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Disparities in childhood asthma among racial and ethnic minorities are examined through five domains: socio-cultural, biological, built environment, behavioral, and health systems.

Introduction
Asthma is a heterogeneous disease that causes inflammation in the respiratory airways, impacts over 25 million Americans, and can lead to permanent airway obstruction and death. Asthma has been shown to disproportionately impact individuals from racial and ethnic minorities, and can be examined through five domains: socio-cultural, biological, built environment, behavioral, and health systems.

Socio-Cultural
Asthmaโ€™s prevalence in Puerto Rican and non-Hispanic Black children (21.2% and 14.5%, respectively) is higher than in non-Hispanic White and Mexican American children (8.2% and 7.5%, respectively). Sub-populations within the Hispanic population experience worsened disparities as degrees of African ancestry increase. Similarly, asthma mortality rates are twice as high for African Americans as for white Americans (21.8 vs 9.5 death rate per million).

Biological
Genome-wide association studies (GWASs) of asthma discern that loci associated with asthmaโ€™s prevalence, while detected in European, Asian, and Latino individuals, has been less robust in African populations until recently, and requires further study. Studies of developing asthma in twin siblings indicate that the impact of ancestry in this disease is difficult to quantify and is confounded by multiple factors impacting health, such as social determinants and environmental exposures.

Built Environment
A healthy, nutrient-rich diet is associated with protective factors against asthma by modulating systemic inflammation, oxidative stress, etc. In the US, 12% of the population have limited access to adequate, healthy food, and this is exacerbated in racial and ethnic minority communities that live in rural areas. Racial and ethnic minorities are also overrepresented in neighborhoods with inadequate housing, higher levels of pollution, and crime. The concentration of Black and other minority groups in substandard neighborhoods is a result of racist redlining policies. Today, emergency asthma visits are 2.4 times higher for residents of areas that were more likely to be redlined than for residents of areas that were less likely to be redlined.

Behavioral
Racial and ethnic minority patients with asthma have lower rates of medication adherence, increasing the existing disparities in asthma prevalence rates. This has been attributed to various factors including beliefs about medication, patient-provider interactions, language barriers and racial concordance, and barriers to accessing insurance and medication. In addition, patients experiencing racism and discrimination are further burdened with psychological stressors associated with worsened health outcomes.

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Health Systems
Mistreatment in, and lack of access to health systems have been well-documented for patients from racial and ethnic minority groups, due to systemic racism. These patients lose trust in the healthcare system, and as a result, African American caregivers of children with asthma report higher levels of dissatisfaction with patient-provider relationships, leading to lower likelihood of contacting providers regarding health concerns and higher rates of preventable emergency room visits. Providers seeing these patients are also less adherent to asthma guideline recommendations, and may underestimate asthma severity. Implicit bias in providers worsens disparities in asthma morbidity in these populations.

Summary
This article concludes with a call to action for healthcare professionals to address the domains that contribute to asthma disparities among their racial and ethnic minority patients, both on an individual level and systemically.

Source
Perez, M. F., & Coutinho, M. T. (2021). An Overview of Health Disparities in Asthma. Yale Journal of Biology and Medicine, 94(3), 497-507. PMID: 34602887