Transcript
Announcer:
You’re listening to Clinician’s Roundtable on ReachMD. On this episode, we’ll learn about the disparities and inequities affecting children with asthma with Dr. Andrea Pappalardo Wlochowicz. She’s an Associate Professor in Medicine and Pediatrics and the Allergy Service Director in the Division of Pulmonary, Critical Care, and Sleep and Allergy at the University of Illinois Chicago. Let’s hear from Dr. Pappalardo Wlochowicz now.
Dr. Pappalardo:
The most significant disparities in asthma care in children are across the board. I'd say there's definitely an increase of asthma prevalence, meaning more children who are non-Hispanic Black and/or of Puerto Rican ethnicity have an increased risk of having asthma and have asthma. There's also an increased risk of emergency room visits for asthma, which are completely preventable, and unfortunately, mortality as well.
We also see that there's a disconnect between people being able to receive the care that they need. So a lot of people have asthma and have no idea that they have asthma, they're being overtreated for something that they don't have, or they think their asthma's outgrown when it hasn't been. So all of these lead to this ongoing persistence of disparities in asthma, both in diagnosis and in treatment across this country that's been persistent for decades.
There are many reasons why these disparities exist and persist, and I think one of the reasons is a lack of attention to modifying the upstream factors that influence health. We know these as the social and structural determinants of health, and these are essentially the factors that we are born into and/or live through that impact us based on where we live, learn, and play. And this includes a lack of adequate healthcare access where your providers are addressing your care needs with the most up-to-date guidelines, you're not able to access subspecialists when you need it in a timely manner, and the providers and the medical system itself have biases or racism that's impacting their clinical decisions within the infrastructure in which you live.
In addition, there are a lot of issues with structural integrity of buildings and aging infrastructure across the nation, and this is especially important in rural areas and in some urban areas as well. And this could include not only your home, but schools and workplaces.
All of these things, including environmental exposures, which are difficult to control from an individual standpoint in many ways as far as air pollution, soil, and other things, contribute to these ongoing health disparities in asthma, especially in children, but across the lifespan.
Due to these multiple factors related to the disparities and the social and structural determinants of health, a child's day-to-day life is adversely affected. First of all, if you're living in a home that has many different exposures, you're working outside, or you're in a school that has these, you're going to have triggers everywhere. If you continuously have asthma triggers, you're going to have asthma symptoms and inflammation, so your asthma is not controlled. And if you don't have a medical home to check in with because you have a rotating primary care doctor that might have left or isn't consistent, insurance keeps on changing, or you don't have insurance, the asthma symptoms go unchecked without any access to medication to control them.
And this is a huge problem. And if you do seek care and that care is not following guideline-based care or there are some biases among those that are providing that care, this becomes a very difficult situation for a child. They will be sick more often, they'll miss school more often, their earning potential is impacted, and their overall lifespan health status is negatively impacted as well.
Announcer:
That was Dr. Andrea Pappalardo Wlochowicz talking about disparities in asthma care. To access this and other episodes in our series, visit Clinician’s Roundtable on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!