Elizabeth C. Matsui|Craig Evan Pollack|Roger D. Peng|Corinne Keet
Closing the door on social determinants of health and asthma disparities: Not so fast
The University of Texas at Austin|Johns Hopkins University|Johns Hopkins University|Johns Hopkins University|Johns Hopkins Medicine
read interest article guilbert et al1guilbert zeiger rs haselkorn iqbal alvarez c mink dr et alracial disparities asthmarelated health outcomes children severedifficulttotreat asthmaj allergy clin immunol pract 2019 7 568577abstract full text full text pdf pubmed scopus 32 google scholar aims address important question whether racial ethnic asthma disparities caused differences social determinants health although asthma disparities research critically important particularly made little progress reducing disparities methodologic limitations overinterpretation results call reevaluation studys conclusions implications statistically significant differences measures asthma burden black white children eliminated including various factors statistical models authors concluded study extends finding increase asthma burden black compared white children phenotype severe difficulttotreat asthma results analyses however suggest substantial proportion differences observed black white children fact explained fairly simplistic measures socioeconomic status ses example adjustment residence urban area health insurance type median income zip code residence reduced differences exacerbation score approximately 40 suggesting addressing poverty neighborhoodassociated factors would reduce exacerbation disparity amount degree reduction would dwarf advances reducing disparities made 3 decades second concern measures ses environmental differences unlikely capture relevant variation race resulted multigenerational policies segregation racial discrimination one hand experience means live urban core neighborhood particular level ses quite different black white families important implications health outcomes2laveist pollack k thorpe jr r fesahazion r gaskin place race disparities dissipate southwest baltimore blacks whites live similar conditionshealth aff millwood 2011 30 18801887crossref pubmed scopus 230 google scholar hand measures fail capture multiple aspects ses3braveman pa cubbin c egerter chideya marchi ks metzler et alsocioeconomic status health research one size fit alljama 2005 294 28792888crossref pubmed scopus 1516 google scholar example even comparing blacks whites similar incomes blacks experience much greater financial social hardship one study found differences hardship explained approximately 40 differences asthma readmission rates black white children4beck af huang b simmons jm moncrief sauers hs chen c et alrole financial social hardships asthma racial disparitiespediatrics 2014 133 431439crossref pubmed scopus 117 google scholar measures financial social hardship captured guilbert et al study factors wealth health literacy direct measures host environmental exposures also captured authors acknowledge limitation magnitude limitation warrants reevaluation conclusions final important point framing racial ethnic differences burden asthma confounded ses factors rather mediates racial ethnic differences focusing mediation enables us pay critical attention role raceincluding broad range historical antecedents contemporary policies everyday experiencesplays distribution factors may turn catalyze poorer outcomes5matsui ec adamson peng rd times adopt biopsychosocial model address racial ethnic disparities asthmaj allergy clin immunol 2019 143 20242025abstract full text full text pdf pubmed scopus 23 google scholar although agree conclusion high unmet need population importance improving outcomes black patients pediatric asthma focus biologic factors underlie disparities asthma outcomes obscures modifiable factors help us understand address large portion disparities replythe journal allergy clinical immunology practicevol 7issue 6previewwe thank matsui et al1 interest analysis epidemiology natural history asthma outcomes treatment regimens tenor observational study2 title closing door social determinants health asthma disparities fast implies conclusions albeit inadvertently deemphasized importance social determinants asthma disparities certainly intention indeed despite able fully explain blackwhite differences accounting socioeconomic status ses environmental factors available tenor database described research examined individual risk factors neighborhood qualities determine differences fulltext pdf