Racial, social disparities influence asthma-related hospital readmissions

African ancestry appeared strongly associated with readmission following an asthma-related hospital admission among children, according to study results published in Journal of Allergy and Clinical Immunology.

However, researchers noted the association was resolved when accounting for family hardships and disease management.

“The study is the first, to our knowledge, to demonstrate that increased African ancestry is positively associated with increased likelihood of pediatric asthma readmission. Yet, our findings suggest that this association is mediated by hardship and the association of hardship with other exposures,” Tesfaye B. Mersha, PhD, associate professor in the department of pediatrics at University of Cincinnati, and colleagues wrote. “In other words, children with higher proportions of African ancestry experienced increased asthma readmission because of adverse social and environmental exposures and not direct biologic consequences of their genetics. Those with increased African ancestry were more likely to be poor, have a single parent, sleep away from home more frequently, be sensitized to common fungi and be exposed to pollution.”

Mersha and colleagues conducted a prospective cohort study of 695 Black and white children aged 1 to 16 years (mean age, 6.28 years; 65.6% male) with an asthma-related admission, with 448 children (64.5%) self-reporting as Black and 247 children (35.5%) self-reporting as white.

Researchers used single nucleotide polymorphisms to scale patients’ African ancestry from 0 to 1, with 1 indicating 100% African ancestry. The researchers also assessed variables organized into six different domains: outdoor environmental exposures, indoor environmental exposures, disease management, community factors, family hardships and allergens.

Hospital readmission within 12 months served as the study’s primary outcome.

Overall, 134 children (19.3%) included in the study were readmitted within a year. Of those, 106 (79.1%) self-reported as Black and 28 (20.9%) self-reported as white.

After adjusting for age and sex, researchers found a significant correlation between higher African ancestry and asthma readmission (OR for every 10% increase in African ancestry = 1.11; 95% CI, 1.05-1.18). Patients with less than 20% African ancestry had significantly lower readmission rates than those with more than 20% African ancestry (ancestry 80%; HR = 2.2; 95% CI, 1.38-3.46).

Variables related to family hardship (P .001) — which included factors such as not owning a vehicle or home, an annual income less than $15,000 per household, education level of high school or below, or having a single, never married caregiver — and disease management (P = .001) — which included factors such as property and violent crime rate, running out of or missing medicine, or sleeping outside regularly — accounted for more than half of the association between ancestry and readmission.

These findings support the concept that structural racism and social adversity contribute to asthma-related racial disparities, according to Mersha and colleagues.

“Ancestry is a genetic construct but here its health ramifications stem from the social consequences of racism,” the researchers wrote. “This study suggests future research examining a genetic basis for asthma disparities should include social and environmental variables and affirms the need for comprehensive social and environmental strategies to reduce asthma disparities.”