Socioeconomic disparities explain racial differences in severe asthma exacerbation risk
Published online July 9, 2025
Black adults with asthma in the United States experience a disproportionately high burden of disease compared with White adults. Additionally, studies have shown that the prevalence of asthma and poor asthma outcomes are strongly influenced by social determinants of health, such as low income, low health literacy, limited access to quality health care services, and increased exposure to air pollution. However, the complex relationships between race and ethnicity, social determinants of health and asthma outcomes are not fully understood.
In a recent analysis published in The Journal of Allergy and Clinical Immunology: In Practice, Baptist et al. examined data collected from patients enrolled in the CHRONICLE study to identify factors that may contribute to the higher rates of asthma exacerbations observed among Black patients compared with non-Black patients. CHRONICLE was a real-world observational study of US adults with severe asthma who were receiving subspecialist care from allergists, immunologists, or pulmonologists. The authors first identified potential exacerbation risk factors that were collected in CHRONICLE and then used propensity score methods to determine if any of these were significantly associated with Black race. A generalized linear model was used to assess the association between Black race and exacerbation rates after adjusting for these factors.
The analysis included 180 Black patients and 574 non-Black patients. The authors found that socioeconomic status was most strongly associated with race, followed by environmental conditions, demographic characteristics, smoking status and comorbidities. Before adjustment, the generalized linear model showed a 1.28-fold higher exacerbation rate among Black patients compared with non-Black patients. However, after adjusting for the identified risk factors, Black race was no longer significantly associated with exacerbation risk. Similar trends were observed for the rates of emergency department visits and hospitalizations related to asthma exacerbations.
The authors conclude that the higher exacerbation rates observed in Black patients with severe asthma compared with non-Black patients may be explained by lower socioeconomic status and other social determinants of health associated with Black race. This finding highlights the potential to reduce racial disparities in asthma outcomes by addressing socioeconomic inequalities and other social determinants of health.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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