Unlike many other conditions, asthma is a household name. It’s one of the most common chronic diseases in the U.S., affecting about 1 out of every 12 people. But it doesn’t affect every population group equally. Research shows that asthma is more common, and more serious, among the Black population than in people of other races.
Asthma's Impact on the Black Community
In 2020, 4 million Black adults and children reported they had asthma. The actual number may be higher since many people go undiagnosed. Studies suggest startling differences between Black people with asthma and other groups:
- Non-Hispanic Black people are 30% more likely to have asthma than non-Hispanic White people.
- Black people are three times more likely to die from asthma-related causes than White people.
- Black children are more than four times more likely to be admitted to the hospital for asthma than White children.
- Black children are more than seven times more likely to die from asthma-related causes than White children.
In the United States, 10 people die from asthma each day – deaths that are largely avoidable if asthma is treated properly. Black people are twice as likely to die, compared to White people. Black females are three times more likely to die from asthma than White males.
What Causes These Disparities?
So why do Black people struggle with asthma more than their peers? The reasons are complicated and involve:
- Discriminatory public policies
- Inequalities in health care and research
- Economic and social factors
- Environmental pollution, both indoor and outdoor
Research has found there may also be genetic differences that add to the higher rates and worse symptoms of asthma among Black people.
The Effects of Poverty
Income inequality increases asthma’s burden on the Black community in several ways.
Access to care. Although the gap has narrowed since the Affordable Care Act took effect, Black people in the U.S. are still less likely than White people to have health insurance coverage. And even those who have insurance may not:
- Have asthma specialists (pulmonologists) or even primary caredoctors in their area
- Have reliable transportation to get to medical care
- Be able to easily get off work
Such barriers can mean that Black children and adults get much of their asthma care from emergency rooms, instead of stable and consistent treatment by a doctor. They can also delay an asthma diagnosis, which can seriously affect long-term health outcomes.
Costs of treatment. Treating any chronic condition can be expensive when you include tests, labs, doctor visits, and treatments. Even those with insurance may have trouble affording copays for doctor visits or asthma medications. The average annual medical cost of asthma is $3,266 per person, according to the Asthma & Allergy Foundation.
The Effects of Your Environment
Where you live can affect whether you have asthma. Both indoor contaminants and outdoor pollution can trigger asthma attacks and make symptoms worse.
Indoor asthma triggers. People of color are more likely to rent rather than own their homes, and many live in lower-income housing. Often, this housing is older and in poor condition. This can expose you to asthma triggers such as rodents, insects, and mold.
Whether they rent or own, Black people are more likely than White people to live in housing that the Department of Housing and Urban Development classifies as “inadequate.” If you’re a renter, or have to spend more than half of your income on housing, you’re unlikely to be able to make housing repairs or updates.
Secondhand smoke plays a role as well. It raises the risk that young children will get the condition. And children with asthma who live with smokers have more and worse attacks, and need more asthma medicine, than others. According to the CDC, Black people are more likely to be exposed to secondhand smoke than any other group.
Outdoor pollution. Regardless of their incomes, Black families tend to live in areas with higher levels of air pollution. People of color make up 52% of those who live in areas with unhealthy air quality, though they’re about 42% of the U.S. population. Because of discriminatory zoning and land-use policies over the years, highways and factories are often concentrated in minority neighborhoods. A lack of trees in these communities can further add to unhealthy air.
Children exposed to air pollution are more likely to have asthma. In people who already have it, poor air quality can worsen symptoms and make it harder to manage them.
Inequities and Discrimination in Health Care
Bias among health care providers and researchers also plays a role in delayed diagnoses, insufficient treatment, and worse outcomes for asthma in Black people.
Bias in health care. Bias within the health care system, including implicit bias, may affect treatment decisions and patient education. Implicit bias is when you have feelings or thoughts about a group of people without being aware of them. For example, some White people may have thoughts about Black people being criminals without realizing it.
Bias can show up among health care providers just as it can in the general population. As a result, Black people may get poor or incomplete care, or their symptoms may be dismissed. An Institute of Medicine report found that minority patients got inferior medical care for asthma and other diseases regardless of their income and health insurance coverage.
Many health care organizations are working to address such bias, doing things like training health care workers about it and encouraging more people of color to enter medical fields.
Clinical trials and research. Clinical trials help scientists develop fine-tuned diagnoses and treatments for many conditions. They use real people to help solve big medical issues. Until recently, clinical trials were largely filled with White males.
While Black people are more likely to have asthma than other racial groups, they are largely missing from most asthma clinical trials. This results in a lack of data that keeps scientists from fully understanding how asthma may affect people of color or how they react to treatment. This is true for research into other conditions as well. For example, only 18% of cancer research studies include Black people.
Cultural and Social Barriers
Certain cultural and social barriers may also help to increase poor outcomes for Black people with asthma.
Mistrust of medical professionals. Due to historical injustices like the U.S. Public Health Service Tuskegee Syphilis Study (in which researchers left Black men with syphilis untreated), and also due to personal experiences with discrimination, some members of the Black community lack trust in the health care system. This may keep them from visiting a doctor for their asthma, or from effectively working with their doctors to improve their health.
This mistrust may extend to medications used to treat asthma. In one study of Black adults, more than half said they weren’t sure whether inhaled corticosteroids (a common treatment) were safe to use. This mistrust may lead Black patients and caregivers to try less effective home remedies instead of standard medical treatments .
Lack of health literacy. People living in low-income areas, many of whom are minorities, are more likely to have low health literacy. Health literacy is defined as the ability to find, understand, and use credible information about health. Those with low levels of health literacy are less likely to understand how to get adequate health care and correctly use medications.
For immigrant Black families, communication issues may also hinder diagnosis and treatment.
Social burdens. Many caregivers for Black children with asthma face challenges with finances, work, and their own health. This makes managing an unpredictable condition like asthma all the more difficult.
Further, long-term stress from dealing with racism and discrimination not only makes it harder to control asthma, but may increase your chances of getting it in the first place.
What Role Does Biology Play?
Ethnicity is linked to your ancestry. And your genes also help determine whether you get asthma and how serious it is.
Genetics. Scientists have identified certain genes that are linked to an increased risk of asthma in those with African ancestry, such as Black and Puerto Rican people. Your genes may not only influence how likely you are to get asthma, but how serious it is and how well treatments work. Researchers are continuing to study this genetic connection.
Inflammation. Studies also suggest Black people are more likely to have a certain type of inflammation in their airways that leads to hard-to-control asthma. This inflammation, called eosinophilic airway inflammation, also may make it harder for Black patients to respond to certain asthma treatments. We need more research to understand this difference and come up with possible solutions.
The Color of Change
Despite the harsh statistics, some efforts are underway to help close the racial gap for asthma patients.
The American Lung Association has partnered with historically black colleges and universities for its “Breathe Well, Live Well” program. The program aims to help college students understand asthma triggers and learn to better manage their asthma in partnership with their doctors. It also helps raise awareness about how asthma impacts the Black community.
The Health Equity, Advancement and Leadership (HEAL) initiative, from the Asthma and Allergy Foundation of America, funds local projects that address the asthma burden on communities of color.
Early data shows the HEAL program had these impacts within its first six months:
- 100% increase in people who felt confident they couldmanage their asthma
- 69% increase in people whose asthma was well-controlled
- 59% decrease in unplanned emergency room and doctor visits due to asthma
- 35% reduction in the use of rescue inhalers or nebulizers for daily asthma management
- 31% of people in the program who saw an asthma specialist (pulmonologist), some for the first time
The foundation’s “Asthma Disparities in America” report highlights the burden of asthma on diverse communities and the potential solutions. Some progress has been made in reducing the disparities. For example, more Black people (over 2.7 million) have insurance due to the Affordable Care Act. Nationwide efforts to address outdoor air pollution and indoor air quality are also in progress.
But there’s more work ahead. Experts are looking for ways to close the gap. Some ideas on the table include:
- Establishing federally qualified health centers in Black neighborhoods, while continuing to address air pollution
- More community public health programs to increase asthma education
- Putting price caps on asthma medications
- Increasing diversity in asthma clinical trials
- Encouraging more people of color to consider medical careers – as asthma specialists, asthma researchers, and more
Show Sources
Photo Credit: DigitalVision/Getty Images
SOURCES:
Hannah Jaffee, research manager, Asthma and Allergy Foundation of America.
Lynne Bosma, health equity manager, Asthma and Allergy Foundation of America.
Melanie Carver, chief mission officer, Asthma and Allergy Foundation of America.
Cedric “Jamie” Rutland, MD, FCCP, pulmonary, critical care, and internal medicine doctor; owner, Rutland Medical Group, Newport Beach, California.
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Allergy and Asthma Proceedings: “Homes of low-income minority families with asthmatic children have increased condition issues.”
Milken Institute School of Public Health: “Communities of Color Across the U.S. Suffer A Growing Burden from Polluted Air.”
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