African Americans are four times more likely to be hospitalized and five times more likely to die of asthma than non-African Americans. This is not an isolated statistic; while the ethnic minority population in the United States continues to grow and is expected to account for 50% of the country’s population by 2050, the gap in health disparities between whites and minorities still exists.
The February 2006 issue of the Journal of Allergy and Clinical Immunology (JACI) presents research about the disparity between ethnicities in regard to asthma, what can be done to improve treatment for ethnic minorities, and how genetics play a role in asthma prevalence. The studies can be found on the JACI’s Web site at http://www.jacionline.org. The JACI is the peer-reviewed, scientific journal of the American Academy of Allergy, Asthma and Immunology (AAAAI).
The disparity in asthma prevalence and treatment has been studied at length; statistics include:
- Asthma prevalence is highest for Puerto Rican Americans (13.1%), followed by Native Americans (9.9%) and non-Hispanic blacks (9.5%).
- Asthma mortality for whites increased from the 1980-1984 time period to 2000-2001 time period from 2.1 to 2.6 deaths per 1,000,000 population; during the same time, the mortality rate for African Americans increased from 9.9 to 13.2 deaths per 1,000,000 population.
National efforts to improve asthma care over the past decade do not appear to have reduced the black/white gap for differences in hospitalizations and mortality. Reducing disparities in asthma care should be a national priority for research, health policy, and community action, according to a study entitled “The widening black/white gap in asthma hospitalizations and mortality” by Ruchi S. Gupta, MD, MPH, Northwestern University Feinberg School of Medicine and Children’s Memorial Hospital, Chicago, Ill., and colleagues.
According to Gupta, when treating children with asthma, it is important to consider the racial/ethnic factors that might prevent hospitalizations and premature mortality. Gupta also noted:
- The number of uninsured adults is increasing, and lack of insurance for adults could explain why asthma prevalence and mortality has increased.
- In a survey of Medicaid-insured children with asthma, black children had worse asthma status and less use of preventive medication than white children; fewer black adults also reported receiving asthma self-management education.
- Genetics might be related to how black subjects have different responsiveness to the controller and reliever medications.
Differences in genetics can differ between African Americans, Puerto Ricans, and Mexican Americans, and this might contribute to the differences in disease prevalence, according to a study entitled “Genetic epidemiology of health disparities in allergy and clinical immunology” by Kathleen C. Barnes, PhD, Johns Hopkins Asthma and Allergy Center, Baltimore.
In holding with this theory, Barnes noted several studies have demonstrated that although Puerto Rico has a high prevalence of asthma, the prevalence is similarly high among Puerto Ricans in the mainland United States compared with other groups, including other Hispanic Americans. A higher than expected asthma prevalence among Puerto Ricans living both in the mainland and on the island suggests a possible role of genetics.
One way to reduce asthma disparities is through the traditional disease prevention strategies, according to a study entitled “Applying epidemiologic concepts of primary, secondary, and tertiary prevention to the elimination of racial disparities in asthma” by Christine L.M. Joseph, PhD, of the Henry Ford Health System, Detroit, and colleagues.
Joseph noted that primary prevention looks to reduce the number of people with asthma by identifying and removing risk factors that are more common among minorities. After that, secondary prevention involves disease detection, management, and control; the third part of the equation involves identifying the difference race makes in treating and controlling the disease and also looks at the factors that lead to asthma deaths.
Although physicians may not have any control over patients’ genetic makeup or environmental exposure, they can make a difference with patients by improving the social climate, improving access to care, and focusing on patient-physician interaction, according to an editorial entitled “The influence of health disparities on individual patient outcomes: What is the link between genes and environment?” written by Andrea J. Apter, MD, MSc, of the University of Pennsylvania School of Medicine.
The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease.
Revision date: July 6, 2011
Last revised: by Andrew G. Epstein, M.D.