This document summarizes research on uncontrolled asthma among Medicaid-enrolled children. It explores the challenges of asthma, why this demographic is uniquely affected, and the potential for improved disease management. Key points include: asthma affects 20 million Americans and costs $59 billion annually; Medicaid children have poorer control and higher costs despite lower direct healthcare costs; socioeconomic factors like poverty, housing, and access to care do not fully explain disparities; and research shows racial disparities in prescription of preventative medications like inhaled corticosteroids that lead to unnecessary hospitalizations and exacerbations.

1. Uncontrolled
Asthma in Medicaid-
Enrolled Children
AKUNNA IHEDURU

2. This project, designed as an attempt to understand and mitigate
asthma’s growing impact, will explore the following:
How great of a national
challenge is asthma?
Why are Medicaid-
enrolled children
uniquely affected by
poorly controlled
asthma?
What is the potential
for improved disease
management within
this demographic?
How can adjustments
in treatment protocol
reduce resource
utilization and
medical costs?

3. Asthma is a complex disease currently affecting
almost 20 million Americans.
Symptoms of Asthma Current Standards of
Care and
Management
Current Prevalence
• Wheezing,
• Chest tightness,
• Shortness
• of breath
• Patient Education &
Asthma Action Plan
• Referrals to pulmonary
specialists,
allergist/immunologist
• Inhaled Beta-agonists,
(albuterol, etc.)
• Inhaled & Oral
Corticosteroids
• People of all backgrounds
• Prevalence is higher in
minority and low-SES
populations
• Also associated with area of
residence, level of
education, etc.
• Increasing by a factor of
1.5% annually
Costs
• $59 billion in 2009
• $270 million for acute ED
care to pediatric patients
• Average costs total $3,000
annually for each patient

4. Intermittent
Persistent hb
Level of Control Well Controlled
Poorly
Controlled
Very Poorly
Controlled
Classifying Asthma
Asthma can be distinguished in different ways depending on the frequency and severity of symptoms
experienced and how easily therapeutic and lifestyle interventions can improve conditions.

6. Why Are There Still Inequities?
Children enrolled in Medicaid are at a special risk for having poorly-controlled asthma. As direct health costs are drastically
reduced for beneficiaries of public insurance, clinicians in the field generally suggest that other income-related factors must
contribute to worse health outcomes.
Lower
Socio-
Economic
Status
Poor
Housing
Conditions,
Exposure to
Allergens
Inadequate
Access to
Medical
Care

7. Income-
Related
Factors
?
Significant
Disparity
These factors alone are not significant enough to explain disparities, Dozens of researchers have shown that
disparities exist even when controlling for income.
Does that Completely Explain the Disparity?

8. Unfortunately, a majority of the research has underscored race as the sole predicating factor, while
disregarding potential income-related confounders.
Data analyzing race can be useful (STRICTLY AS A PROXY FOR INCOME), but CAN NOT independently reveal
scientifically-acceptable causation.
Adults who needed care right away for an illness, injury, or
condition in the last 12 months who sometimes or never got care
as soon as wanted, by race and ethnicity, stratified by income,
2006, AHRQ.
Important to Keep in Mind…

9. 63 67 68
BLACK HISPANIC WHITE
SYMPTOM SEVERITY
Severe Symptoms
Children of all races are statistically equally as likely to
present to the ED with severe symptoms-dispelling the
notion of medical “moral hazard”.
What is the Reason For This Disparity?
There are many hypotheses, for instance,
Are Minority Patients Going to the ED Unnecessarily?

10. 0.8 0.8
1
BLACK HISPANIC WHITE
NEW RX OF STEROIDS AT
DISCHARGE
Odds Ratio of New Rx
34 31
14
BLACK HISPANIC WHITE
ADMISSION HISTORY
% Admitted for Asthma in Past Year
The Recurring Deviation in Care is Apparent in the Prescription of
Inhaled Corticosteroids
Several studies have highlighted the fact that physicians fail to prescribe an adequate amount of preventative
medications to certain demographics. These practices lead to unnecessary and avoidable hospitalizations and
exacerbations, and in some cases death.
If Black and Hispanic children are requiring emergency care more frequently, one would expect a higher rate of
inhaled corticosteroid prescription

11. Consequences of Under-Prescription