Multi-Ethnic Black adults, specifically Puerto Rican Black Latinx individuals, have an increased risk for emergency department/urgent care (ED/UC) visits and systemic corticosteroid (SCS) use for asthma compared with Black individuals identifying with other Black cultural subgroups, according to study findings published in the Journal of Allergy and Clinical Immunology.
Asthma disproportionately affects Black adults, who are often considered as a homogenous group in research trials despite the many existing Black cultural subgroups. Investigators therefore evaluated differences in asthma morbidity among adults from Black ethnic subgroups, using data from the randomized, open-label, pragmatic Person Empowered Asthma Relief (PREPARE) trial (ClinicalTrials.gov Identifier: NCT02995733).
The current secondary analysis included data from 744 Black adults with moderate to severe asthma from PREPARE. Participants were originally recruited from November 2017 through March 2021 and resided in the continental US and Puerto Rico.
Subgroups were based on participant self-identification as either African American Black (AA/B; n=518), which included those who described their ethnicity as being American, or Multi-Ethnic Black (ME/B; n=226). Individuals identifying as ME/B were then divided into 2 subgroups. The first group (Caribbean, continental African, or other Blacks; CAO/B) included participants who self-identified as Caribbean Black (n=42), continental African (origin identified as being from Africa; n=17), or other Black (n=21). The second group included individuals who self-identified as Black Latinx (n=146).
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This study highlights the importance of distinguishing ethnic subgroups within the Black population since cultural factors impact asthma morbidity.
The primary outcome was self-reported asthma exacerbations in the year before enrollment.
ME/B individuals were significantly more likely, compared with AA/B participants, to be younger, to reside in the Northeastern US, and to have fewer medical comorbidities. ME/B vs AA/B participants had increased rates of ED/UC visits (incident rate ratio [IRR], 1.34; 95% CI, 1.04-1.72) and greater SCS use for asthma (IRR, 1.27; 95% CI, 1.00-1.62), but did not have more hospitalizations, including after adjustment.
Black Latinx vs AA/B adults had significantly higher rates of ED/UC visits (IRR, 1.53; 95% CI, 1.15-2.04) and SCS use for asthma (IRR, 1.33; 95% CI, 1.00-1.77) after adjustment. Black Latinx and AA/B individuals had comparable rates of hospitalizations for asthma and levels of asthma control and asthma-related quality of life.
Puerto Rican Black individuals had significantly increased rates of ED/UC visits (IRR, 1.64; 95% CI, 1.22-2.21) and SCS use (IRR, 1.43; 95% CI, 1.06-1.92) for asthma vs AA/B participants after adjustment. Puerto Rican Black Latinx individuals had significantly higher rates of ED/UC visits for asthma (IRR, 1.91; 95% CI, 1.01-3.60) vs non-Puerto Rican Black Latinx individuals after adjustment. No significant differences in SCS courses or hospitalizations for asthma, asthma control, or asthma-related quality of life were found between the 2 groups.
No significant differences were observed in rates of ED/UC visits, SCS courses, or hospitalizations for asthma among Black Puerto Rican adults residing in Puerto Rico.
In citing study limitations, the researchers noted that the subgroups were based on participants’ self-identification of race and ethnicity and not genetic ancestry, and asthma exacerbations were based on self-reported retrospective data. In addition, there were relatively few participants, and most were female.
“This study highlights the importance of distinguishing ethnic subgroups within the Black population since cultural factors impact asthma morbidity,” stated the investigators. “Clinicians should tailor asthma education in a culturally sensitive manner,” they added. “Policymakers and researchers should realize the unique barriers to health care access among adults with asthma that vary not only by country of origin, race, and ethnicity, but also by culture, and design interventions that break down such barriers.”
Disclosure: QVAR and QVAR Redihaler inhalers and support for the AssistRx pharmacy were provided by Teva Branded Pharmaceuticals Products R&D, Inc. NIOX VERO devices for measuring exhaled nitric oxide were provided by Circassia Pharmaceuticals, Inc. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
