Understanding Disparities in Asthma Outcomes Among African Americans

Racial disparities in asthma have many causes. The literature is consistent in pointing out racial differences in quality and access to asthma care at the level of health care systems. Although this poses an urgent problem, contextual factors at the level of families and neighborhood are central to understanding racial disparities in asthma. In some instances, such contextual factors (eg, housing characteristics and traffic patterns) have the propensity to increase asthma morbidity through their effects on exposure to allergens and pollutants. Similarly, there is emerging evidence of the effect of stress on asthma management behaviors, and the effect of social support on asthma management may vary by community norms and cultural beliefs. The racial disparities seen in asthma also reflect historical and current policy approaches that perpetuate racial differences in the physical and social environment, financing, and access to care. Ongoing and future research should discover gene-environment interactions that may contribute to the observed disparities. However, a number of modifiable causes of the disparities are known. Based on available evidence, even as we wait for research advances to further elucidate and then ameliorate mechanisms leading to racial disparities in asthma, much of the racial gap in asthma morbidity and mortality could be closed by modifying social and health care policy.