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The article focuses on COVID-19 pandemic has significantly affected health care utilization in the U.S. being outpatient visits procedures were intentional in preparation for increases in COVID-19–related volume, National Syndromic Surveillance Program data indicate that weekly emergency department (ED) visits decreased. Topics icnlude the group of the U.S. hospitals has reported reduction, and the ED visit trends for other serious diagnoses requiring acute intervention or hospitalization.

BACKGROUND: Empirical research and health policies on asthma have focused on children and young adults, even though asthma morbidity and mortality are higher among older asthmatics. OBJECTIVE: To explore the relationship of asthma-related beliefs and self-reported controller medication adherence in older asthmatics. DESIGN: An observational study of asthma beliefs and self-management among older adults. PARTICIPANTS: Asthmatics ages ≥60 years ( N = 324, mean age 67.4 ± 6.8, 28 % white, 32 % black, 30 % Hispanic) were recruited from primary care practices in New York City and Chicago. MAIN MEASURES: Self-reported controller medication adherence was assessed using the Medication Adherence Report Scale. Based on the Common Sense Model of Self-Regulation, patients were asked if they believe they only have asthma with symptoms, their physician can cure their asthma, and if their asthma will persist. Beliefs on the benefit, necessity and concerns of treatment use were also assessed. Multivariate logistic regression was used to examine the association of beliefs with self-reported medication adherence. KEY RESULTS: The majority (57.0 %) of patients reported poor adherence. Poor self-reported adherence was more common among those with erroneous beliefs about asthma illness and treatments, including the 'no symptoms, no asthma' belief (58.7 % vs. 31.7 %, respectively, p < 0.001), 'will not always have asthma' belief (34.8 % vs. 12.5 %, p < 0.001), and the 'MD can cure asthma' belief (21.7 % vs. 9.6 %, p = 0.01). Adjusting for illness beliefs, treatment beliefs and demographics, patients with a 'no symptoms, no asthma' belief had lower odds of having good self-reported adherence (odds ratio [OR] 0.45, 95 % confidence interval [CI] 0.23-0.86), as did those with negative beliefs about the benefits (OR 0.73, 95 % CI 0.57-0.94) and necessity (OR 0.89, 95 % CI 0.83-0.96) of treatment. CONCLUSIONS: Illness and treatment beliefs have a strong influence on self-reported medication adherence in older asthmatics. Interventions to improve medication adherence in older asthmatics by modifying illness and treatment beliefs warrant study. [ABSTRACT FROM AUTHOR]

Asthma disproportionately affects non-whites in urban areas and those of low socioeconomic status, yet asthma's social patterning is not well-explained by known risk factors. We hypothesized that disadvantaged urban populations experience acute and chronic housing stressors which produce psychological stress and impact health through biological and behavioral pathways. We examined eight outcomes: six child respiratory outcomes as well as parent and child general health, using data from 682 low-income, Chicago parents of diagnosed and undiagnosed asthmatic children. We created a continuous exposure, representing material, social and emotional dimensions of housing stressors, weighted by their parent-reported difficulty. We compared the 75th to the 25th quartile of exposure in adjusted binomial and negative binomial regression models. Higher risks and rates of poor health were associated with higher housing stressors for six of eight outcomes. The risk difference (RD) for poor/fair general health was larger for children [RD = 6.28 (95% CI 1.22, 11.35)] than for parents [RD = 3.88 (95% CI −1.87, 9.63)]. The incidence rate difference (IRD) for exercise intolerance was nearly one extra day per 2 weeks for the higher exposure group [IRD = 0.88 (95% CI 0.41, 1.35)]; nearly one-third extra day per 2 weeks for waking at night [IRD = 0.32 (95% CI 0.01, 0.63)]; and nearly one-third extra day per 6 months for unplanned medical visits [IRD = 0.30 (95% CI 0.059, 0.54)]. Results contribute to the conceptualization of urban stress as a “social pollutant” and to the hypothesized role of stress in health disparities. Interventions to improve asthma outcomes must address individuals' reactions to stress while we seek structural solutions to residential stressors and health inequities. [ABSTRACT FROM AUTHOR]

Death certificate data were used to examine asthma mortality among African Americans and Whites aged 5 through 34 years in Chicago from 1968 through 1991. African Americans experienced consistently higher asthma mortality throughout the period. Asthma mortality remained stable among Whites from 1968 through 1991 but increased by 337% among African Americans from 1976 through 1991 (P< .001). The increase was greatest among 20-through 34-year-olds. Between 1979 and 1991, outpatient and emergency department deaths increased significantly, while the proportion of dead-on-arrival cases remained stable at 51%. This shift to non-inpatient deaths suggests that lack of access to health care may play a role in increasing asthma mortality. [ABSTRACT FROM AUTHOR]