Infectious Disease

Racial, social inequalities influence asthma-related hospital admissions

August 16, 2021

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The authors of the study do not report any relevant financial information.

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According to study results published in the Journal of Allergy and Clinical Immunology, African ancestry appeared to be strongly linked to readmission after asthma-related hospitalization in children.

However, the researchers found that the association was resolved when familial hardships and disease management were taken into account.

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“As far as we know, the study is the first to show that increased African ancestry is positively associated with an increased likelihood of re-admission of pediatric asthma. However, our results suggest that this association is mediated through hardening and the association of hardship with other exposures. ” Tesfaye B. Mersha, PhD, Associate Professor in the Department of Pediatrics at the University of Cincinnati and colleagues wrote. “In other words, children with a higher proportion of African ancestors experienced increased asthma resumption due to adverse social and environmental exposures rather than direct biological consequences of their genetics. Those of higher African descent were more likely to be poor, have a single parent, sleep outside the home more often, are sensitized to common mushrooms and are exposed to pollution. “

Mersha and colleagues conducted a prospective cohort study of 695 black-and-white children aged 1 to 16 years (mean age 6.28 years; 65.6% male) with asthma-related admission, with 448 children (64.5%) self as blacks and 247 children (35.5%) said they were white.

The researchers used single nucleotide polymorphisms to scale the patients’ African ancestry from 0 to 1, with 1 indicating 100% African ancestry. The researchers also rated variables that were broken down into six different areas: outdoor pollution, indoor pollution, disease management, community factors, family hardship, and allergens.

Hospital readmission within 12 months served as the primary endpoint of the study.

A total of 134 children (19.3%) included in the study were re-enrolled within one year. Of these, 106 (79.1%) said they were black and 28 (20.9%) said they were white.

After adjusting for age and gender, the researchers found a significant correlation between higher African ancestry and asthma resumption (OR for every 10% increase in African ancestry = 1.11; 95% CI 1.05-1.18). Patients with less than 20% African descent had significantly lower readmission rates than patients with more than 20% African descent (descent 80%; HR = 2.2; 95% CI 1.38–3.46).

Variables related to family hardship (P .001) – including factors such as no vehicle or home ownership, an annual income of less than $ 15,000 per household, high school education level or below, or a single caregiver who has never been married – and disease management (P = 0.001) – which included factors such as property and violent crime, missing or missing medication, or sleeping regularly outdoors – accounted for more than half of the relationship between parentage and readmission.

These findings support the concept that structural racism and social adversity contribute to asthma-related racial differences, said Mersha and colleagues.

“Ancestry is a genetic construct, but here its health effects result from the social consequences of racism,” the researchers wrote. “This study suggests that future research examining a genetic basis for asthma disparities should include social and environmental variables, and confirms the need for comprehensive social and environmental strategies to reduce asthma disparities.”

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