In this MD Newsline exclusive interview with allergist and immunologist Dr. Sakina Bajowala, we discuss how asthma disparities affect Black and Brown communities.
Do racial/ethnic minority patients experience more severe asthma? If so, why?
Dr. Sakina Bajowala:
“There are multiple factors that contribute to why people of color bear a greater burden of asthma severity and frequency of exacerbations. Of these factors, the most significant determinants are structural and social in nature.
So when you look into the history of redlining and how certain communities of color have been corralled into urban areas adjacent to highways where they have greater exposure to airborne pollution and particulate matter, that’s a determinant.
The social determinant of decreased income, so income disparity, which then plays into the ability to afford medications, to have access to reliable and high-quality healthcare—these factors play into asthma disparities, and also, a history of mistrust of the medical profession.
For Black communities and Indigenous communities, in particular, there’s been a well-documented history of inequity and overt discrimination and abuse in healthcare in the past. This history has led to a deep-seated mistrust of medical professionals and medical recommendations in certain communities. And so, we have a lot to overcome.
You know, people ask if genetic factors or individual behaviors can be the determinant of why we’re seeing these differences in asthma severity in communities of color, but the data don’t really bear that out. The structural and social determinants of health are way more impactful than individual determinants. And so, that means we have an opportunity with legislative agendas and healthcare agendas to really make a big difference in asthma disparities if we make the right choices.
So the burden of asthma definitely falls disproportionately on communities of color, specifically African Americans, the Latinx community, and Indigenous populations. When compared to white Americans, Black Americans are 1.5 times more likely to have asthma, 5 times more likely to visit the emergency room due to asthma, and 3 times more likely to die from asthma. Black women have the highest rates of death from asthma.
When compared to white Americans, Puerto Ricans have the highest rate of asthma prevalence compared to any other racial or ethnic group in the United States. And Indigenous adults are 2 times more likely to experience daily asthma symptoms and are far more likely to have asthma symptoms that wake them up at night when compared to their white counterparts.
These disparities have persisted despite significant advances in the management of severe asthma from the medication and biologic standpoint. And what we know is that structural racism in society has resulted in lower economic opportunity, higher rates of medical comorbidities, decreased access to high-quality preventive healthcare, and increased exposure to environmental pollution in Black and Brown communities. Mistrust of the healthcare system also compounds the problem.
As mentioned, genetic factors and individual behaviors contribute significantly less to asthma disparities than structural and social determinants. This finding means we have opportunities as a society to implement changes that can benefit large populations in the long term, even if we can’t do anything about the genetic determinants of health.”
Can you give us an example of how socioeconomic status impacts patients with asthma?
Dr. Sakina Bajowala:
“An example of how socioeconomic status impacts patients with asthma is exposure to airborne particles. We have data showing that individuals with lower incomes tend to live in areas with closer proximity to major roadways, and therefore higher exposure to traffic-related pollution from trucks and automobiles.
Prenatal exposure to airborne pollution and particulate matter is associated with increased rates of wheezing and asthma development in children, regardless of whether the mother has a history of asthma herself. Pollution exposure has also been linked to increased rates of asthma development in school children and adults. And once asthma is established, increased exposure to traffic-related air pollution is associated with a greater risk of exacerbations as well.
The most effective solution is relocation out of that area, but that’s unfortunately not a viable option for individuals who may rely on subsidized housing, which tends to be located in these high-risk areas. Or, they may not have the ability to live in a less urban area due to lack of funds or lack of transportation.”
Responses have been condensed and lightly edited.