ORIGINAL INVESTIGATION Effect of Race on Asthma Management and Outcomes in a Large, Integrated Managed Care Organization

ately affects black people. Whether this excess morbidity is fully explained by differences in asthma severity, access to care, or socioeconomic status (SES) is unknown. Methods:Weassessedwhether therewere racial dispari-ties in asthma management and outcomes in a managed care organization that provides uniform access to health care and then determined to what degree these disparities were explained by differences in SES, asthma severity, and asthma management. We prospectively studied 678 pa-tients from a large, integrated health care delivery system. Patients who had been hospitalized for asthmawere inter-viewedafterdischarge toascertain informationaboutasthma history, health status, and SES. Small-area socioeconomic data were ascertained by means of geocoding and linkage to theUSCensus 2000. Patients were followed up for sub-sequent emergency department (ED) visits or hospitaliza-tions (median follow-up, 1.9 years). Results: Black race was associated with a higher risk of ED visits (hazard ratio [HR], 1.93; 95 % confidence interval [CI], 1.39-2.66) and hospitalizations (HR, 1.89; 95 % CI, 1.30-2.76). This finding persisted after adjusting for SES and differences in asthma therapy (adjusted HR for ED visits, 1.73; 95 % CI, 1.07-2.81; and adjusted HR for hospitalizations, 2.01; 95 % CI