Find Asthma's Harm Rising Fastest Among Blacks
(Beyond Pesticides, February 15, 2006) The rates of deaths and hospitalizations of black children from asthma have increased at a disproportionate rate during the last two decades, according to three new studies released this week. Researchers continue to look for reasons why programs aimed at eliminating such health disparities have not succeeded.
Black children between the ages of 5 and 18 experienced a significant rise in asthma hospitalizations and deaths between 1980 and 2002, amounting to an additional 46 deaths per year. White children, meanwhile, experienced 12 additional deaths per year during the same period.
Ruchi S. Gupta, MD, lead author of the article examining the widening racial gap, which appears in the February issue of the Journal of Allergy and Clinical Immunology, said it is easy to see that something as yet undetermined, such as genetics or environment, may play a large role.
"We need to really look into what's causing this -- whether it's the quality of care received, the treatments offered to certain populations and not others," said Dr. Gupta, an assistant professor of pediatrics at the Northwestern University Feinberg School of Medicine and Children's Memorial Hospital, both in Chicago.
Generally, African-Americans have a higher prevalence of asthma than whites. They are five times more likely to die of the disease and four times more likely to be hospitalized. Asthma prevalence, however, is highest among Puerto Ricans, followed by Native Americans and non-Hispanic blacks, the study points out.
Dr. Gupta and the other researchers note that the largest factor associated with quality in asthma management, beyond access to health insurance, is the medication used to treat the disease. Black children on Medicaid had worse cases of asthma, for instance, and less use of preventive medication than white children, according to Gupta's study.
But other researchers note that little-understood genetic differences may be influencing how blacks respond to asthma medications. Environment, especially in urban areas where residents may be exposed to more pollutants, also has long been suspected as a culprit. Children who live in poverty in inner cities are the most at risk for asthma, as they live in crowded, inadequate housing where poor conditions lead to at high risk of many asthma triggers and causes, including to chemical pesticides—both legal and illegal—used to control the pests. Additionally, most housing projects are routinely sprayed with insecticides
Others say treatment may have nothing to do with the disparities, according to the researchers. "We need to understand how cultural beliefs and attitudes influence disease management," said Christine Joseph, epidemiologist with the Henry Ford Health System in Michigan, the lead author of one of the journal articles.
More than six million American children have asthma, which is the leading cause of school absenteeism attributed to chronic conditions and the third-leading cause of hospitalizations among children under age 15. Asthma can be a life-threatening disease if not properly controlled through appropriate asthma care management, which relies on physicians’ and nurses’ clinical knowledge and skills, as well as parents’ and children’s daily attention to asthma triggers and medications. Environmental asthma triggers include allergens and pollutants. Allergens can be dust mites, cockroaches, animal allergens, molds, and pollens. Indoor and outdoor pollutants include secondhand smoke, chemicals, pesticides, combustion by-products, smog and fine particles.
To learn about the link between pesticides and asthma, check out Beyond Pesticides’ 15-page color booklet, Asthma, Children and Pesticides: What you should know to protect your family. The booklet examines children's susceptibility to asthma, the differences between the causes of asthma and asthma triggers, specific pesticides linked to asthma, the demographics of asthma, tips for controlling pests linked to asthma without using pesticides and steps you can take to avoid asthma causes and triggers. The brochure is available online or by calling Beyond Pesticides, 202-543-5450 for hardcopies.