Patricia Collins Higgins

Differences in Prevalence, Treatment, and Outcomes of Asthma Among a Diverse Population of Children With Equal Access to Care: Findings From a Study in the Military Health System

OBJECTIVE To assess racial and ethnic differences in asthma prevalence, treatment patterns, and outcomes among a diverse population of children with equal access to health care. DESIGN Retrospective cohort analysis. SETTING The Military Health System. PARTICIPANTS A total of 822 900 children aged 2 through 17 years continuously enrolled throughout 2007 in TRICARE Prime, a health maintenance organization-type benefit provided by the Department of Defense. MAIN OUTCOME MEASURES Prevalence of diagnosed asthma, potentially avoidable asthma hospitalizations, asthma-related emergency department visits, visits to asthma specialists, and use of asthma medications among children aged 2 to 4, 5 to 10, and 11 to 17 years. RESULTS Black and Hispanic children in all age groups were significantly more likely to have an asthma diagnosis than white children (ranging from odds ratio [OR]=1.16; 95% confidence interval [CI], 1.09-1.24; to OR=2.00; 95% CI, 1.93-2.07). Black children in all age groups and Hispanic children aged 5 to 10 years were significantly more likely to have any potentially avoidable asthma hospitalizations and asthma-related emergency department visits (ranging from OR=1.24; 95% CI, 1.11-1.37; to OR=1.99; 95% CI, 1.37-2.88) and were significantly less likely to visit a specialist (ranging from OR=0.71; 95% CI, 0.61-0.82; to OR=0.88; 95% CI, 0.79-0.98) 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 (ranging from OR=1.11; 95% CI, 1.02-1.21; to OR=1.11; 95% CI, 1.04-1.19). CONCLUSIONS Despite universal health insurance coverage, we found evidence of racial and ethnic differences in asthma prevalence, treatment, and outcomes.

Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients.

This study aims to compare racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients and non–health center patients. Data for the study came from the 2002 Community Health Center User Survey and the 2003 National Healthcare Disparities Report. Descriptive analysis was performed using nationally representative survey data pertaining to access to care and quality of care for people of different races, ethnicities, incomes, and education levels. Results of the study show that health center patients experience fewer racial/ethnic and socioeconomic disparities in access to care and quality of care, compared with non–health center patients nationally. Racial/ethnic disparities favoring whites occur in non–health center patients in every measure of quality and access included in this study. Conversely, there are few disparities favoring whites among health center users. Education and income-related disparities occur for several measures of access and quality in both health center and non–health center patients; however, the magnitude of these disparities is usually greater among non–health center patients compared with health center patients. In conclusion, health centers have been touted for cost-efficient, high-quality care. This study adds to growing evidence that health centers may also help eliminate racial/ethnic and socioeconomic disparities in access to care and quality of care.

Treatment and outcomes for congestive heart failure by race/ethnicity in TRICARE.

BackgroundEquitable access to health insurance coverage may improve outcomes of care for chronic health conditions and mitigate racial/ethnic health disparities. This study examines racial/ethnic disparities in the treatment and outcomes of care for TRICARE beneficiaries with congestive heart failure (CHF). MethodsUsing a retrospective cohort analysis, we examined demographic characteristics, sources of care, and comorbid conditions for 2183 beneficiaries of the Military Health Systems TRICARE program (representing 115,584 beneficiaries after adjusting for survey weights) with CHF. Treatments included use of CHF-related medications, while the outcome of interest was any CHF-related potentially avoidable hospitalizations (PAHs). ResultsWhile African Americans were less likely than whites to have received beta blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers following a CHF diagnosis (P<0.0001). Hispanics were, in some cases, equally likely as whites to receive pharmacological treatments for CHF. In multivariate models, there were no significant racial/ethnic differences in the odds of a PAH; age greater than 65 was the most significant predictor of a PAH. ConclusionsThis study suggests that although there are some racial and ethnic disparities in the receipt of pharmacological therapy for CHF among TRICARE beneficiaries, these differences do not translate into disparities in the likelihood of a PAH. The findings support previous research suggesting that equal access to care may mitigate racial/ethnic health disparities.

Racial and Ethnic Health Disparities in TRICARE

BACKGROUND As a major provider of health care for racial and ethnic minority groups, the federal government has affirmed its commitment to the elimination of health disparities. Although numerous studies have examined health care disparities in various federal systems of care, few have examined these issues within TRICARE, the Department of Defense (DoDJs program for providing health care coverage to members of the uniformed services and their dependents. METHODS This study provides an exploratory analysis examining apparent disparities in health status, access to and satisfaction with care, and use of preventive care using the 2007 Health Care Survey of DoD Beneficiaries. Analyses compare outcomes by race/ethnicity and between TRICARE beneficiaries and national norms derived from the National Consumer Assessment of Health Plans Study Benchmarking Database and the National Healthcare Disparities Report, and are stratified by duty status. RESULTS Compared to black non-Hispanics, a higher proportion of white non-Hispanic active-duty and retiree TRICARE beneficiaries reported good to excellent health status. However, on most measures, we found no differences between white non-Hispanic beneficiaries and members of racial/ethnic groups. When differences did exist, minority populations were likely to report better access to and use of services than whites. CONCLUSIONS Although health disparities exist in health status and some measures of preventive care, black non-Hispanics and Hispanics often receive more equitable care under TRICARE than in the nation as a whole. These findings suggest the need to explore the characteristics of TRICARE that may be associated with more-favorable outcomes for racial and ethnic minority groups.