Advertisement

The Challenge of Asthma in Minority Populations

  • Albin B. Leong
Chapter
Part of the Current Clinical Practice book series (CCP)

Abstract

  • Although asthma affects all races and ethnic groups, there is a significant disparity in asthma morbidity and mortality. Minority populations suffer disproportionately higher rates of fatalities, hospitalizations, and emergency department visits resulting from asthma. For example, non-Hispanic blacks have more than three times the death rate of non-Hispanic whites in the United States.

  • Few studies have addressed ethnic differences in asthma in countries outside of the United States. International survey data have shown considerable variation in asthma prevalence in both children and adults among other countries, with higher prevalence in English-speaking countries, including the United Kingdom, Australia, New Zealand, and Ireland.

  • In the United States, Puerto Ricans, blacks, and American Indians/Alaskan Natives have the highest current and lifetime asthma prevalence and asthma attack rate.

  • Racial/ethnic designations may disguise important differences within groups. For example, Puerto Rican Americans have the highest Hispanic current, lifetime, and asthma attack prevalence, which are comparable to, and exceed rates for, blacks. The larger numbers of Mexican Americans, who have a low prevalence, mask this difference. Hispanics have consequently been considered to have low asthma prevalence.

  • Low socioeconomic status (SES) is an independent and significant factor for increased asthma morbidity and mortality for many minority groups. When controlling for SES, significant disparities in asthma morbidity and mortality generally remain for racial/ethnic minority populations.

  • Barriers to care exist because of lower SES, with decreased access to care and inadequate care, including underprescription of inhaled corticosteroids, increased environmental exposures in urban settings, substandard living conditions, and increased psychosocial dysfunction and cultural differences.

  • Comprehensive and individualized environmental intervention strategies can be effective in reducing allergen environmental burden in urban settings and reduce asthma morbidities.

  • Asthma-susceptibility genes with different ethnic frequencies have been found, with the strongest evidence for 6p21 in European Americans, 11q21 in blacks, and 1p32 in Hispanic Americans. Questions remain regarding the degree of heterogeneity, gene-gene interactions, and gene-environment interactions for different racial/ethnic groups.

  • Culturally competent strategies can be effective in helping to reduce the disparity in asthma health care and outcomes in racial/ethnic minorities.

  • Reduction of asthma disparity in racial and ethnic minority groups is an important challenge and goal and a national priority.

Keywords

Allergy Clin Immunol Minority Population Environmental Tobacco Smoke Royal Jelly Asthma Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Population Resource Center. Available at: http://www.prcdc.org/summaries/changingnation/changingnation. html. Last accessed January 1, 2005.
  2. 2.
    Asthma Prevalence, Health Care Use and Mortality, 2002. Available at: http://www.cdc.gov/nchs/prod-ucts/pubs/pubd/hestats/asthma/asthma.htm. Last accessed December 30, 2004.
  3. 3.
    Action against asthma. A strategic plan for the Department of Health and Human Services. May 2000. Available at: http://aspe.hhs.gov/sp/asthma/. Last accessed January 1, 2005.
  4. 4.
    Department of Health and Human Services. Coordination of Federal Asthma Activities. Available at: http://www.nhlbi.nih.gov/resources/docs/asth01rpt.htm. Last accessed January 8, 2005.
  5. 5.
    Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet 1998; 351: 1225–1232.CrossRefGoogle Scholar
  6. 6.
    Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998; 12: 315–335.PubMedCrossRefGoogle Scholar
  7. 7.
    Variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS). Eur Respir J 1996: 9: 687–695.PubMedCrossRefGoogle Scholar
  8. 8.
    Pearce N, Sunyer J, Cheng S, et al., on behalf of the ISSAC Steering Committee and the European Community-Respiratory Health Survey. Comparison of asthma prevalence in the ISAAC and the ECRHS. Eur Respir J 2000; 16: 420–426.PubMedCrossRefGoogle Scholar
  9. 9.
    Sheikh A, Panesar SS, Lasserson T, Netuveli G. Recruitment of ethnic minorities to asthma studies. Thorax 2004; 59: 634.PubMedGoogle Scholar
  10. 10.
    Hjern A, Haglund B, Bremberg S, Ringbäck-Weitoft G. Social adversity, migration and hospital admissions for childhood asthma in Sweden. Acta Paediatr 1999; 88: 1107–1112.PubMedCrossRefGoogle Scholar
  11. 11.
    Partridge MR. In what way may race, ethnicity or culture influence asthma outcomes? Thorax 2000; 55: 175–176.PubMedCrossRefGoogle Scholar
  12. 12.
    Sin DD, Wells H, Svenson LW, Paul Man SF. Asthma and COPD among aboriginals in Alberta, Canada. Chest 2002; 121: 1841–1846.PubMedCrossRefGoogle Scholar
  13. 13.
    Mitchell EA. Racial inequalities in childhood asthma. Soc Sci Med 1991; 32: 831–836.PubMedCrossRefGoogle Scholar
  14. 14.
    Shafazand S, Cokice G. Asthma. The epidemic has ended, or has it? Chest 2004; 125: 1969–1970.PubMedCrossRefGoogle Scholar
  15. 15.
    Mannino DM, Homa DM, Akinbami LJ, et al. Surveillance for asthma-United States, 1980-1999. MMWR Surveill Summ 2002; 51 (SS1): 1–13.Google Scholar
  16. 16.
    Asthma Prevalence, Health Care Use and Mortality, 2000-2001. Available at: http://www.cdc.gov/ nchs/products/pubs/pubd/hestats/asthma/asthma.htm. Last accessed October 1, 2004.
  17. 17.
    Meng YY, Babey SH, Malcolm E, Brown ER, Chawla N. Asthma in California: Findings from the 2001 California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, 2003.Google Scholar
  18. 18.
    Burchard EG, Avila PC, Nazario S, et al. Genetics of Asthma in Latino Americans (GALA) Study. Lower bronchodilator responsiveness in Puerto Rican than in Mexican subjects with asthma. Am J Respir Crit Care Med 2004; 169: 386–392.PubMedCrossRefGoogle Scholar
  19. 19.
    Boudreaux ED, Emond SD, Clark S, Camargo Jr CA, on behalf of the Multicenter Airway Research Collaboration Investigators. Race/ethnicity and asthma among children presenting to the emergency department: Differences in disease severity and management. Pediatrics 2003; 111: e615–e621.PubMedCrossRefGoogle Scholar
  20. 20.
    Boudreaux ED, Emond SD, Clark S, Camargo Jr CA. Acute asthma among adults presenting to the emergency department. The role of race/ethnicity and socioeconomic status. Chest 2003; 124: 801–812.CrossRefGoogle Scholar
  21. 21.
    Chen JT, Krieger N, Van Den Eeden SK, Quesenberry CP. Different slopes for different folks: Socioeconomic and racial/ethnic disparities in asthma and hay fever among 173,859 U.S. men and women. Environ Health Perspect 2002; 10 (suppl 2): 211–216.Google Scholar
  22. 22.
    Holguin F, Mannino DM, Antó J, et al. Country of birth as a risk factor for asthma among Mexican Americans. Am J Respir Crit Care Med 2005; 171: 103–108.PubMedCrossRefGoogle Scholar
  23. 23.
    Lieu TA, Lozano P, Finkelstein JA, et al. Racial/ethnic variation in asthma status and management practices among children in managed Medicaid. Pediatrics 2002; 109: 857–865.PubMedCrossRefGoogle Scholar
  24. 24.
    Jones CA, Clement LT. Inner city asthma. In: Leung DYM, Sampson HA, Geha RS, Szefler SJ, eds. Pediatric allergy. Principles and practice. Mosby, St. Louis, MO, 2003, pp. 392–404.Google Scholar
  25. 25.
    Grant EN, Lyttle CS, Weiss KB. The relation of socioeconomic factors and racial/ethnic differences in US asthma mortality. Am J Public Health 2000; 90: 1923–1925.PubMedGoogle Scholar
  26. 26.
    Miller JE. The effects of race/ethnicity and income on early childhood asthma prevalence and health care use. Am J Public Health 2000; 90: 428–430.PubMedCrossRefGoogle Scholar
  27. 27.
    Yeatts K, Davis KJ, Sotir M, Herger C, Shy C. Who gets diagnosed with asthma? Frequent wheeze among adolescents with and without a diagnosis of asthma. Pediatrics 2003; 11: 1046–1054.CrossRefGoogle Scholar
  28. 28.
    Weitzman M, Gortmaker S, Sobol A. Racial, social, and environmental risks for childhood asthma. AmJDis Child 1990; 144: 1189–1194.Google Scholar
  29. 29.
    Litonjua AA, Carey VJ, Weiss ST, Gold DR. Race, socioeconomic factors, and area of residence are associated with asthma prevalence. Pediatr Pulmonol 1999; 28: 394–401.PubMedCrossRefGoogle Scholar
  30. 30.
    Weitzman M, Byrd RS, Auinger P. Black and white middle class children who have private health insurance in the United States. Pediatrics 1999; 104: 151–157.PubMedGoogle Scholar
  31. 31.
    Brown ER, Ojeda VD, Wyn R, Levan R. Racial and ethnic disparities in access to health insurance and health care. UCLA Center for Health Policy Research, Los Angeles, CA, 2000.Google Scholar
  32. 32.
    Apter AJ, Boston RC, George M, et al. Modifiable barriers to adherence to inhaled steroids among adults with asthma: It’s not just black and white. J Allergy Clin Immunol 2003; 111: 1219–1226.PubMedCrossRefGoogle Scholar
  33. 33.
    Montalto D, Bruzzese J-M, Moskaleva G, Higgins-D’Alessandro A, Webber MP. Quality of life in young urban children: Does asthma make a difference? J Asthma 2004; 41: 497–505.PubMedCrossRefGoogle Scholar
  34. 34.
    Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N EnglJ Med 2004; 351: 575–584.CrossRefGoogle Scholar
  35. 35.
    Mortimer KM, Neas LM, Dockery DW, Redline S, Tager IB. The effect of air pollution on inner-city children with asthma. Eur Respir J 2002; 19: 699–705.PubMedCrossRefGoogle Scholar
  36. 36.
    Weil CM, Wade SL, Bauman LJ, et al. The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma. Pediatrics 1999; 104: 1274–1280.PubMedCrossRefGoogle Scholar
  37. 37.
    Morgan WJ, Crain EF, Gruchalla RS, et al., for the Inner-City Asthma Study Group. Results of a home-based environmental intervention among urban children with asthma. N EnglJ Med 2004; 351: 1068–1080.CrossRefGoogle Scholar
  38. 38.
    Sullivan SD, Weiss KB, Lynn H, et al., for the National Cooperative Inner-City Asthma Study Investigators. The cost-effectiveness of an inner-city asthma intervention for children. J Allergy Clin Immunol 2002; 110: 576–581.PubMedCrossRefGoogle Scholar
  39. 39.
    Galant SP, Crawford LJR, Morphew T, Jones CA, Bassin S. Predictive value of a cross-cultural asthma case-detection tool in an elementary school population. Pediatrics 2004; 114: e307–e316.PubMedCrossRefGoogle Scholar
  40. 40.
    Fisher EB, Strunk RC, Sussman LK, Sykes RK, Walker WS. Community organization to reduce the need for acute care for asthma among African American children in low-income neighborhoods: The Neighborhood Asthma Coalition. Pediatrics 2004; 114: 116–123.PubMedCrossRefGoogle Scholar
  41. 41.
    Lester LA, Rich SS, Blumenthal MN, et al., and the Collaborative Study on the Genetics of Asthma. Ethnic differences in asthma and associated phenotypes: Collaborative Study on the Genetics of Asthma. J Allergy Clin Immunol 2001; 108: 357–362.PubMedCrossRefGoogle Scholar
  42. 42.
    Blumenthal MN, Langefeld CD, Beaty TH, et al. A genome-wide search for allergic (atopy) genes in three ethnic groups: Collaborative Study on the Genetics of Asthma. Human Genet 2004; 114: 157–164.CrossRefGoogle Scholar
  43. 43.
    Xu J, Meyers DA, Ober C, et al., and the Collaborative Study on the Genetics of Asthma. Genome wide screen and identification of gene-gene interactions for asthma-susceptibility loci in there U.S. popula-tions: Collaborative Study on the Genetics of Asthma. Am J Human Genet 2001; 68: 1437–1446.CrossRefGoogle Scholar
  44. 44.
    Federico MJ, Covar RA, Brown EE, Leung DYM, Spahn JD. Racial differences in T-lymphocyte response to glucocorticoids. Chest 2005; 127: 571–578.PubMedCrossRefGoogle Scholar
  45. 45.
    Choudhry S, Ung N, Avila PC, et al. Pharmacogenetic differences in response to albuterol between Puerto Ricans and Mexicans with asthma. Am J Respir Crit Care Med 2005; 171: 563–570.PubMedCrossRefGoogle Scholar
  46. 46.
    Evans DAP, McLeod HL, Pritchard S, Tariq M, Mobarek A. Interethnic variability in human drug responses. Drug Metab Dispos 2001; 29: 606–610.PubMedGoogle Scholar
  47. 47.
    George M. The challenge of culturally competent health care: Applications for asthma. Heart Lung 2001; 30: 392–400.PubMedCrossRefGoogle Scholar
  48. 48.
    Lipson JG, Dibble SL, Minarik PA. Culture and nursing care: A pocket guide. UCSF Nursing Press, San Francisco, 1996.Google Scholar
  49. 49.
    Hardie GE, Janson S, Gold W, Carrieri-Kohlman V, Boushey HA. Ethnic differences: Word descrip-tors used by African-American and white asthma patients during induced bronchoconstriction. Chest 2000; 117:935–943.PubMedCrossRefGoogle Scholar
  50. 50.
    Pachter LM, Cloutier MM, Bernstein BA. Ethnomedical (folk) remedies for childhood asthma in a mainland Puerto Rican community. Arch Pediatr Adolesc Med 1995; 149: 982–988.PubMedGoogle Scholar
  51. 51.
    Beach MC, Cooper LA, Robinson KA, et al. Strategies for Improving Minority Healthcare Quality. Evidence Report/Technology Assessment No. 90 (Prepared by the Johns Hopkins University Evidenced-based Practice Center, Baltimore, MD). Agency for Healthcare Research and Quality, Rockville, MD, January 2004. AHRQ Publication No. 04-E008-02.Google Scholar
  52. 52.
    Lie TA, Finkelstein JA, Lozano P, et al. Cultural competence policies and other predictors of asthma care quality for Medicaid-insured children. Pediatrics 2004; 114: e102–e110.CrossRefGoogle Scholar
  53. 53.
    Epstein A, Ayanian J. Racial disparities in medical care. N Engl J Med 2001; 344: 1471–1472.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2006

Authors and Affiliations

  • Albin B. Leong
    • 1
  1. 1.Department of Pediatric Pulmonology and AllergyKaiser Permanente Medical GroupSacramento

Personalised recommendations