Race, Income, Urbanicity, and Asthma Hospitalization in California: Medical practice stylesThe provider of care and differences in medical practice styles (private physician, community health center, etc) can affect the type of care received. Finkelstein et al found significant differences in the quality of asthma primary care for black and Hispanic vs white young children with asthma in Boston. However, after adjustment for primary-care practice type, the effect of race disappeared, suggesting that the variations in the quality of asthma primary care may be associated with differences in the type of provider. Minorities and the poor tend to receive treatment at facilities that do not practice “state of the art’’ asthma care. Perrin et al found differences in the asthma hospital admission rates among children in Rochester, Boston, and New Haven and, in a follow-up study, Homer et al found large variations in the preventive care received for asthma among children in these three cities. Socioeconomic status, a trenchant predictor of asthma morbidity, is a surrogate for limited health-care access. Wissow et al reported that black children in Maryland were at increased risk of hospitalization for asthma. In contrast to our findings, Wissow et al found that the increased risk was related to poverty rather than to race. Haas et al also reported that socioeconomic status partially explains the differences in the quality of care received by asthma patients of both lower and higher socioeconomic status.

This study is unique in examining asthma rates of hospitalization among Asians. Notably, Asian children <5 years were at slightly higher risk of asthma hospitalization than white children regardless of the socioeconomic strata examined. In the only study (to our knowledge) to delineate asthma mortality of Asians, Schenker et al. found similar rates of asthma mortality among nonelderly Asians and whites from 1960 to 1989 residing in California, where the population is largely composed of persons of Filipino, Chinese, and Japanese descent.