ASTHMA SEVERITY AND ACCESS TO CARE IN A NATIONAL SAMPLE OF SPANISH-SPEAKING CHILDREN Jane M Brotanek MD ¹, Jill Halterman MD ¹, Peggy Auinger MS ^1,2 and Michael Weitzman MD ². ¹Strong Children's Research Center, Rochester, NY; and ²The AAP Center for Child Health Research, Rochester, NY.

BACKGROUND: Asthma prevalence remains high among Hispanic children in the US. It has been shown that children from Spanish-speaking families are at high risk for inadequate maintenance asthma therapy. The reasons for this remain unclear.

OBJECTIVE: To compare patterns of asthma severity and access to care between English-speaking and Spanish-speaking children with asthma.

DESIGN/METHODS: Cross-sectional data from a nationally representative sample of children with asthma 2-17 years of age were analyzed from the 1999 National Health Interview Survey. Children with asthma from Spanish-speaking families were compared to children with asthma from English-speaking families on multiple measures of asthma severity and access to care. Measures of asthma severity included parental report of hospitalizations, ED visits, nighttime symptoms, limitation of activity, and school absences during the past 12 months. Access to care was based on parental identification of a usual place for sick care and usual health care provider. Chi-square and logistic regression analyses were used to compare asthma severity and access to care by language. SUDAAN software was used to account for the complex sampling design.

RESULTS: Among the 1,229 children with asthma in our sample, 67 were from Spanish-speaking families and 1,162 were from English-speaking families. No differences in any of the measures of asthma severity were found between the two groups (hospitalizations 5% vs 2%, ED visits 36% vs 34%, nighttime symptoms 39% vs 30%, limitation of activity 42% vs 31%, school absences 31% vs 19% ; all p values > 0.05). Children from Spanish-speaking families were less likely to have a usual source of sick care (87% vs. 97%, p=0.04), to see one healthcare provider (55% vs 83%, p=0.003), and to have taken an asthma class (12% vs 23%, p=0.02). In a multivariate model controlling for demographic variables(gender, insurance, poverty)children with asthma from Spanish-speaking families were one-third less likely to have a usual health care provider (p=0.01).

CONCLUSIONS: Children from Spanish-speaking families experienced a similar level of severity relative to children from English-speaking families but were less likely to have a usual healthcare provider. Differences in access to care may contribute to inadequate asthma maintenance therapy among these children.