Journal of General Internal Medicine

, Volume 22, Issue 7, pp 976–981

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

  • Sande O. Okelo
  • Albert W. Wu
  • Barry Merriman
  • Jerry A. Krishnan
  • Gregory B. Diette
Original Article



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.


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.


Frequency of underestimation, asthma care, and communication.


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).


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.


asthma racial disparities patient–physician communication 


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Sande O. Okelo
    • 1
  • Albert W. Wu
    • 2
    • 3
    • 4
  • Barry Merriman
    • 4
  • Jerry A. Krishnan
    • 2
    • 4
  • Gregory B. Diette
    • 2
    • 4
  1. 1.Department of PediatricsJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of MedicineJohns Hopkins UniversityBaltimoreUSA
  3. 3.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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