Health Disparities in Pediatric Asthma

In the United States, minoritized and marginalized groups such as non-Hispanic Black children, Puerto Rican children, American Indian/Alaska Native children, and multiracial children share a disproportionate burden of asthma, largely because of greater exposure to environmental, lifestyle, and behavioral risk factors than white children. Such unequal exposure is due to racism and discriminatory policies that affect social determinants of health and, ultimately, area of residence and access to resources. In this focused article, I first review the epidemiology and selected risk factors for health disparities in asthma and then briefly discuss knowledge gaps and future directions in this field. Except for genetics, risk factors for disparities in asthma and poor asthma outcomes are potentially modifiable and co-exist at the individual or community level, including exposure to violence and related distress; indoor and outdoor pollutants; unhealthy dietary habits; overweight or obesity; and barriers to adequate health care, such as lack of health insurance and poor parental health literacy. Research plays an important role in advancing our knowledge of the determinants and prevention of health disparities in asthma but should not preclude the development and implementation of policies that foster funding of inclusive research studies and clinical trials, "environmental justice," and universal health care. Advocating for such policies requires concerted efforts by all key stakeholders to achieve better health outcomes for all children with asthma.