Lingering disparities in childhood asthma should be addressed with additional research and quality improvement efforts that work in concert to improve children’s health, according to a new paper published this week by researchers from the University of Chicago Medicine in the medical journal Pediatrics.
“If there was a simple solution to reduce disparities, it would have been done already,” said Valerie Press, MD, MPH, assistant professor of medicine and pediatrics and co-author on the study. “However, solutions exist and it is critical to work toward eliminating these disparities to improve outcomes for all children with asthma.”
Though rates of childhood asthma have plateaued, some racial, ethnic and socioeconomic groups remain at a disadvantage. According to studies dating back to the 1980s, children of racial and ethnic minorities have consistently faced worse asthma outcomes than white children—including things like death rates, hospitalizations and school performance. Non-Hispanic black children have two to three times higher hospitalization rates than white children. Black children face an asthma mortality rate that’s nearly five times higher than their white counterparts.
Linking asthma care across clinical and non-clinical sectors is one key step the researchers say needs to be taken to address disparities.
Anna Volerman, MD, assistant professor of medicine and pediatrics and the study’s primary author, said one explanation for the lingering disparities is that there is no comprehensive approach for asthma care that is scalable, sustainable and widely disseminated. She said enabling research with funding while providing other support for health organizations to address disparities will be critical.
“There’s now a greater incentive for health organizations, insurance companies and payers to look at non-clinical settings—communities, schools, homes—and develop broader strategies for addressing asthma disparities,” she said.
In addition to health care policies and health systems operations, the researchers said solutions must address the many other issues that contribute to the disparities including family, social and environmental factors. Press said people often focus on doing research to inform policy development, but in some cases should focus more on how to make them work in practice.
“In this case, for example, we have a policy in place for schools to protect children with asthma, such as the right to self-carry their inhalers. But carrying the medicine with you isn’t enough if you don’t know how to use it correctly,” she said. “We need to do the research to understand how to implement this policy.”
Other factors affecting disparities include clinic-centric care, indoor allergen exposure, limited primary care and subspecialty access, and poor health literacy.
“Differences in a child’s health outcomes because of his or her race, ethnicity, or economic situation are unacceptable,” said co-author Marshall Chin, MD, MPH, the Richard Parrillo Family Professor and associate chief and director of research in the Section of General Internal Medicine “We must make the elimination of health disparities a national priority and provide clinicians and health care organizations the models and support necessary to make health equity a reality.”
The paper, “Solutions for Asthma Disparities,” was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health, the Chicago Center for Diabetes Translation Research, a National Institute of Diabetes and Digestive and Kidney Diseases Midcareer Investigator Award in Patient-Oriented Research, the Robert Wood Johnson Foundation Finding Answers: Solving Disparities Through Payment and Delivery System Reform Program Office, and the National Heart, Lung, and Blood Institute. It will be published in the March print edition of the journal Pediatrics.