African Americans are three times more likely to die from asthma than Caucasian Americans. And while the prevalence of asthma is on the rise across the country, the rate is consistently higher in Blacks, forcing one to wonder why this controllable disease has had such an impact on one population.
Are these statistics the result of poor environmental conditions? Poor medical care? Or genetics?
Environmental Asthma Triggers
There have been many studies linking environmental factors to asthma prevalence. Pollution, pet dander, smoking and even cockroach droppings have been shown to increase the asthma risk.
A 2002 study by the American Lung Association showed that 71 percent of African Americans live in regions of the United States with air pollution at levels that violate federal standards, compared to 58 percent of whites. This shows one clear environmental difference between populations, but the problem isn't just at home.
One recent study, published this June in the American Journal of Industrial Medicine, showed that black women who work in the furniture, lumber or wood industry have a six-fold increased risk of being diagnosed with asthma when compared to the rest of the population. Black men who work in construction or in the chemical industry have a five-fold increased risk of being diagnosed with asthma.
Living and working in poor conditions has clearly impacted asthma rates. But, environmental factors are not the only cause. While they may contribute to high rates of asthma, pollution and other triggers don't account for high death rates.
Medical Access and Education
Regular access to medical care is essential for preventing and monitoring disease status. Asthma is a disease that can be controlled, but only if a doctor can diagnose the illness, medication can be prescribed and taken and the patient can be seen regularly to monitor progress.
Health
"A lot of the problem is poor quality of care," says Dr. Raoul Wolf, former board member of the American Lung Association. "That is a problem particularly in poorer areas."
Unfortunately, poor medical coverage also gets in the way. Nineteen percent of African Americans are uninsured, according to census data, above the national average of 15 percent. If a parent is not insured, the children are unlikely to be covered as well. Add on the fact that nearly one in three African Americans live below the poverty line and you begin to see the economic problem.
"You can pay $160 for a one-month supply of one medicine, and most asthma patients need at least two," says Dr. Stephanie Whyte, clinic physician on the Asthma Van at the Mobile Care Foundation, an organization that provides free medical care in poor communities. "That's a lot of money, especially when you are trying to make ends meet. God forbid you have more than one child with asthma and they also need medications."
The lack of insurance and high cost of medical care prevent many African Americans from seeing a doctor regularly. In fact, a third of uninsured Americans have no regular place of medical care, and 20 percent of school-aged African American children have not seen a doctor in the past year.
"The majority of people I see do not understand what asthma is," says Whyte. "They'll come in having symptoms daily and not think that is abnormal."
Genetic Links
Adding to the mix is growing evidence supporting the idea that African Americans are at greater risk for asthma simply because of their genes.
A recent study published in the American College of Chest Physicians showed that higher doses of the medication commonly used to prevent asthma symptoms were needed to suppress the cells responsible for airway inflammation, in both asthmatic and nonasthmatic African Americans.
These results point to an "inherent" disadvantage that affects the way African Americans respond to traditional asthma medications, says Dr. Ronina Cover, of the National Jewish Medical and Research Center, Denver, who lead the study.
Response to treatment is only one way that genes may play a role. While no clear genetic link has been established, Wolf points out that many whites and Hispanics live in similar socioeconomic conditions as African Americans—yet asthma rates among these poorer populations are not notably higher than the national average.
"It's not that environmental factors don't play a part; they obviously do," says Wolf, "But it certainly suggests that genetics are a major factor [for African Americans]."
Breathing Easier
A poor environment, lack of medical care and a genetic predisposition may all contribute to the prevalence and severity of asthma in African Americans.
While there is no quick-fix, doctors encourage everyone to seek quality medical care.
"The key is empowering people to know what care their child should be getting and empowering them to realize that they can ask for it," says Wolf.
"You have to advocate for yourself sometimes," adds Whyte.
