Pharmaceutical Sciences ETDs

Akshay Kharat

Publication Date

8-27-2012

Abstract

Objectives: Inhaled corticosteroids (ICS) are widely used in the management of asthma. Prior research suggests that asthmatic patients access to ICS may vary by ethnicity. The objectives of the study were to determine if there is a difference in the proportion of Hispanic and non-Hispanic White patients in the receipt of ICS prescription for asthma and to determine the independent predictors of receiving an ICS prescription in asthmatic patients. The study further examined the utilization of asthma-related healthcare services (office visits, prescription fills, inpatient visits, and emergency room visits) in Hispanic and non-Hispanic White asthmatic patients. Methods: The U.S. Medical Expenditure Panel Survey (MEPS) 2009 dataset was utilized to compare the receipt of ICS prescription and use of healthcare services among patients with asthma. The sample size was restricted to Hispanic and non-Hispanic White patients, above 4 years of age with ICD-9CM codes for asthma between January 1 and December 31, 2009. The proportion of patients receiving an ICS prescription within the defined timeframe was compared by ethnicity in chi-square analysis. Multivariate logistic regression was used to determine significant predictors of receiving an ICS prescription and utilization of asthma-related healthcare services. Results: A total of 1,469 patients which is representative of 14,476,600 US Hispanic and non-Hispanic White asthmatic patients satisfied the study inclusion criteria. Of the total study population, 16.1% were Hispanics, 59.5% were females, and the mean age of the study population was 39.9±0.03 years. About 40% of non-Hispanic White asthmatics (35% children and 41.6% adults) had a receipt of ICS prescription compared to 22% of Hispanics (23.9% children and 21.2% adults), (p<.0001). Adult Hispanic asthmatic patients (\u226518 years old) had 0.43 (95%CI: 0.28—0.67) times lower odds of receiving an ICS prescription compared to non-Hispanic White asthmatic patients, independent of other factors. However, there was no significant difference between Hispanic and non-Hispanic White asthmatic children (4 to 17 years old) in the receipt of ICS prescription. Among adults, being 65 years and older (vs. 18 to 40 years old OR: 2.23; 95%CI: 1.30—3.84), being a non-smoker (vs. smoker OR: 1.86; 95%CI: 1.13 - 3.07), being uninsured (vs. private insurance OR: 0.34; 95%CI: 0.17—0.7), belonging to high income group (vs. poor/negative income group OR: 3.07; 95%CI: 1.74—5.41), residing in the west (vs. northeast OR: 0.50; 95%CI: 0.31—0.82), having a SABA prescription (vs. no SABA prescription OR: 0.33; 95%CI: 0.23—0.46), and having better overall health (OR: 1.32; 95%CI: 1.06—1.64) were predictive of receipt of ICS prescription, independent of other factors. Among children, patients who received a SABA prescription had 0.23 (95%CI: 0.12—0.43) lower odds of having a receipt of ICS medication as compared to patients who did not receive a SABA prescription. We also found that Hispanic patients had higher odds of having an asthma-related office visit (OR: 1.46; 95%CI: 1.10—1.93), emergency room visit (OR: 3.38; 95%CI: 1.64—6.95), and inpatient visit (OR: 6.94; 95%CI: 1.33—36.24) as compared to non-Hispanic Whites. Also, patients who did not receive an ICS prescription had 0.47 (95%CI: 0.35—0.63) times lower odds of having an asthma-related office visits as compared to patients who received an ICS prescription. Conclusion: The disparity in ICS prescription patterns between Hispanic and non-Hispanic White asthmatic patients may translate into suboptimal asthma management, a higher rate of exacerbations, and higher healthcare costs in this growing minority population. The differences and potential disparities in ICS use between Hispanic and non-Hispanic White asthmatic patients warrant further investigation.

Fourth Committee Member

Petersen, Hans

First Committee Member (Chair)

Raisch, Dennis

Degree Name

Pharmaceutical Sciences

Second Committee Member

Roberts, Melissa

Level of Degree

Masters

Third Committee Member

Blanchette, Christopher

Department Name

College of Pharmacy

Language

English

Document Type

Thesis

Keywords

Adrenocortical hormones--Therapeutic use--Social aspects, Asthma--Chemotherapy--Social aspects, Hispanic Americans--Medical care, Medical care--Cross-cultural studies.

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