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BACKGROUND: The burden of asthma varies by race/ethnicity in the U.S. The objective of this study was to examine race/ethnic difference in asthma hospitalization, mortality, prevalence, and risk factors among Texas residents.
METHODS: Texas Inpatient Hospital Discharge Data with ICD-9 code 493.xx as the principal diagnosis were used to calculate asthma hospital incidence rate ratios (IRRs) by year (2005-2011) for all ages comparing non-Hispanic blacks (NHB) and Hispanics with non-Hispanic whites (NHW). Texas Mortality Data with ICD-10 Code J-45 or J-46 as underlying cause of death were used to calculate asthma mortality rate ratios (RR) by year (2005-2011) for NHB and Hispanics compared to NHW (Stata 13.0). 2012 Texas Behavioral Risk Factor Surveillance System data were used to calculate prevalence of adult current asthma and risk factors (obesity, current smoking, less than high school degree, no health insurance, cost barrier to see a doctor) stratified by race/ethnicity (SAS 9.3).
RESULTS: From 2005 to 2011, 183,613 asthma related hospitalizations were reported in Texas. Each year NHB were twice (IRR ranged from 2.0 to 2.3) as likely as NHW to be hospitalized for asthma. Each year, Hispanics were less likely than NHW to be hospitalized for asthma. The IRRs ranged from 0.7 to 0.9. Between 2005 and 2011, 1,482 asthma-attributable deaths occurred in Texas. Compared to NHW, NHB were more likely to die of asthma with mortality RRs ranging from 1.5 to 2.4 each year. Hispanics were less likely than NHW to die of asthma with mortality RRs ranging from 0.2 to 0.4 each year. In Texas, current asthma prevalence was lower among Hispanics (4.6%) compared to NHW (8.1%) or NHB (9.1%). 42.6% of Hispanics had less than a high school education compared to NHW (7.2%) or NHB (9.6%). NHB and Hispanics had a higher prevalence of obesity (35.6%, 35.2%), no health insurance (28.9%, 54.7%), and cost barriers (25.8%, 29.4%) compared to NHW (obesity: 25.3%, no health insurance: 14.7%, cost barriers: 13.1%). Among NHB, the prevalence of cost barriers was greater for those with asthma (42.0%) than without asthma (28.6%).
CONCLUSIONS: Compared to NHW, NHB were more likely and Hispanics were less likely to be hospitalized or die of asthma. Asthma prevalence was lowest among Hispanics however most risk factors were more prevalent among both NHB and Hispanics than NHW. To explain the race/ethnicity disparities in asthma burden among Texas residents, additional analyses are needed.