By Lakhi Godavarthi Raju, The Peddie School, Hightstown, New Jersey, USA
Asthma is a disease that affects your lungs. It causes inflammation and swelling of the airways which makes it difficult to breathe and may produce extra mucous (Figure 1). The most common symptoms include wheezing, breathlessness, chest tightness, and coughing. It is one of the major respiratory diseases significantly affecting the quality of life of all ages and is one of the most common chronic diseases among children. Asthma symptoms can be triggered by exposure to allergens, irritants in the air, or extreme weather conditions. Exercise or a respiratory illness can also increase susceptibility. Currently, there is no cure for asthma, but effective treatment plans include monitoring the disease with a peak flow meter, identifying and reducing exposure to environmental triggers, and using drug therapies including bronchodilators and anti-inflammatory agents (Asthma and Allergy Foundation of America).
Figure 1: A diagram showing the anatomy of asthmatic lung when compared to a normal Lung (Asthma and Allergy Foundation of America).
Currently, around 26 million Americans have asthma. Of this population, 20.4 million are adults and 6.1 million are children. Asthma prevalence is higher in children (9.4 percent) than in adults (7.7 percent) and more than 4000 people die of asthma each year (CDC, 2020). Asthma is often under-diagnosed and under-treated particularly in low- and middle-income communities and the burden of asthma is especially disproportionate among black and Hispanic minorities living in low-income neighborhoods. Childhood asthma in these neighborhoods is responsible for a large portion of emergency room (ED) visits, hospitalizations, and deaths. The mortality rate is three times higher in black and Hispanic people than amongst white people with asthma (CDC, 2020).
New York City has one of the country’s highest rates of hospitalizations and deaths due to asthma among children and young adults, and African American and Hispanic patients account for more than 50% of the cases. Low-income ZIP codes and Black non-Hispanics consistently had higher asthma ED visit rates than comparison categories within the same county. Bronx is one of the five boroughs in NYC, and it had the highest asthma prevalence and ED visit rate among men and women. Pediatric asthma occurrence and hospitalization visits were also highest in the Bronx (Figure 2). A possible explanation can be due to the poverty rate, with 26% of people living in poverty in the Bronx compared to 11% in the United States (Figure 3). Previous studies have shown that genetic and environmental factors play an important role in pediatric asthma. Among the environmental factors, indoor allergens as well as those associated with inner-city living have been shown to contribute to asthma diagnosis.
Figure 2: Asthma related ED visits of children upto age 4. (Bronx Community Health Dashboard, Montefiore Hospital)
Figure 3: Persons in poverty, percent in Bronx County, NY. (United States Census Bureau, 2022)
Also known as the “asthma alley”, the Bronx is where is the convergence of some of the largest, noisiest, and air polluted highways meet in all of New York City. Neighborhoods like Mott Haven and Port Morris in the south Bronx not only have high childhood asthma rates as seen in Figure 4., but they are also overburdened with environmental pollution from interstate highways and industrial facilities like the Hunts Point Distribution Center—a food distribution center and major destination for long-haul trucks—and numerous waster transfer stations, where garbage trucks spew diesel emissions. According to the 2021 report by the New York City Environmental Justice Alliance that studied air pollution around the Hunts Point Distribution Center, “The health effects of poor air quality are particularly pronounced in low-income communities and communities of color due to historic discrimination in access to housing and racist land-use planning that place polluting infrastructures and facilities in these neighborhoods. (NYC Environmental Justice Alliance, 2021)”
Figure 4. High Asthma related hospitalization rates in South Bronx (Bronx Community Health Dashboard, Montefiore Hospital)
Even though considerable steps including evidence-based programs have been introduced to reduce the asthma burden in low-income minority neighborhoods like the Bronx, the racial gaps in asthma outcomes have not changed. The data shows that there is still a significant amount of progress to be made. Social determinants like socio-economic status, education, employment, neighborhood environment, and access to healthcare largely drive the disparities in asthma. Additionally, an individual’s cultural beliefs play a significant role in self-management asthma programs. Medication adherence is a critical self-management strategy for effective asthma control and is highly impacted by personal and cultural attitudes toward medication use. Studies have identified some trends in negative beliefs related to medication among racial and ethnic lines potentially contributing to disparities in asthma outcomes (Gregory K Fritz et al., 2010). To reduce the asthma disparities among low-income and minority communities should include culturally responsive education, environmental literacy about reducing exposure to allergens and pollutants, steps to reduce obesity among kids, and empowerment of racial and ethnic minority patients to effectively manage their asthma.
References
Asthma and Allergy Foundation of America.org. Retrieved May 2023. https://aafa.org/asthma
Centers for Disease Control and Prevention(CDC), 2020. Retrieved April 2023. https://www.cdc.gov/asthma/most_recent_national_asthma_data.html
Centers for Disease Control and Prevention(CDC), 2020-2021. Retrieved April 2023. https://www.cdc.gov/nchs/hus/contents2020-2021.htm#Table-AsthCh
Figure 1. Asthma and Allergy Foundation of America.org. Retrieved April 2023. https://community.aafa.org/blog/what-happens-in-your-airways-when-you-have-asthma
Figure 2. Bronx Community Health Dashboard, Montefiore Hospital. Retrieved May 2023. https://www.montefiore.org/population-health-dashboards
Figure 3. United States Census Bureau, 2022. Retrieved May 2023. https://www.census.gov/quickfacts/fact/table/bronxcountynewyork,US/PST045222
Figure 4. Bronx Community Health Dashboard, Montefiore Hospital. Retrieved May 2023. https://www.montefiore.org/population-health-dashboards
New York City Environmental Justice Alliance, 2021. Retrieved April 2023. https://nyc-eja.org/campaigns/extreme-heat-and-air-quality/
Daphne Koinis-Mitchell, Elizabeth L McQuaid, Sheryl J Kopel, Cynthia A Esteban, Alexander N Ortega, Ronald Seifer, Cynthia Garcia-Coll, Robert Klein, Elizabeth Cespedes, Glorisa Canino, Gregory K Fritz (2010). Cultural-related, contextual, and asthma-specific risks associated with asthma morbidity in urban children. J Clin Psychol Med Settings. 2010 March. DOI: 10.1007/s10880-009-9178-3. Retrieved May 2023 from https://pubmed.ncbi.nlm.nih.gov/20157798/
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