Racial disparities in asthma-related health outcomes in children with severe/difficult-to-treat asthma

Publication date: Available online 29 August 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Theresa Guilbert, Robert S. Zeiger, Tmirah Haselkorn, Ahmar Iqbal, Cynthia Alvarez, David R. Mink, Bradley E. Chipps, Stanley J. Szefler

Abstract

Background

There are limited data which examine differences in asthma etiology between Black and White children with severe or difficult-to-treat asthma.

Objective

To describe demographic, clinical, and asthma-related outcomes in Black and White children and examine whether differences in outcomes are explained by confounding factors in sequential multivariable models.

Methods

Black (n=86) and White (n=262) children ages 6–11 years from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) 3-year observational study were analyzed. Baseline demographics and clinical characteristics were described for both cohorts and outcomes at Month 12 were analyzed using statistical models, sequentially adjusting for potential confounders.

Results

Black children were more likely to be male (79.1% vs. 66.4%, P<0.05), obese (12.8% vs. 1.5%, P<0.001), and from a lower income stratum (43,400 vs. 55,770 USD; P<0.001) than White children. Black children had higher geometric mean immunoglobulin E levels (434.8 vs. 136.8 IU/mL; P<0.001), were more likely to have very poorly controlled asthma (72.1% vs. 53.4%), use long-term systemic corticosteroids (30.2% vs 9.2%; P<0.001), have poorer quality of life (5.5 vs. 6.1; P<0.001), and have an emergency department visit (27.4% vs. 7.7%, p<0.001) in the three months prior to Month 12. Differences in asthma control and the severity of exacerbations persisted even after accounting for all confounding factors.

Conclusion

Among children with severe or difficult-to-treat asthma, asthma burden is greater in Black than White children particularly related to several clinical and patient-reported outcome measures which are not explained by differences in background or clinical characteristics.