Asthma Risk in People of Color

Asthma is a lung disease that restricts the airways, making it difficult to breathe. It is one of the most common chronic illnesses in the United States, but some populations are more affected than others. Data shows that people from Black, Latinx, and Indigenous communities develop asthma at much higher rates than White Americans, and are more likely to be hospitalized and suffer complications.

While the reasons for these disparities are complex, experts have highlighted an increased exposure to poor air quality and lack of access to health care as some contributing factors.

This article provides an overview of the increased risk of asthma in people of color and discusses equitable treatment options.

Asthma Statistics and Race Disparities

In the United States, asthma and its complications affect Black, Latinx, and Indigenous communities disproportionately when compared to White populations.

Some statistics to put the disparities into perspective include:

• Black Americans are 1.5 times more likely to have asthma, five times more likely to visit an emergency room due to asthma symptoms, and three times more likely to die from an asthma episode when compared to White Americans.
• Puerto Rican Americans are more likely to have asthma compared to any other ethnic group, and are two times more likely to experience asthma attacks than White Americans.
• Indigenous Americans have the highest rates of asthma and are almost twice as likely to experience asthma symptoms on a daily basis compared to White Americans.
• Mexican American children are twice as likely to be hospitalized for asthma compared to their White counterparts, and have rates of asthma that are increasing quicker than all other ethnic and racial groups.
  

What Factors Increase Asthma Risk in People of Color?

There are several different structural, social, and behavioral factors that increase asthma rates in communities of color, including genetics, increased exposure to pollution or allergens, and reduced access to high-quality health care.

Genetics

Experts generally agree that there is a genetic component that increases the risk of asthma. Recent research shows some evidence of this, as people of African ancestry in other countries also appear to have higher rates of asthma, similar to Black Americans.

But having a gene in your DNA doesn't automatically mean you'll develop asthma. Environmental factors must also be present, so genetics is only one part of the explanation for asthma disparities.

Environment

Your surroundings can greatly impact your asthma. A person’s physical environment plays a big role in asthma outcomes because asthma is often triggered by an irritant. These can include:

• Cigarette smoke
• Air pollution
• Dust 
• Chemical fumes
• Pet dander  

For people of color in lower-income neighborhoods, living environment and air quality are significant drivers for developing asthma. This is due to the lower-quality building structures and more frequent exposure to outdoor pollution.

According to the Centers for Disease Control and Prevention (CDC), children who live in those areas or live in households below the federal poverty level have higher rates of asthma.

Access to Health Care

Being able to access timely and affordable health care is a crucial and often lifesaving part of maintaining a treatment plan for asthma. It's well-documented that people of color are more likely to experience unequal access to health care and health insurance.

Other barriers that limit access to health care for asthma include:

• Lack of health insurance
• Inability to take paid time off of work
• Unreliable transportation to medical appointments

Data shows that Black and Latinx children with asthma are less likely to have a regular healthcare provider and more likely to use the emergency department as a form of medical care than White children. They're also less likely than White children to be prescribed or take recommended treatments to control their asthma.

Behavioral and Cultural Factors

Internal factors like a person's beliefs, behaviors, and cultural upbringing play a role in how a person understands and manages a chronic condition like asthma.

Mistrust of the medical system exists in many communities of color due to longstanding historical injustices, mistreatment, and exploitation across generations. This mistrust may be further solidified in first- or second-generation immigrants of color, who may forgo medical treatment for urgent conditions like asthma due to fear, language differences, or other barriers to seeking care.

Chronic Stress and Discrimination

Black, Latinx, and Indigenous American communities have increased exposure to chronic stress in the form of racism and discrimination, violence, and economic disparities. Evidence points to a link between this type of stress and asthma development, worsening symptoms, and less effective treatment.

Some findings have also indicated that it may begin in the womb, showing a connection between long-term maternal stress and an increased risk of childhood asthma.

Asthma Severity in People of Color

Not only are people of color at a greater risk of developing asthma, their asthma cases turn out to be more severe than asthma cases in White populations.

As a staggering example, recent data indicates that Black and Latinx people experience twice as many emergency room visits and deaths due to asthma as White people. Figures also show that Black women are the most likely to die from asthma than women from any other racial or ethnic group.

What's more, many experts hypothesize that these figures are likely underestimated and could be higher. People of color have often been broadly excluded from asthma research, and there's a lack of available data for Indigenous populations.

Equitable Asthma Programs and Treatment

So far, equitable outreach programs and policies in the U.S. have only scratched the surface in addressing disparities in asthma. Because the inequities are complex, solutions will require a multifaceted approach across medicine.

Some local, state, and nationally-based programs have taken steps toward this goal, including:

• American Lung Association's Asthma-Friendly Schools initiative offers tools to schools and communities to improve asthma outcomes in children.
• Nationwide Children’s School-Based Asthma Therapy Program, a group that facilitates asthma care plans and prevention medications for children at school.
• Boston Children's Hospital Community Asthma Initiative aims to improve rates of hospitalization and emergency room visits for children of color with asthma.
• Breathe DC is a nonprofit community organization in Washington, D.C., that aims to combat lung diseases like asthma while promoting healthy lifestyles.
  

Summary

Asthma is a chronic lung disease that causes difficulty breathing. It is a common condition in the United States, but people of color are disproportionately impacted by asthma compared to White populations.

Health inequities in asthma exist for a variety of complex reasons. However, experts suspect that disparities in access to health care, environmental exposure to allergens, chronic stress from discrimination, and genetics likely play a role in the increased risk of asthma in people of color.

A Word From Verywell

Coping with asthma as a person of color can be difficult, particularly when there's the added stress of potentially discriminatory experiences and substandard access to medical care and treatment. Remember that you are not at fault for being diagnosed with asthma. Do what you can to avoid asthma triggers and advocate for better treatment if you feel it's needed.