• Sande O Okelo, Albert W Wu, Barry Merriman, Jerry A Krishnan, and Gregory B Diette.
• Department of Pediatrics, Johns Hopkins University, 200 N. Wolfe Street, Suite 3025, Baltimore, MD 21287, USA. sandeokelo@jhmi.edu
• J Gen Intern Med. 2007 Jul 1; 22 (7): 976981976-81.

BackgroundRacial differences in asthma care are not fully explained by socioeconomic status, care access, and insurance status. Appropriate care requires accurate physician estimates of severity. It is unknown if accuracy of physician estimates differs between black and white patients, and how this relates to asthma care disparities.ObjectiveWe hypothesized that: 1) physician underestimation of asthma severity is more frequent among black patients; 2) among black patients, physician underestimation of severity is associated with poorer quality asthma care.Design, Setting And PatientsWe conducted a cross-sectional survey among adult patients with asthma cared for in 15 managed care organizations in the United States. We collected physicians' estimates of their patients' asthma severity. Physicians' estimates of patients' asthma as being less severe than patient-reported symptoms were classified as underestimates of severity.MeasurementsFrequency of underestimation, asthma care, and communication.ResultsThree thousand four hundred and ninety-four patients participated (13% were black). Blacks were significantly more likely than white patients to have their asthma severity underestimated (OR = 1.39, 95% CI 1.08-1.79). Among black patients, underestimation was associated with less use of daily inhaled corticosteroids (13% vs 20%, p < .05), less physician instruction on management of asthma flare-ups (33% vs 41%, p < .0001), and lower ratings of asthma care (p = .01) and physician communication (p = .04).ConclusionsBiased estimates of asthma severity may contribute to racially disparate asthma care. Interventions to improve physicians' assessments of asthma severity and patient-physician communication may minimize racial disparities in asthma care.

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