Reducing Asthma Disparities
Gaps in the implementation of clinical practice guidelines for asthma contribute to the ongoing problem of asthma-related health disparities among at-risk groups. Closing this disparity gap is a major emphasis of the Guidelines Implementation Panel (GIP) Report , which offers recommendations and strategies for addressing asthma disparities across six priority messages derived from the Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma (EPR-3).
Regardless of age, race, ethnicity, gender, class, income, or personal history, advances in asthma treatment mean that asthma control is achievable for nearly all persons with asthma, but only if clinicians and patients join together to follow the asthma guidelines.
Disparities in the Burden of Asthma
Not all things are equal when it comes to the burden of asthma. Consider these quick facts: (Sources appear at bottom of page)
- The rates of hospitalizations and deaths due to asthma are both 3 times higher among African Americans than among whites. [1,2]
- Puerto Ricans have the highest rates of asthma attacks and deaths due to asthma. 
- Children have 2 times the rate of emergency department visits and hospitalizations for asthma as adults. 
- Compared to white children, asthma prevalence is higher in children who are Puerto Rican (2.4 times), African American (1.6 times), and American Indian/Alaska Native (1.3 times). 
- Women account for nearly two-thirds of all deaths due to asthma in the United States. 
- The percentage of people with asthma taking daily medicine to control asthma is lower among Hispanics (23.2%) and African Americans (25.1%) than among Whites (35.1%). 
Asthma is more common and more severe among children; women; low-income, inner-city residents; and African American and Puerto Rican communities. In general, these disadvantaged and at-risk populations experience above-average rates of emergency department visits, hospitalizations, and deaths that are much higher than differences in asthma prevalence would suggest.
The reasons for these disparities are complex, but cannot be attributed to genetic differences alone. Economic, social, and cultural factors—ranging from lack of access to quality health care to differences in health beliefs between patients and their doctors—add to the greater asthma burden among these groups. Individuals within disadvantaged populations also may face substandard housing and work conditions that place them at greater risk for frequent and prolonged exposure to environmental allergens and irritants that worsen asthma.
Bridging the Disparity Gap
Despite their higher burden of disease, access to medical care for asthma and the quality of care provided is often lower among minority and socioeconomically disadvantaged populations. Disparities in the burden and care of asthma suggest that culturally competent clinical and educational approaches, such as those identified in the GIP Report , are needed to implement the EPR-3 asthma guidelines in high-risk groups and to improve access to quality asthma care. Examples of such approaches include the Physician Asthma Care Education (PACE) Program and multipronged strategies for addressing exposure to environmental factors that worsen asthma at home, school, or work.
Bridging this disparity gap is a challenge. It will require innovative and sustained efforts at multiple levels to translate, tailor, and deliver effective asthma care to diverse populations in line with the recommendations of the EPR-3 guidelines and its companion GIP Report.
All stakeholders involved in controlling asthma have a role to play in reducing asthma-related health disparities. We encourage you to get involved in the NACI National Champions Program and help people in your community breathe easier.
- Centers for Disease Control and Prevention. Asthma prevalence, health care use and mortality: United States, 2003-05.
- Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B. Deaths: Final Data for 2006. National vital statistics reports; vol 57 no 14. Hyattsville, MD: National Center for Health Statistics. 2009.
- Akinbami LJ, Moorman JE, Garbe PL, Sondik EJ. Status of Childhood Asthma in the United States, 1980–2007. Pediatrics. 2009 Mar;123 Suppl 3:S131-45.
- Chevarley, F.M. Asthma Preventive Medicine in 2006—Who Takes Them? Statistical Brief #237. March 2009. Agency for Healthcare Research and Quality, Rockville, MD.