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Are Physician Estimates of Asthma Severity Less Accurate in Black than in White Patients?

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Abstract

Background

Racial differences in asthma care are not fully explained by socioeconomic status, care access, and insurance status. Appropriate care requires accurate physician estimates of severity. It is unknown if accuracy of physician estimates differs between black and white patients, and how this relates to asthma care disparities.

Objective

We hypothesized that: 1) physician underestimation of asthma severity is more frequent among black patients; 2) among black patients, physician underestimation of severity is associated with poorer quality asthma care.

Design, Setting and Patients

We conducted a cross-sectional survey among adult patients with asthma cared for in 15 managed care organizations in the United States. We collected physicians’ estimates of their patients’ asthma severity. Physicians’ estimates of patients’ asthma as being less severe than patient-reported symptoms were classified as underestimates of severity.

Measurements

Frequency of underestimation, asthma care, and communication.

Results

Three thousand four hundred and ninety-four patients participated (13% were black). Blacks were significantly more likely than white patients to have their asthma severity underestimated (OR = 1.39, 95% CI 1.08–1.79). Among black patients, underestimation was associated with less use of daily inhaled corticosteroids (13% vs 20%, p < .05), less physician instruction on management of asthma flare-ups (33% vs 41%, p < .0001), and lower ratings of asthma care (p = .01) and physician communication (p = .04).

Conclusions

Biased estimates of asthma severity may contribute to racially disparate asthma care. Interventions to improve physicians’ assessments of asthma severity and patient–physician communication may minimize racial disparities in asthma care.

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Acknowledgments

Dr. Okelo was supported by grants from the National Institute of Environmental Health Science (ES 09609), the Environmental Protection Agency (R826724), and by the National Heart, Lung, and Blood Institute training grant (HL07534). Dr. Diette was supported by grants from the National Institutes of Health (HL04266 and ES 09606) and the Environmental Protection Agency (R826724). Dr. Krishnan was supported by the Parker B. Francis Foundation and the National Institutes of Health (HL67850).

Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Johns Hopkins University, 200 N. Wolfe Street, Suite 3025, Baltimore, MD, 21287, USA

    Sande O. Okelo MD

  2. Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Albert W. Wu MD, MPH, Jerry A. Krishnan MD, PhD & Gregory B. Diette MD, MHS

  3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Albert W. Wu MD, MPH

  4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Albert W. Wu MD, MPH, Barry Merriman MA, Jerry A. Krishnan MD, PhD & Gregory B. Diette MD, MHS

Authors
  1. Sande O. Okelo MD
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  2. Albert W. Wu MD, MPH
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  3. Barry Merriman MA
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  4. Jerry A. Krishnan MD, PhD
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  5. Gregory B. Diette MD, MHS
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Corresponding author

Correspondence to Sande O. Okelo MD.

Appendices

Appendix 1

Table 4 National Asthma Education and Prevention Program (NAEPP) Guidelines for Asthma Severity Classifications*
Full size table

Appendix 2

Table 5 Patient-Reported Quality of Asthma Care: Domains, Indicators, and Patient Survey Questions*
Full size table

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Okelo, S.O., Wu, A.W., Merriman, B. et al. Are Physician Estimates of Asthma Severity Less Accurate in Black than in White Patients?. J GEN INTERN MED 22, 976–981 (2007). https://doi.org/10.1007/s11606-007-0209-1

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  • DOI: https://doi.org/10.1007/s11606-007-0209-1

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