JACI Article on Asthma
In the JACI article on asthma, Fitzpatrick, Gillespie, Mauger, Phillips, Bleecker, Israel, Meyers, Moore, Sorkness, Wenzel, & Bacharier (2019) seek to answer the question on existing racial disparities with regard to the existing health problem on asthma. The article reflects more on the understanding that black patients find themselves experiencing disproportional effects associated with asthma while also having poorer outcomes when compared to their white counterparts living within the same society. That serves as a clear reflection of the fact that indeed there exists a significant challenge in dealing with racial disparities in dealing with the health issue of asthma. Specifically, Fitzpatrick et al. (2019) seek to determine the existing relationship between black and white patients when focusing on the health issue of asthma and asthma-related health care use. That would help towards highlighting the possible link between quality health care and ability to deal with cases of asthma in an effective manner.
Regarding its methodology, it must be noted that the study conducted was part the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. Fitzpatrick et al. (2019) engaged in a prospective observational cohort that was conducted for a period of two and a half years between November 2012 and February 2015. However, the observation of the participants in the study took a period of 1 years after which the researchers embarked on a process of completing relevant data. The study involved a total of 579 participants, who were aged 6 years and older. It can also be noted that the study sought to incorporate the use of inverse probability of treatment weighting as a way of creating balance with regard to the racial groups and the differences in socioeconomic variables.
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The findings of the study pointed to the fact that black patients had a greater odd of using the emergency department (ED) for purposes of asthma with an odd ratio of 2.19. Additionally, the researchers also concluded that there was a significant different between black and white patients when dealing with the baseline variables being considered as part of the study. In this case, black patients experienced a majority >50% of the baseline variables, which sought to build on the understanding that there was indeed a significant racial disparity. Lastly, the study also found that black patients were much less likely to engage an outpatient physician when dealing with cases of asthma management. From the findings, the odd ratio for black patients consulting with an outpatient physician was 0.57, which sought to suggest that indeed there was a serious challenge for blacks in dealing with the health issue on asthma.
Chest Article on Adult-Onset Asthma
In this article, Coogan, Yu, O'Connor, Brown, Cozier, Palmer, & Rosenberg (2014) sought to examine the question on whether daily life experiences of racism may be considered as a key risk factor contributing to adult-onset asthma while seeking to focus on the experiences associated with black women in a rather racial society. The issue of racism has been noted as a key factor contributing to the possibility of asthma in adults considering that most of those experiencing racism find themselves suffering from chronic stress. Williams & Cooper (2019) reflect on unequal treatment on grounds of race and ethnic arguing that the United States is experiencing a significant challenge with regard to racial and ethnic inequalities arising in health care. It is from this perspective that the study sought to examine how racism may serve as a contributor to the possibility of an adult finding him or herself being diagnosed with asthma attributed to stress.
When focusing on the methodology used, Coogan et al. (2014) engaged in a prospective cohort with the focus being black women within the United States. Specifically, the study sought to engage a total number of 38,142 participants since 1995. The researchers mailed biennial questionnaires to the participants with the aim being towards following up on their progress with regard to daily experiences of racism and incidents of asthma. Using the results from five questions raised as part of the questionnaire, Coogan et al. (2014) were able to create an everyday racism score, which was essential towards determining the probability of a participant finding herself being exposed to racism. The questions asked focused on different areas within which the possibility of racism was rife with an intention of linking such cases to the possibility of adult-onset asthma.
The findings indicated that from the total number of participants that were followed up between 1997 and 2011, approximately 1,068 participants reported cases of asthma. In examining the findings, the researchers used Cox regression models with the aim being towards deriving multivariable incidence rate ratios (IRRs). The findings indicated that the IRRs for the h highest compared with the lowest quartile occurring in 1997 reflecting on cases of everyday racism was 1.45 in comparison to 1.44, which was the result from the highest compared with the lowest category occurring in 1997 touching on the issue of lifetime racism. Coogan et al. (2014) were able to find a positive link between asthma and racism with the outcome being that the higher the exposure to racism, the higher the likelihood that an individual would be exposed to adult-onset asthma.
Proposed Changes
The main change that I would propose would revolve around focusing on the health issue of asthma in adults not only from the perspective of its biological factors but also reflecting on some of the psychological factors contributing to the onset of the issue. Matsui, Adamson, & Peng (2019) indicates that, “Adopting this model (biopsychological model) would help protect against an explicit and implicit focus on the biology of ‘‘race,’’ which distracts from the likely more important social determinants of health” (p.2025). From this understanding, it is clear that the issue of asthma ought to be evaluated from multiple perspective in trying to find a lasting solution on how to reduce the existing racial disparities. For example, alleviating cases of racism and exposure to racial discrimination may be seen as one of the key steps that would be of great value towards reducing stress, which is a key contributor for adult-onset asthma.
The other change that I would propose would revolve around dealing with the problem of racial and ethnic inequalities arising within the health care sector as a way of ensuring that persons from racial and ethnic minority communities are able to access quality care. By providing access to comprehensive care, which would involve screening and treatment, it would be much more likely that the government would be in a position allowing for reducing some inequities arising in health care (Williams & Cooper, 2019). That would serve as one of the ways through which to prompt more people towards engaging in screening to allow for early detection of chronic conditions such as cancer and asthma. The ultimate result is that this would be seen as a platform through which to deliver on the expected outcomes in promoting positive health outcomes for all racial groups.
References
Coogan, P. F., Yu, J., O'Connor, G. T., Brown, T. A., Cozier, Y. C., Palmer, J. R., & Rosenberg, L. (2014). Experiences of racism and the incidence of adult-onset asthma in the Black Women's Health Study. Chest , 145 (3), 480-485.
Fitzpatrick, A. M., Gillespie, S. E., Mauger, D. T., Phillips, B. R., Bleecker, E. R., Israel, E., Meyers, D. A., Moore, W. C., Sorkness, R. L., Wenzel, S. E. & Bacharier, L. B. (2019). Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program. Journal of Allergy and Clinical Immunology , 143 (6), 2052-2061.
Matsui, E. C., Adamson, A. S., & Peng, R. D. (2019). Time's up to adopt a biopsychosocial model to address racial and ethnic disparities in asthma outcomes. Journal of Allergy and Clinical Immunology, 143 (1), 2024-2025.
Williams, D. R., & Cooper, L. A. (2019). Reducing Racial Inequities in Health: Using What We Already Know to Take Action. International journal of environmental research and public health , 16 (4), 606-632.
