Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=100461
Story Retrieval Date: 5/19/2013 1:43:13 AM CST
Much can happen in the span of a decade, but for African-Americans and Latinos suffering from severe asthma in Chicago, it may as well still be 1998.
"Even though we’ve known for 10 years," said Molly Martin, a preventative medicine physician at Rush University, "nothing has changed in that entire 10 years. The [mortality] rates are really driven by the African-American and Puerto Rican population. That's the driving force, and things have not changed."
African-Americans are 20 percent more likely to have severe asthma and Latinos are 30 percent less likely to have the chronic disease when compared to whites, according to the Chicago Respiratory Health Survey.
When combined, these groups are four to six times more likely than whites to die from asthma, as the asthma mortality rates for Chicago’s white population have declined over the past 10 years.
When compared with diabetes or heart disease, the number of asthma deaths is relatively small; probably around 150 in Cook County in the past year, said Dolores Weems, an epidemiology research specialist at the University of Chicago.
But she noted: “The thing about people dying from asthma is that it’s a chronic disease that you should be able to live with if you have quality care."
As to the cause of the mortality gap, Maureen Damitz, senior program director for the Respiratory Health Association, said “I don’t think we have that answer.”
A variety of factors contribute to the problem, Weems said.
“If I could put my finger on that one thing, I would,” she said, pointing out the myriad of factors that contribute to the persistent problem, from older homes full of mold to stress to the quality of care received.
“There’s a difference between having access to health care and having access to quality care,” Weems said. “There are some people who have had severe asthma all their lives, but they’ve never seen a pulmonologist. How (is that possible)? Because the neighborhood clinics aren’t referring them.”
In addition, Damitz said, “Most of our schools aren’t air-conditioned, and have old heating systems. We haven’t met federal air quality standards yet.”
Pile on top of that a problem with health literacy: a prescription can be given to a patient, but the patient may never have been shown how to actually take the medicine.
As physicians and public health departments try to get a handle on all of the different factors, researchers have recently turned to genetic explanations.
“There’s different genetic predispositions in African-Americans and Puerto Ricans than, for example, whites and Mexican-Americans,” said Martin.
“Asthma severity is more of a genetic-environmental interaction, so there’s probably something happening between your genetic predisposition and your social and physical environment."
“But a genetic predisposition is only part of it,” Martin emphasizes.
“It’s not so easy to say ‘we just need to give people better medicine’ or ‘fix a better drug.’ We really need to fix the communities and make them stronger.”
There are numerous organizations in place to do exactly that, including the Respiratory Health Association of Chicago, the Chicago Asthma Consortium, and the Sinai Asthma Education Training Institute.
Despite extensive state efforts to fund such programming, Martin said the work on decreasing asthma mortality in minority populations has just begun.
“We’re in the very preliminary stages in Chicago,” Martin said. “Even though we’ve known for 10 years, nothing has changed in that entire 10 years.
“There’s interest among the politicians, and especially the people working in Austin, in Humboldt Park, they’re quite aware of the magnitude of the problem. [But] there are more resources, more research and more efforts into improving asthma for white people than there are for minorities.”
“I think people are aware but I think it’s going to be awhile before people move it to the front of their policy agenda.”
Weems, on the other hand, thinks that a decrease in the number of blacks and Latinos dying from asthma is entirely possible in the next five years, as physicians, public health officials, and community health workers continue to seek solutions to the problem.
It's unrealistic to say that no one should die from severe asthma,Weems said, “but that a lot less people should.”