Low socioeconomic status associates with worse asthma among Black and Latinx adults
Published: May 18, 2022
African American/Black (AA/B) and Hispanic/Latinx (H/L) patients disproportionately bear the burden of asthma morbidity and healthcare costs in the US relative to Whites. Higher asthma morbidity rates amongst AA/B and H/L are due to multifactorial causes, some of which are related to inequitable distribution of social determinants of health and structural racism. However, empirical data about potential mediators of the association between low socioeconomic status (SES) and asthma morbidity are lacking, particularly among AA/B and H/L adults. Most research on the role of SES in asthma morbidity has been unable to disentangle the independent contributions from SES and race/ethnicity to asthma morbidity.
In a recent article in The Journal of Allergy and Clinical Immunology (JACI), Cardet et al. conducted an in-depth analysis of SES among AA/B and H/L adults with asthma. The study analyzed enrollment data from the PeRson EmPowered Asthma RElief (PREPARE) randomized trial, which found that a reliever-triggered inhaled corticosteroid strategy added to usual care decreased asthma exacerbations relative to usual care alone. The authors utilized structural equation modelling to investigate the direct and indirect relationship of SES to asthma morbidity, and modelled how health literacy, perceived stress, and self-reported discrimination mediate these relationships. The effect of socioeconomic status was investigated using a multidomain latent variable defined by poverty, unemployment, and low educational attainment.
The study found that lower SES among AA/B and H/L patients was directly associated with more asthma-related hospitalizations and worse asthma control. There was no effect for mediation of SES through self-reported racial discrimination on asthma control.
Stress was identified as a notable mediator for the relationship between SES and worse asthma outcomes. Further, low educational attainment and unemployment were the SES components that primarily drove the stress-mediated association between SES and asthma control. Identifying other stressors in future studies and addressing educational and employment issues may lessen asthma-related morbidity among these populations. These findings support a role for health care delivery models and policy interventions to address social determinants of health.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.
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