Addressing Racial Disparities in Childhood Asthma

Lara J. Akinbami, MD Infant, Child and Women's Health Statistics Branch National Center for Health Statistics Centers for Disease Control and Prevention Hyattsville, MD 20782. Medical Research Interview with:
Lara J. Akinbami, MD
Infant, Child and Women’s Health Statistics Branch
National Center for Health Statistics
Centers for Disease Control and Prevention
Hyattsville, MD 20782.

MedicalResearch.com: What are the main findings of the study?

Dr. Akinbami : We analyzed national data to assess recent trends in racial disparities on childhood asthma outcome. Historically, racial disparities in asthma prevalence (the percent of children who have asthma) were much smaller than those for asthma outcomes (emergency department visits, hospitalizations and deaths). However, asthma prevalence disparities have recently increased, from 40% higher asthma among black children compared to white children in 2001, to 100% higher in 2010. Because black children are now twice as likely to have asthma than white children, some of the disparities in adverse outcomes could be due just to this higher rate of asthma. So we looked at disparities in two ways: the traditional way where populations as a whole are compared, and an “at risk” analysis where we compared asthma outcomes only between black and white children who had asthma.

When comparing populations of black and white children aged 0-18 years as a whole, black-white disparities in asthma outcomes either remained the same from 2001-2010 (asthma emergency department visit rates and hospitalizations were about three times higher among black children), or increased (asthma deaths increased from 5 times higher among black children in 2001 to 7 times higher in 2010). But when we refocused the analysis to just children who had asthma in an at-risk analysis, we found that racial disparities either remained the same (asthma deaths) or decreased (emergency room visits and hospitalizations). In 2010, black children with asthma were about twice as likely than white children with asthma to visit the ED or be hospitalized for asthma, and 4 times as likely to die from asthma.

These racial disparities in adverse asthma outcomes among children with asthma are still high, but the pattern of stable or decreasing trends in disparities is very encouraging news. There has been concerted effort on many fronts to improve asthma outcomes overall, and in particular among populations suffering from high asthma prevalence and morbidity. Many local studies have shown positive impact of good asthma management, and the national picture reflects this progress. Unfortunately, it is not known how to prevent children from developing asthma, but the tools to control asthma once it develops have been proven effective. The national data suggests that these tools may also be important in addressing disparities in asthma outcomes. When possible, assessing outcomes among the population at risk (i.e., those who have asthma) can provide additional insight into trends in asthma disparities.

Citation:

Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010
Lara J. Akinbami, MD, Jeanne E. Moorman, MS Alan E. Simon, MD, Kenneth C. Schoendorf, MD, MP

Journal of Allergy and Clinical Immunology Available online 1 August 2014