The Challenge of Asthma in Minority Populations
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.
KeywordsAllergy Clin Immunol Minority Population Environmental Tobacco Smoke Royal Jelly Asthma Care
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- 1.Population Resource Center. Available at: http://www.prcdc.org/summaries/changingnation/changingnation. html. Last accessed January 1, 2005.
- 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.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.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.
- 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.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.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
- 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
- 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
- 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
- 28.Weitzman M, Gortmaker S, Sobol A. Racial, social, and environmental risks for childhood asthma. AmJDis Child 1990; 144: 1189–1194.Google Scholar
- 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
- 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
- 48.Lipson JG, Dibble SL, Minarik PA. Culture and nursing care: A pocket guide. UCSF Nursing Press, San Francisco, 1996.Google Scholar
- 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