Asthma morbidity measures across Black ethnic subgroups - 05/02/24

Doi : 10.1016/j.jaci.2023.10.028

Leah Ishmael, DO ^a, Andrea Apter, MD, MA, MSc ^b, Paula J. Busse, MD ^c, Rafael Calderon-Candelario, MD ^d, Jennifer K. Carroll, MD ^e,^f, Thomas Casale, MD ^a, Juan C. Celedón, MD, DrPH ^g, Rubin Cohen, MD ^h, Tamera Coyne-Beasley, MD, MPH ⁱ, Jing Cui, MD, PhD ^j, Brianna Ericson, MPH ^k, Paulina Hernandez, MSW ^k, David C. Kaelber, MD, PhD, MPH ^l,^m, Nancy Maher, MPH ^k, Conner Merriman, BS ^a, Giselle Mosnaim, MD, MS ⁿ, Sylvette Nazario, MD ^o, Wanda Phipatanakul, MD, MS ^p, Victor Pinto-Plata, MD ^q, Isaretta Riley, MD, MPH ^r, Kartik Shenoy, MD, MA ^s, Juan Wisnivesky, MD, DrPH ^t, Barbara Yawn, MD, MSc ^u, Elliot Israel, MD ^v,^{^{∗
These authors contributed equally as senior authors.}}, Juan Carlos Cardet, MD, MPH ^a,^⁎^{^{∗
These authors contributed equally as senior authors.}}
^a Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
^b Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
^c Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
^d Division of Pulmonary and Critical Care, Miami VA Healthcare System, Miami, Fla
^e American Academy of Family Physicians National Research Network, Leawood, Kan
^f Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colo
^g Division of Pediatric Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pa
^h Division of Pulmonary Critical Care and Sleep Medicine, Syracuse VA Medical Center, SUNY Upstate Medical University, Syracuse, NY
ⁱ Department of Adolescent Medicine, University of North Carolina, Chapel Hill, NC
^j Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Mass
^k Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Mass
^l Center for Clinical Informatics Research and Education, MetroHealth System, Cleveland, Ohio
^m Departments of Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
ⁿ Division of Allergy, Asthma, and Immunology, Northshore University Health System, Evanston, Ill
^o Allergy and Immunology Section, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
^p Departments of Allergy and Immunology and Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
^q Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, Burlington, Mass
^r Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, NC
^s Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
^t Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
^u Department of Family and Community Health, University of Minnesota, Minneapolis, Minn
^v Divisions of Pulmonary and Critical Care Medicine and Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, Mass

^∗Corresponding author: Juan Carlos Cardet, MD, MPH, 13801 Bruce B. Downs Boulevard, Suite 505, Tampa, FL 33613.13801 Bruce B. Downs BoulevardSuite 505TampaFL33613

Graphical abstract

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Abstract

Background

Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences.

Objective

We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups.

Methods

Adults with moderate-severe asthma were recruited across the continental United States and Puerto Rico for the PREPARE (PeRson EmPowered Asthma RElief) trial. Using self-identifications, we categorized multiethnic Black (ME/B) participants (n = 226) as Black Latinx participants (n = 146) or Caribbean, continental African, or other Black participants (n = 80). African American (AA/B) participants (n = 518) were categorized as Black participants who identified their ethnicity as being American. Baseline characteristics and retrospective asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids [SCs], emergency department/urgent care [ED/UC] visits, hospitalizations) were compared across subgroups using multivariable regression.

Results

Compared with AA/B participants, ME/B participants were more likely to be younger, residing in the US Northeast, and Spanish speaking and to have lower body mass index, health literacy, and <1 comorbidity, but higher blood eosinophil counts. In a multivariable analysis, ME/B participants were significantly more likely to have ED/UC visits (incidence rate ratio [IRR] = 1.34, 95% CI = 1.04-1.72) and SC use (IRR = 1.27, 95% CI = 1.00-1.62) for asthma than AA/B participants. Of the ME/B subgroups, Puerto Rican Black Latinx participants (n = 120) were significantly more likely to have ED/UC visits (IRR = 1.64, 95% CI = 1.22-2.21) and SC use for asthma (IRR = 1.43, 95% CI = 1.06-1.92) than AA/B participants. There were no significant differences in hospitalizations for asthma among subgroups.

Conclusions

ME/B adults, specifically Puerto Rican Black Latinx adults, have higher risk of ED/UC visits and SC use for asthma than other Black subgroups.

El texto completo de este artículo está disponible en PDF.

Key words : health care disparities, severe persistent asthma, African American, Caribbean Black, Continental African, Latinx, minority health, asthma exacerbations, ED visits, hospitalizations, health care utilization

Abbreviations used : AA/B, ACT, ASUI, BHLS, BMI, CAO/B, ED, Feno, IRR, ME/B, PHQ-2, SC, UC

Esquema

Methods

Study population

Black ethnic subgroups

Participant characteristics

Asthma morbidity measures

Statistical analysis

Results

Baseline characteristics

Asthma outcomes across Black ethnic subgroups

Exploratory analyses

Discussion

Disclosure statement

Clinical trial registration: ClinicalTrials.gov (NCT02995733), ClinicalTrials.gov Identifier: NCT02995733.

Exportación

Vol 153 - N° 2

P. 408-417 - février 2024 Regresar al número

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Asthma morbidity measures across Black ethnic subgroups - 05/02/24

Graphical abstract

Abstract

Background

Objective

Methods

Results

Conclusions

Esquema

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Contenido

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