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Published on: August 7, 2017
Genetic ancestry differences in pediatric asthma readmission are mediated by socioenvironmental factors
Tesfaye B Mersha1, Ke Qin1, Andrew F Beck2
1Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
Insights
Higher African ancestry increases asthma readmission risk in children. This association is primarily explained by social factors like family hardship and disease management, not genetics alone.
Area of Science:
- Pediatric Asthma Research
- Genetics and Health Disparities
- Social Determinants of Health
Background:
- Asthma readmissions disproportionately affect Black children compared to White children.
- Social, financial, and environmental factors contribute significantly to this disparity.
Purpose of the Study:
- To investigate the association between African ancestry and asthma readmissions in children.
- To determine if socioenvironmental factors mediate this relationship.
Main Methods:
- Prospective cohort study of 695 Black and White children (1-16 years) with asthma admissions.
- Assessed African ancestry using single nucleotide polymorphisms and collected data on 37 social, environmental, and clinical variables.
- Employed survival and mediation analyses to examine readmission within 12 months.
Main Results:
- 19.3% of children were readmitted within 12 months.
- Increased African ancestry correlated with higher asthma readmission risk (OR 1.11 per 10% increase).
- Family hardship and disease management mediated over 50% of the effect of African ancestry on readmission.
Conclusions:
- African ancestry is strongly linked to asthma readmission, with mediation by social and clinical factors.
- Findings suggest structural racism and social adversity drive asthma-related racial disparities.
Background:
Social and financial hardships, combined with disease managment and environmental factors explain approximately 80% of the observed disparity in asthma-related readmissions between Black and White children.
Objective:
We sought to determine whether asthma-related readmissions differed by degree of African ancestry and the extent to which such an association would also be explained by socioenvironmental risk factors.
Methods:
This study used data from a prospective cohort study of 695 Black and White children aged 1 to 16 years with an asthma-related admission. The primary outcome was a similar readmission within 12 months. Each subject's African ancestry was determined by single nucleotide polymorphisms on a continuous scale ranging from 0 to 1 (0 = no African ancestry; 1 = 100% African ancestry). We also assessed 37 social, environmental, and clinical variables that we clustered into 6 domains (for example, hardship, disease management). Survival and mediation analyses were conducted.
Results:
A total of 134 children (19.3%) were readmitted within 12 months. Higher African ancestry was associated with asthma readmission (odds ratio 1.11, 95% confidence interval 1.05-1.18 for every 10% increase in African ancestry) with adjustment for age and gender. The association between African ancestry and readmission was mediated by hardship (sβ = 3.42, P < .001) and disease management (sβ = 0.046, P = .001), accounting for >50% of African ancestry's effect on readmission. African ancestry was no longer significantly associated with readmission (sβ = 0.035, P = .388) after accounting for these mediators.
Conclusions:
African ancestry was strongly associated with readmission, and the association was mediated by family hardship and disease management. These results are consistent with the notion that asthma-related racial disparities are driven by factors like structural racism and social adversity.
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