11/12/03 Can universal access to health care eliminate asthma health care inequalities?SummaryChildren from poor families are much more likely to have emergency visits for asthma exacerbations. This pattern has been attributed to financial barriers to good preventive asthma care for poor families. Sin et al of the Univ. of Alberta in Edmonton, Canada investigated whether this was really the case. They carried out a longitudinal, population based study in a region where health care is provided free to all inhabitants. All children (n=90,845) were classified by family income into very poor, poor, and non-poor. During a 10 year follow-up, very poor children were 23% more likely to have had an emergency visit for asthma than children from non-poor families (RR=6.32) while the asthma emergency visit frequency was similar in the poor and non-poor groups (RR=0.97). The frequency of office visits for asthma was similar in the very poor and non-poor groups. The authors concluded that universal free access to health care may reduce but not eliminate disparities in emergency care for asthma in difference income groups. Reference Chest 2003; 124:51-6 Editor's Comments The findings in this study were perhaps not surprising to many of us. The authors did not state their conclusions why there continued to be disparities in emergency care in the very poor children. I certainly do not have definitive "answers" to what is likely a complex issue possibly involving cultural differences in attitudes about health care, increased exposure to cigarette smoke and other inhalant offenders, and logistic limitations in bringing children to health care facilities for preventive health care visits (e.g.- 2 working parents, large families). The latter factor may not have been a major element here since the frequency of attendance with scheduled office visits for asthma care was not significantly reduced in the very poor children. It would be of interest to see the effects of having a high quality asthma care facility operating during evening hours in or near housing facilities populated by the very poor.
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