What to know about asthma in African Americans
Causes of higher asthma rates in African Americans
Although research into the differences in rates of asthma among African Americans and other racial groups continues — including studies about genetics, environmental triggers, and socioeconomic status — experts have identified certain factors that contribute to the disparity. A 2017 study involving 1,018 participants with the disease found that African American participants had greater levels of eosinophilic inflammation in their airways than white participants, even though both groups received the same dosage of asthma medications.
Eosinophilic airways inflammation is one of the main causes of asthma symptoms, such as shortness of breath, chest tightness, wheezing, coughing, and trouble sleeping. When it occurs in the lungs, it can cause bronchospasms, making it difficult to breathe.
The findings suggest that African Americans are at increased risk for developing severe asthma because of their genetic makeup, according to Dr. David H. Williams, professor of medicine at Duke University Medical Center and coauthor of the study. He says that although there are many reasons why African Americans develop asthma, the difference in eosinophil counts could explain some of the disparities.
Risk factors for asthma in African Americans
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As of 2018, non- Hispanic black people in the United States are roughly 40% more likely to develop asthma than non-Hispanic whites in the U.S., according to research published in JAMA Internal Medicine. Additionally, when the researchers published this information, 10.6%of non-Hispanic Black people had asthma, compared with 7.6% of non-Hispanic white people. This study found that, compared with white people with asthma in the U.S, African American people with this disease are five times more likely to visit the emergency room for their symptoms. They are also much less likely to use preventative medications.
The authors noted that although the prevalence of asthma among African Americans has increased over the past decade, it still remains lower than the rates reported for white people. However, the researchers pointed out that there has been little change in the percentage of asthma deaths due to race. In fact, African Americans are almost three times more likely to die from an asthma attack than white people.
African Americans with Asthma
The purpose of this article is to discuss the current state of knowledge regarding the genetics of asthma in African American populations. Although there are many similarities between asthma in African Americans and Caucasians, there are important differences. This article summarizes some of the most significant findings reported in the literature and discusses how they might contribute to our understanding of the pathophysiology of asthma in African Americans.
BIOLOGICAL RELEVANCE OF THE SOCIAL CONSTRUCT OF ETHNICITY AND RACE
The social construction of race is a complex issue that has received considerable attention over the past decade. In fact, there are now numerous books devoted to the subject, most notably the multi-authored Oxford Textbook of Race and Ethnicity edited by Peter Brimelow and Robert Breen (32). However, despite the extensive discussion of the subject in both popular and academic circles, there still exists considerable confusion about what constitutes race and how it relates to biology. This confusion stems largely from the fact that the term “race” encompasses several different concepts. For instance, some people consider race to be synonymous with ancestry; others define race as the inherited characteristics of individuals based on physical appearance; and still others equate race with culture. These three distinct definitions—ancestry, appearance, and culture—are often conflated into one concept known as “biological race.”
In contrast, the terms ethnicity and culture are generally considered to be less ambiguous because they refer solely to group affiliation. Thus, for example, an individual could be described as belonging to either the Hispanic or Latino ethnicity or the American Indian or Alaska Native culture. Furthermore, whereas the term “culture” refers to shared customs, traditions, and beliefs, the term
LINKAGE DISEQUILIBRIUM AND LESSONS LEARNED FROM THE HAPMAP
The Human Genome Project (HGP) completed mapping of the entire genome sequence of humans in 2003; however, it took another decade of research to understand how the different parts of our genomes interact with one another. This process of understanding the relationship between genes and disease is called linkage disequilibrium (LD). LD occurs when alleles are inherited together because they are located close enough together on chromosomes. For example, having a common ancestor does not mean that you and I are related. We might both be descended from someone else—but if we inherit identical versions of a particular gene, we are likely to develop similar diseases.
In addition to providing insight into the nature of disease, LD provides information about population history and migration. The HapMap project mapped hundreds of thousands of single nucleotide polymorphisms (SNPs)—genetic variations where one version differs from another—across the genome of three individuals representing four major continental populations. By comparing the SNP data from these individuals, scientists could determine whether certain SNPs were shared among populations, indicating that they had existed in ancestral populations prior to the out-of-Africa expansion.
This type of analysis revealed that European populations separated from Asian and American populations much earlier than previously thought. Additionally, researchers found that regions of high LD tend to cluster around genes involved in immune response, suggesting that natural selection may have acted on those loci over long periods of time.
Asthma is a chronic disease that affects many people worldwide. While it can affect anyone, some people are more likely to develop asthma than others. Asthma causes inflammation in the airways, making breathing difficult. People with asthma often experience attacks called “exacerbations,” during which their lungs become even tighter, causing additional problems. These exacerbations can happen suddenly, and without warning. Some people with asthma might notice changes in their symptoms over time; however, there is no cure for asthma. There are treatments available to help control asthma symptoms, such as medications, inhalers, and steroids.
AFRICAN AMERICANS AND DISPARITIES IN ASTHMA AND ALLERGIC DISEASE: A GENETIC BASIS?
Asthma affects millions of people worldwide and is increasing in frequency and severity. Asthma is one of the most costly diseases in terms of health care costs and lost productivity. Disparities exist in asthma prevalence and morbidity among populations around the world, including those residing in developed countries. This review examines the current literature regarding asthma and allergies in African American populations and discusses potential explanations for the disproportionate burden of asthma and allergy in African Americans.
A recent study published in the journal American Journal of Respiratoria Critical Care Medicine suggests that genetics plays a part in explaining why black Americans are more likely to develop asthma than white Americans. Researchers analyzed data from a large population-based survey conducted in 2001-2002 among 1,441 adults aged 18 to 49. They found that people with specific genetic variations had lower levels of airway responsiveness to inhaled beta2 agonists. This finding held true across racial groups.
The findings raise several questions about how to best treat patients with asthma. “We don’t know whether these genetic variants are causing the disease or merely predisposing individuals to it,” says lead author Dr. John D. Williams III, assistant professor of medicine at Johns Hopkins University School of Medicine. “But we do know that many patients with asthma are undertreated.”
Inequities in healthcare
Inequities in healthcare exist for many different reasons, including systemic racism, and policies that discriminate against certain racial groups. These inequities are often tied to socioeconomic factors such as poverty, education, employment status, and insurance coverage. Racism and discrimination impact one’s ability to obtain healthcare, leading to lower quality care and worse health outcomes. This impacts people of color disproportionately because they face barriers accessing medical facilities and providers due to race, ethnicity, gender identity, sexual orientation, disability status, immigration status, language, and religion.
A lack of accessible healthcare may cause someone to develop poorly managed asthma. Asthma affects approximately 20 million Americans, according to the Centers for Disease Control and Prevention (CDC). Poorly controlled asthma can cause long-term damage to lung tissue and contribute to cardiovascular disease, heart attack, stroke, and even death.
explain why some people are more likely to develop certain diseases than others
The term social determinants was coined in 2001 by Dr. Michael Pratt, a professor of epidemiology at Columbia University. He defined it as “the forces beyond individual control that shape health.”
Pratt says there are four categories of social determinants:
1. Environmental influences – These can include the quality of one’s home or neighborhood, access to healthy food, and air quality.
2. Socioeconomic influences – This includes poverty, education level, occupation, and race.
3. Political influences – This includes political power, laws, regulations, and policies.
4. Cultural influences – This includes religion, values, customs, beliefs, and traditions.
In addition, he notes that people with different cultural backgrounds often use language differently, which could affect how they interpret information about disease risk.
Low birth weight
The study found that compared to white women, black women are less likely to receive prenatal care, especially during the second trimester of pregnancy. They also had lower rates of cesarean section delivery and epidural analgesia use during labor among those who did deliver vaginally. These differences persisted even after researchers took into account income levels, education, insurance coverage, maternal age, smoking, alcohol consumption, drug abuse and diabetes.