was a higher proportion of black children dying in all three settings: in the hospital, in the emergency room and clinics, and out of the hospital.”
In addition, the researchers found that a greater number of asthma deaths occurred in black children in the inpatient setting (50%) than in white (30%) or Hispanic children (14%). While inpatient deaths have increased over the years, the amount of outpatient and out-of-hospital asthma deaths have decreased.
“Over the study period, we noted a significant decrease in the proportion of out-of-hospital deaths for black and Hispanic children, possibly suggesting that there has been an improvement in access to care,” Arroyo said. “However, we still found that the majority of deaths occurred in the emergency room and clinic setting, which did not significantly change over time, suggesting that there are still further areas for improvement.” – by Katherine Bortz and Bob Stott
Chen Arroyo AJ, et al. Abstract 283. Presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting; March 3-6, 2017; Atlanta.
Disclosure: The researchers report no relevant financial disclosures.