February 17, 2020
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Racial differences persist in older adults with asthma

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In a study of 4,700 older adults with asthma, researchers found that symptoms and health care utilization remained different among African American and Hispanic survey respondents compared with white respondents even after adjustment for multiple social determinants.

“As the population continues to age, it’s important that researchers look at the impact of asthma on older populations and how it differs from younger patients,” Nicole M. Cremer, MD, from the division of internal medicine at the University of Michigan in Ann Arbor, said in a press release. “The number of older adults with asthma is going to increase, and understanding these health disparities is crucial if we hope to provide effective treatment.”

Cremer and Alan P. Baptist, MD, MPH, from the department of medicine and the division of allergy and clinical immunology at the University of Michigan, analyzed data from the 2015 Behavioral Risk Factor Surveillance Survey and the Asthma Call-Back Survey among adults aged 55 years and older with current asthma.

Of the 4,700 participants included in the study, 86.3% self-identified as white, 6.3% as African American and 7.4% as Hispanic. The mean age was 66.5 years and more than two-thirds were women.

The researchers evaluated a number of social factors, including health care access, health care costs and demographic data. According to the findings, African American and Hispanic respondents were younger and had higher BMI than white respondents. They reported lower level levels of education, with 69% of African American respondents and 70% of Hispanic respondents reporting graduating high school or less as their highest level of education vs. 38% of white respondents (P < .001), and lower household incomes, with 32% of African American respondents and 40% of Hispanic respondents vs. 12% of white respondents having household incomes of less than $15,000 (P < .001). African American and Hispanic respondents were also more likely than among white participants to be smokers (23% and 18%, respectively vs. 11%; P < .001).

Additionally, African American and Hispanic respondents were more likely to report impaired access to health care due to cost (28% and 34%, respectively vs. 16%; P < .001) and gaps in health insurance coverage (5% and 8%, respectively vs. 3%; P < .001).

More African American and Hispanic respondents than white respondents also reported not using asthma medication or using rescue medication only (61% and 59%, respectively vs. 46%; P = .007), whereas white respondents reported slightly greater use of inhaled corticosteroids or another single agent (8% vs. 6% and 6%; P = .007) and greater use of two controller medications (18% vs. 9% and 12%, respectively; P = .007).

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Overall, results showed that 32% of African American respondents and 23% of Hispanic respondents, as compared with 14% of white respondents, reported visiting the ED during the previous 12 months for asthma symptoms. After controlling for a number of factors, including income, education and comorbidities, the analysis indicated that odds for having at least one asthma-related ED visit during the previous 12 months were twice as high for African American and Hispanic respondents, as compared with white respondents (P < .001). However, African American and Hispanic respondents were 40% less likely than white respondents to report uncontrolled daytime asthma symptoms (P = .002 and .008, respectively).

“While social determinants certainly account for some asthma outcomes, we found that didn’t account for all of them,” Cremer said. “While these groups are also less likely to be on an inhaled corticosteroid, we find they are still more likely to visit an emergency room after controlling for medication use. That means there are still factors out there leading to African Americans and Hispanics requiring more frequent ER visits.” – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.