Original Articles: Asthma, Lower Airway Diseases
Racial disparities in asthma-related health outcomes in severe or difficult-to-treat asthma

https://doi.org/10.1016/S1081-1206(10)60490-5Get rights and content

Background

The underlying reasons for racial disparities in asthma morbidity are not well understood. Multivariate epidemiologic studies evaluating the presence and extent of racial differences in a large cohort of adults with severe or difficult-to-treat asthma are lacking.

Objective

To analyze an extensive array of clinical and patient-reported outcomes, using multivariate analysis with a sequential approach, to explain racial differences in asthma-related outcomes in one of the largest cohorts of difficult-to-treat asthmatic patients.

Methods

Black and white patients (≥18 years old at baseline) were included (n = 2,128). Differences between the 2 racial groups were assessed using several outcome measures at month 12. Assessments were adjusted for confounding variables using a sequence of statistical models.

Results

Most patients were white (88.6%). Blacks were slightly younger, less educated, and more likely to live in urban areas than whites. Blacks were more likely to have severe asthma and to be treated with 3 or more long-term controllers. Poorer quality of life, more asthma control problems, and higher risk of emergency department visits were observed in blacks compared with whites; differences were not explained by adjustment for broad sets of confounding variables. Differences in asthma-related health outcomes remained statistically significant after adjusting for asthma severity.

Conclusions

Asthma is a serious health problem in blacks and is not explained by differences in demographics, severity, or other health conditions.

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.

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    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.

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