African Americans Less Likely To Obtain Outpatient Asthma Care

Anne Fitzpatrick, PhD

The most important factor in keeping asthma symptoms under control is seeing a healthcare provider on a regular basis. A recent study out of Emory University found that African-Americans, the demographic most impacted by asthma, are less likely to see an outpatient physician for disease management.

The research, led by Anne Fitzpatrick, PhD, director of the Asthma Clinical Research Program at Emory University School of Medicine, evaluated data from the National Heart, Lung and Blood Institute’s Severe Asthma Research Program (SARP). Information on lung function, asthma biomarkers, and asthma control was collected from 579 subjects aged 6 years and older.

According to the US Department of Health and Human Services Office of Minority Health, in 2015, African Americans had an asthma death rate 10 times that of non-Hispanic white children, and are more likely to be admitted to the hospital for asthma.

Primary eligibility for SARP was a physician diagnosis of asthma. Levels of total serum Immunoglobulin E (IgE), allergen-specific IgE, and blood eosinophils were measured. Race, healthcare use over the previous 12 months, current medications, and current environmental exposures (such as tobacco smoke) were self-reported by participants.

Asthma Control Questionnaire, Asthma Control Test (ACT), or Childhood Asthma Control Test assessed disease management, and asthma-related quality of life was calculated using the Asthma Quality of Life Questionnaire or Pediatric Asthma Quality of Life Questionnaire.

While African Americans had a greater risk of emergency room (ER) use (OR, 2.19; 95 % CI, 1.43-3.35), after socioeconomics and environmental exposures were accounted for, the differences in ER use between African-Americans and non-Hispanic whites disappeared.

However, African-Americans remained less likely to see an outpatient physician for asthma management (AOR, 0.57; 95% CI, 0.38-0.85).

Historically, African Americans have had a thorny relationship with the medical community. One study found that African-Americans were less likely to trust their doctors, which can negatively impact research participation.

Fitzpatrick said healthcare providers need to establish trust with their patients by talking with them about possible struggles with seeking care, such as costs, transportation, or inflexible work schedules.

“It is also important to talk to patients about their asthma beliefs. Some people are worried about medication side effects and other people may believe that the medications don’t help them,” she said. “There are many ways to treat asthma and skilled healthcare providers can work with patients to develop personalized treatment plans.”

It can also be difficult to recognize asthma symptoms, which don’t always display as cough or wheeze.

“Some people with asthma have fatigue, difficulty sleeping at night or difficulty with exercise,” Fitzpatrick said. “In some patients, these symptoms come and go and may worsen during certain seasons or following exposure to a trigger (such as cigarette smoke or cold air). Many people are not aware that these symptoms may reflect uncontrolled asthma and do not realize that medications may reduce these symptoms.”

Further studies need to gather better data to figure out how much access to healthcare, mistrust with the medical system, and differences in lived experience with asthma explain the differences in outpatient care for African Americans. In addition, understanding the intricate elements associated with race can help formulate better interventions to address gaps in asthma care.

The study, “Racial Disparities in asthma-related healthcare use in the National Heart, Lung, and Blood Institutes Severe Asthma Research Program,” was published online in the Journal of Allergy and Clinical Immunology.