Original Articles: Asthma, Lower Airway DiseasesRacial disparities in asthma-related health outcomes in severe or difficult-to-treat asthma
Section snippets
INTRODUCTION
The prevalence of asthma and asthma-related hospitalizations and deaths is higher in the black population vs the white population.1, 2, 3 Mortality rates in the United States between 1980 and 2002 indicate that the asthma mortality gap between blacks and whites had widened.3 In 2002, a US Centers for Disease Control and Prevention survey showed that of 30.8 million people, the asthma prevalence was almost 38% higher in blacks than in whites.1 According to the survey, blacks had an approximate
Objectives, Study Design, and Participants
The primary objective of the TENOR study was to better understand the natural history of disease in patients with severe or difficult-to-treat asthma. Secondary objectives were to examine the relationship between asthma treatments and outcomes, to observe the frequency of comorbid conditions, and to describe the relationship between IgE levels and disease.
The methods and baseline population characteristics of the TENOR study have been described previously.22 Briefly, TENOR was a prospective,
Univariate Analyses
Of the 4,756 enrolled patients, 2,128 were included in this analysis. There were no differences between the study population analyzed and the excluded patients. Most patients were white; black patients were slightly younger than whites (Table 1). Black patients had significantly lower levels of income and education and were more likely to live in urban areas. Black patients were heavier and were less likely to be covered by a preferred provider organization. Although blacks were more likely to
DISCUSSION
To our knowledge, this is the first analysis to examine racial differences in several asthma-related health outcomes in a large cohort of adults with severe or difficult-to-treat asthma. Blacks were more likely to have poorer asthma-related quality of life, more asthma control problems, and higher risk of an asthma-related ED visit compared with whites, even after adjusting for confounding variables. No differences in barriers to disease management between the 2 groups were observed, yet blacks
ACKNOWLEDGMENTS
We thank Cynthia Mamay, PhD, of Genentech Inc for her help in the preparation of the manuscript.
REFERENCES (56)
- et al.
The widening black/white gap in asthma hospitalizations and mortality
J Allergy Clin Immunol
(2006) - et al.
Racial differences in physiologic parameters related to asthma among middle-class children
Chest
(2000) - et al.
Ethnicity and skin test reactivity to aeroallergens among asthmatic children in Connecticut
Chest
(2004) - et al.
Asthma morbidity and treatment in the Chicago metropolitan area: one decade after national guidelines
Ann Allergy Asthma Immunol
(2005) - 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) - et al.
Reducing disparities in asthma care: priorities for research: National Heart, Lung, and Blood Institute workshop report
J Allergy Clin Immunol
(2002) - et al.
Applying epidemiologic concepts of primary, secondary, and tertiary prevention to the elimination of racial disparities in asthma
J Allergy Clin Immunol
(2006) - et al.
Acute asthma among adults presenting to the emergency department: the role of race/ethnicity and socioeconomic status
Chest
(2003) The influence of health disparities on individual patient outcomes: what is the link between genes and environment?
J Allergy Clin Immunol
(2006)- et al.
Use of regularly scheduled albuterol treatment in asthma: genotype-stratified, randomised, placebo-controlled cross-over trial
Lancet
(2004)
Design and baseline characteristics of The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study: a large cohort of patients with severe or difficult-to-treat asthma
Ann Allergy Asthma Immunol
Assessing productivity loss and activity impairment in severe or difficult-to-treat asthma
Value Health
Association of being overweight with greater asthma symptoms in inner city black and Hispanic children
J Pediatr
Sociodemographic correlates of indoor allergen sensitivity among United States children
J Allergy Clin Immunol
Variation in total and specific IgE: effects of ethnicity and socioeconomic status
J Allergy Clin Immunol
Total serum IgE levels in a large cohort of patients with severe or difficult-to-treat asthma
Ann Allergy Asthma Immunol
Racial differences in emergency department use persist despite allergist visits and prescriptions filled for antiinflammatory medications
J Allergy Clin Immunol
Emergency department visits by urban African American children with asthma
J Allergy Clin Immunol
Asthma-related healthcare services utilization by African-Americans enrolled in West Virginia Medicaid
Respir Med
Racial differences in T-lymphocyte response to glucocorticoids
Chest
The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol
Chest
Salmeterol response is not affected by β2-adrenergic receptor genotype in subjects with persistent asthma
J Allergy Clin Immunol
Asthma Prevalence. Health Care Use and Mortality, 2002
Epidemiology of asthma
Semin Respir Crit Care Med
Racial, social, and environmental risks for childhood asthma
Am J Dis Child
Race and sex differences in consistency of care with national asthma guidelines in managed care organizations
Arch Intern Med
Racial and ethnic differences in access to medical care in managed care plans
Health Serv Res
The relation of socioeconomic factors and racial/ethnic differences in US asthma mortality
Am J Public Health
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2022, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Asthma prevalence is also correlated with body mass index (BMI) in women [13], and extremes of BMI impact on perinatal mortality [14]. Another factor is race, as black women have more asthma morbidity than white women outside [15] and during pregnancy [16]. The interactions of these factors could therefore exert significant effects on pregnancy and perinatal outcome [17–21].
Tree canopy, pediatric asthma, and social vulnerability: An ecological study in Connecticut
2022, Landscape and Urban PlanningFractional exhaled nitric oxide response to oral corticosteroids in children with mild-to-moderate asthma: Influence of race
2020, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Socioeconomic hardship (eg, low annual household income, caregiver education attainment), cultural beliefs, failure to fill prescriptions, poor adherence to controller medication, limited access to health care, and environmental exposure to perennial indoor allergens (house dust mite, cockroach) and pollution may contribute to racial disparities in asthma outcomes.32,33 With that said, differences in asthma morbidity persist even after statistical adjustments for all these factors,14,32,34-38 with some studies suggesting that asthma could be more severe in AA children owing to different underlying pathobiology.38,39 There are some limitations to this study.
Race and Asthma Outcomes in Older Adults: Results from the National Asthma Survey
2020, Journal of Allergy and Clinical Immunology: In Practice
Disclosures: Dr Haselkorn has been a paid consultant for Genentech Inc since December 2002. Dr Lee is employed by Genentech Inc. Mr Mink is employed by Ovation Research Group, a company that receives research funding from Genentech Inc and other pharmaceutical and biotechnology companies. Dr Weiss serves as an adviser to, has received educational grants from, and participates in speaker programs for GlaxoSmithKline, Roche Pharmaceuticals, AstraZeneca Pharmaceuticals LP, Millennium Pharmaceuticals Inc, Genentech Inc, Schering-Plough Corp, Variagenics Inc, Genome Therapeutics, and Merck & Co Inc.
Funding Sources: The TENOR study is funded by Genentech Inc and Novartis Pharmaceuticals Corp.