Asthma Researchers Examine Racial, Ethnic Experiences, Representation

Research presented at the 2022 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting highlighted a few of the ways that non-White populations experience suboptimal asthma care.

Black/African American and Hispanic people in the United States are disproportionately impacted by asthma with increased prevalence, morbidity, and mortality.

It is already known from prior work that diverse populations and those on Medicaid and other publicly funded plans are dissatisfied with their experiences trying to access and receive health care for asthma. These difficulties are linked with “poor perceptions of asthma control and lower satisfaction with therapy,” according to researchers.

The investigators examined whether racial/ethnic or socioeconomic factors are linked with the perceived quality of care team interactions in patients with asthma, since health outcomes can be impacted by the patient/care team relationship.

Between August 2021 to October 2021, surveys were emailed to 550 people nationwide by the Allergy & Asthma Network. The survey asked patients about their perceptions of their providers on measures of trust, equality, empathy, and communication.

Surveys were completed by 212 individuals aged 6-74 years old. Half were female and the majority self-identified as Black (66%). While there were slight differences between races/ethnicities, 98% percent of respondents had health insurance coverage.

Overall, non-White and publicly insured individuals perceived less-positive interactions with their care teams. The vast majority of patients who were White or who had private medical insurance were satisfied that their care providers gave them “fair medical advice.”

However, more diverse populations disagreed with the idea that they were receiving fair advice. Specifically, 23% of Blacks and 12% of Hispanics and American Indian/Alaskan Natives disagreed; by insurance status, 32% of publicly insured (compared with 10% of privately insured) patients disagreed that their team provided fair advice.

Similar observations in perceptions of equal treatment/respect were seen, as patients who reported satisfaction in this aspect were more likely to report well-controlled asthma symptoms (75%) and satisfaction with current therapy (86%) versus those not perceiving equal treatment/respect (29%).

However, patient-reported asthma symptoms and treatment satisfaction did not vary substantially between races/ethnicities or publicly/privately insured group.

Another study examined the racial/ethnic makeup of participants in clinical trials, which informed the 2020 National Heart, Lung, and Blood Institute (NHLBI) asthma management guidelines focused update. As with other areas of clinical research, diverse populations are often underrepresented in asthma clinical and translational research studies, creating a barrier to achieving health equity.

The researchers analyzed papers in order to determine the frequency of papers reporting sample racial/ethnic demographics and the percent of identified racial/ethnic groups among the studies.

Less than half of papers describing clinical trials reported race/ethnicity data. White participants were generally overrepresented and Black and Hispanic populations were underrepresented within trials.

Specifically, racial demographics were reported in only 36% (16/45) of papers.

For US trials only (n = 6), all papers reported racial/ethnic demographics, but just 2 reported demographics for the white racial group.

In the set of all papers reporting race/ethnicity, the breakdown was as follows:

• 70.8% (n = 31,675) of participants identified as White
• 10.4% (n = 4653) as Black
• 0.2% (n = 91) as Hispanic

American Indian/Alaskan Native/Native Hawaiian/Pacific Islander comprised 2.6% and the classification of Other was 6.1%.

“Intentional inclusion efforts are needed to increase the racial/ethnic diversity of trials informing national asthma guidelines,” the authors concluded. “These factors should also be considered when developing such guidelines.”