Original Article
Racial Disparities in Asthma-Related Health Outcomes in Children with Severe/Difficult-to-Treat Asthma

These data were presented at the American Thoracic Society 2017 Annual Meeting, May 19-24, 2017, Washington, DC, and the 2018 Annual Scientific Session of the Western Society of Allergy, Asthma & Immunology, January 21 to January 25, 2018, Maui, HI.
https://doi.org/10.1016/j.jaip.2018.07.050Get rights and content

Background

There are limited data that examine differences in asthma etiology between black and white children with severe or difficult-to-treat asthma.

Objective

To describe demographic, clinical, and asthma-related outcomes in black and white children and examine whether differences in outcomes are explained by confounding factors in sequential multivariable models.

Methods

Black (n = 86) and white (n = 262) children aged 6-11 years from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens 3-year observational study were analyzed. Baseline demographics and clinical characteristics were described for both cohorts, and outcomes at month 12 were analyzed using statistical models, sequentially adjusting for potential confounders.

Results

Black children were more likely to be male (79.1% vs 66.4%; P < .05), obese (12.8% vs 1.5%; P < .001), and from a lower income stratum (USD43,400 vs 55,770; P < .001) than white children. Black children had higher geometric mean IgE levels (434.8 vs 136.8 IU/mL; P < .001), were more likely to have very poorly controlled asthma (72.1% vs 53.4%), use long-term systemic corticosteroids (30.2% vs 9.2%; P < .001), have poorer quality of life (5.5 vs 6.1; P < .001), and have an emergency department visit (27.4% vs 7.7%, P < .001) in the 3 months before month 12. Differences in asthma control and the severity of exacerbations persisted even after accounting for all confounding factors.

Conclusions

Among children with severe or difficult-to-treat asthma, asthma burden is greater in black than white children particularly related to several clinical and patient-reported outcome measures that are not explained by differences in background or clinical characteristics.

Section snippets

TENOR study design

TENOR was a 3-year (2001-2004), multicenter, prospective, observational study conducted at 283 sites in the United States. The details of the study design and methodology, as well as baseline cohort characteristics, have been previously published.14, 15 Briefly, TENOR enrollment included patients 6 years of age and older from diverse geographic areas with severe or difficult-to-treat asthma receiving care from an allergist or pulmonologist. Patients were selected for TENOR if they: (1) had

Univariable analyses

A total of 86 black children and 262 white children aged 6-11 years were included in the analyses. Mean age at baseline was similar between black and white children: 9.2 ± 1.6 vs 9.0 ± 1.7, respectively (Table I). Black children were more likely than white children to be male (79.1% vs 66.4%; P = .03), to reside in urban core areas (80.2% vs 61.8%; P = .006 for overall comparison of residential area), to be in a lower family income stratum (USD43,400 vs 55,770; P < .001), and to have Medicaid

Discussion

This report from the TENOR observational study provides the most comprehensive assessment of the black/white differences in pediatric asthma by attempting to explain the poorer asthma-related health outcomes in black patients using a rigorous statistical approach of sequential adjustment for confounding variables. In addition, this study examined a wide breadth of variables, including demographic, clinical, and patient-reported outcomes in a real-world setting, some of which have not been

Acknowledgments

The authors would like to thank the investigators, patients, and parents/caregivers who participated in TENOR.

References (47)

  • E. Goleva et al.

    Airway remodeling and lack of bronchodilator response in steroid resistant (SR) asthma

    J Allergy Clin Immunol

    (2007)
  • A.S. DeSantis et al.

    Associations of salivary cortisol levels with inflammatory markers: the multi-ethnic study of atherosclerosis

    Psychoneuroendocrinology

    (2012)
  • A.B. Yee et al.

    Preventive asthma care delivery in the primary care office: missed opportunities for children with persistent asthma symptoms

    Academic Peds

    (2013)
  • Asthma FastStats

  • National Ambulatory Medical Care Survey: 2014 State and National Summary Tables

  • National Hospital Ambulatory Medical Care Survey: 2014 Emergency Department Summary Tables

  • National Ambulatory Medical Care Survey: 2010 Outpatient Department Summary Tables

  • Ethnic Disparities in the Burden and Treatment of Asthma

  • L.J. Akinbami et al.

    Asthma prevalence, health care use, and mortality: United States, 2005-2009

    Natl Health Stat Report

    (2011)
  • L.J. Akinbami et al.

    Trends in racial disparities for asthma outcomes among children 0-17 years, 2001-2010

    J Allergy Clin Immunol

    (2014)
  • L.J. Akinbami et al.

    Changing trends in asthma prevalence among children

    Pediatrics

    (2016)
  • C.L. Gamble

    Racial disparities in asthma severity: a comparison between black and white adult asthmatics in the Severe Asthma Research Program. Dissertation

    (2011)
  • T.S. Chang et al.

    Childhood asthma clusters and response to therapy in clinical trials

    J Allergy Clin Immunol

    (2014)
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    The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study and this analysis were funded by Genentech, Inc., South San Francisco, CA, and Novartis Pharmaceuticals Corporation, East Hanover, NJ.

    Conflicts of interest: T. Guilbert receives personal fees from American Board of Pediatrics Pediatric Pulmonary Subboard, GSK, Regeneron Pharmaceuticals, Merck, Sanofi/Regeneron, Novartis/Regeneron, GSK/Regneron, and Aviragen; grants from the National Institutes of Health (NIH) and Sanofi/Regeneron; and royalties from UpToDate. R. S. Zeiger is employed by the Southern California Permanente Medical Group. He reports grants from the National Heart, Lung, and Blood Institute (NHLBI), Aerocrine, Genentech, AstraZeneca/MedImmune, and Merck; and personal fees from AstraZeneca, Genentech, Novartis, TEVA, GlaxoSmithKline, Theravance BioPharma, Regeneron Pharmaceuticals, Sanofi, and Patara Pharma. T. Haselkorn has received consulting fees from Genentech, Inc. and Novartis Pharmaceuticals Corp. A. Iqbal is an employee of Genentech, Inc. C. Alvarez and D. R. Mink have received funding from Genentech, Inc. through their employer, ICON Clinical Research, for statistical support of the Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study. B. E. Chipps has received consulting/advisory board and speaker bureau fees from AstraZeneca, Boehringer Ingelheim, Circassia, Genentech, Inc., Novartis, and Teva. S. J. Szefler has consulted for Aerocrine, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Genentech, Merck, Novartis, Propeller Health, Roche, and Teva; and has received research support from the NIH, the NHLBI, the Colorado Department of Public Health and Environment Colorado Cancer, Cardiovascular and Pulmonary Disease Program, and GlaxoSmithKline.

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