Are inner-city children with asthma receiving specialty care as recommended in national asthma guidelines?

Karen L. Warman, Ellen J. Silver

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective: To examine whether children with asthma in an urban health care network are receiving asthma specialty care, and which factors, if any, are associated with the receipt of this care, including child's racial/ethnic group, age, socio-economic status (SES), insurance, and/or acute care utilization. Methods: This study is a retrospective cohort study of children aged 7–17 years who received primary care at an urban medical center in 2012 and had a primary or secondary ICD9 code for asthma. Data on asthma-related health care utilization from 1997 to 2012 were accessed using a software application linked to the electronic medical record. Analyses included descriptive statistics (means and percentages) as well as bivariate and multivariable logistic regressions. Results: The participants were 4959 children (59% Hispanic and 37% Black, Non-Hispanic) with a mean age = 11.1 years ± 3.05, with 56.8% males. Only 19% of the children had outpatient asthma specialist care: pulmonary (16%) and/or allergy (7%). Only 42% with an asthma-related hospitalization had an outpatient asthma specialist visit. The receipt of specialty care did not vary by race/ethnicity, SES or private vs. public insurance, but was more likely with hospitalization for asthma (OR 3.4) or ≥2 lifetime ED visits (OR 2.6) and less likely for those who were uninsured (OR 0.7). Conclusions: In contrast to guideline recommendations, few inner-city children with high asthma morbidity in this sample had seen asthma specialists. Efforts are needed to ensure that inner-city children with asthma are receiving guideline-recommended asthma specialty care.

Original languageEnglish (US)
Pages (from-to)517-524
Number of pages8
JournalJournal of Asthma
Issue number5
StatePublished - May 4 2018


  • Allergy
  • guidelines
  • inner-city
  • pediatric
  • pulmonology
  • specialty care
  • spirometry

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine


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