Asthma is one of the most common chronic conditions seen in the United States. Statistics on asthma prevalence show that boys have a higher rate of asthma than girls, but women have a higher rate than men. But are there differences in the races? Yes, and it’s vital that we examine racial disparities when considering the topic of controlling asthma.
Let’s first look at pediatric asthma. The 2016-18 National Health Interview Survey is a review of household interviews that provides nationally representative estimates on a wide range of health data in the United States. Statistics from it display the racial differences in the pediatric asthma rate. White children have an asthma frequency of 6.8%, while the rate is more than twice as high in Black children at 14.2%. The Hispanic pediatric prevalence is slightly higher than white at 7.5%. What’s very interesting is what we find when Hispanic children are separated into Mexican and Puerto Rican subsets; for Mexican it’s 6.6% of children with asthma, while for Puerto Rican, it’s more than twice that with 13.6%. This points out the need for better understanding of the range within the Hispanic population in terms of caring for asthma. In the same survey, looking at the percentage of those with asthma flares in the past 12 months, the numbers were around the same for white, Black and Hispanic populations at approximately 50%, which points out the need for better control of symptoms for all children with asthma.
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In the adult asthma population, we also see differences between races from the 2016-18 National Health Interview Survey data. Whites comprised 8.2% of those with asthma, Blacks 9.6% and Hispanics 6%. Again, we find a disparity in prevalence between Puerto Rican and Mexican Hispanics, with Puerto Ricans at 14.2% and Mexicans about a third of that number at 4.8%.
From surveillance data from the Centers for Disease Control and Prevention, the death rate in pediatric and adult asthma for 2018 was evaluated by examining death rate per million population. For the white population, it was 9.5 per million, less than half the rate in the Black community at 21.8, while the Hispanic rate was 6.3. Any death from asthma is a tragedy, but it’s alarming to see the very high rate in the Black population.
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What are some of the reasons for the racial disparities seen in asthma? One answer is the response to asthma medications. Studies have shown that Puerto Ricans in the U.S. respond with less improvement in opening up their lungs with medications like albuterol than do Mexicans. In the Black asthma population, research has shown that these patients respond less well than Whites to long-acting bronchodilators and inhaled corticosteroids, which are commonly used together for regular asthma control. It appears that Black people with asthma have more persistent inflammation in their lungs due to white blood cells called eosinophils, leading to poorer control of their disease with inhaled corticosteroids. Also, Blacks with asthma have a higher IgE level than seen in their White counterparts. IgE is the antibody involved in allergic reactions. All of this suggests that genetics play a role in more severe asthma, and there is a need for an increase in clinical studies to assess how different asthma medications work depending on race.
Are genetics the only reason we see the differences in asthma morbidity and mortality between ethnic groups? The answer is no. There are many factors involved. There are factors such as cultural differences that question the necessity of medication in asthma control, which has been illustrated in the Hispanic population. Surveys in the Hispanic and Black populations have shown a greater use of complementary and alternative asthma medications than in whites, which may lead to poorer control. A major issue is health care coverage within certain groups. Access to quality care, employment, education and neighborhood and physical environment may hamper asthma management and consistent medication use. Dealing with systemic racism is a priority for allergists. A 2019 study in Annals of Allergy, Asthma, and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology, showed a link between an increased amount of stress caused by racism and other race-based factors faced by Black caregivers and a worsening of asthma control in their children.
[READ MORE: COPD, Asthma and the Environment.]
Much needs to be done by medical research, the local community and by national policy makers to address disparities in asthma in the U.S. so that everyone has equal access to quality asthma care.
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