Structural Inequities in Medicine that Contribute to Racial Inequities in Asthma Care

Abstract

Structural inequities in medicine have been present for centuries in the United States, but only recently are these being recognized as contributors to racial inequities in asthma care and asthma outcomes. This chapter provides a systematic review of structural factors such as racial bias in spirometry algorithms, the history of systemic racism in medicine, workforce/pipeline limitations to the presence of underrepresented minority health care providers, bias in research funding awards, and strategies to solve these problems.

Keywords

asthma - spirometry - systemic racism - workforce/pipeline - research funding inequities - strategies

Publikationsverlauf

Artikel online veröffentlicht:
11. Oktober 2022

• References

• 1 Ramsey NB, Apter AJ, Israel E. et al. Deconstructing the way we use pulmonary function test race-based adjustments. J Allergy Clin Immunol Pract 2022; 10 (04) 972-978
• 2 Braun L. Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics. 1st ed.. Minneapolis, MN: University of Minnesota; 2014
• 3 Braun L. Race correction and spirometry: why history matters. Chest 2021; 159 (04) 1670-1675
• 4 Lujan HL, DiCarlo SE. Science reflects history as society influences science: brief history of “race,” “race correction,” and the spirometer. Adv Physiol Educ 2018; 42 (02) 163-165
• 5 Cartwright SA. The diseases and physical peculiarities of the negro race. South Med Rev 1851; 2: 421-429
• 6 Scanlon PD, Shriver MD. “Race correction” in pulmonary-function testing. N Engl J Med 2010; 363 (04) 385-386
• 7 Wilson MG, Edwards DJ. Diagnostic value of determining vital capacity of lungs of children. J Am Med Assoc 1922; 78: 1107-1110
• 8 Rossiter CE, Weill H. Ethnic differences in lung function: evidence for proportional differences. Int J Epidemiol 1974; 3 (01) 55-61
• 9 Braun L, Wolfgang M, Dickersin K. Defining race/ethnicity and explaining difference in research studies on lung function. Eur Respir J 2013; 41 (06) 1362-1370
• 10 Global Initiative for Asthma. Global Strategy for asthma management and prevention. 2021 Accessed September 14, 2022 at: www.ginasthma.org
• 11 Cloutier MM, Baptist AP, Blake KV. et al; Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC). 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol 2020; 146 (06) 1217-1270
• 12 Culver BH, Graham BL, Coates AL. et al; ATS Committee on Proficiency Standards for Pulmonary Function Laboratories. Recommendations for a standardized pulmonary function report. An Official American Thoracic Society Technical Statement. Am J Respir Crit Care Med 2017; 196 (11) 1463-1472
• 13 Centers for Disease Control and Prevention. Most recent asthma data. Accessed September 14, 2022 at: https://www.cdc.gov/asthma/most_recent_data.htm
• 14 Cooper BG, Stocks J, Hall GL. et al. The Global Lung Function Initiative (GLI) Network: bringing the world's respiratory reference values together. Breathe (Sheff) 2017; 13 (03) e56-e64
• 15 Sokol KC, Sharma G, Lin YL, Goldblum RM. Choosing wisely: adherence by physicians to recommended use of spirometry in the diagnosis and management of adult asthma. Am J Med 2015; 128 (05) 502-508
• 16 Baugh AD, Shiboski S, Hansel NN. et al. Reconsidering the utility of race-specific lung function prediction equations. Am J Respir Crit Care Med 2022; 205 (07) 819-829
• 17 Braun L. Spirometry, measurement, and race in the nineteenth century. J Hist Med Allied Sci 2005; 60 (02) 135-169
• 18 Miller K. et al. A review of Hoffman's Race traits and tendencies of the American Negro by Kelly Miller. 1897 Accessed August 27, 2022 at: https://tile.loc.gov/storage-services/service/rbc/rbaapc/19301/19301.pdf
• 19 Steinberg M, Becklake MR. Socio-environmental factors and lung function. S Afr Med J 1986; 70 (05) 270-274
• 20 Hegewald MJ, Crapo RO. Socioeconomic status and lung function. Chest 2007; 132 (05) 1608-1614
• 21 Van Sickle D, Magzamen S, Mullahy J. Understanding socioeconomic and racial differences in adult lung function. Am J Respir Crit Care Med 2011; 184 (05) 521-527
• 22 Harik-Khan RI, Fleg JL, Muller DC, Wise RA. The effect of anthropometric and socioeconomic factors on the racial difference in lung function. Am J Respir Crit Care Med 2001; 164 (09) 1647-1654
• 23 Harik-Khan RI, Muller DC, Wise RA. Racial difference in lung function in African-American and White children: effect of anthropometric, socioeconomic, nutritional, and environmental factors. Am J Epidemiol 2004; 160 (09) 893-900
• 24 Lowe KE, Make BJ, Crapo JD. et al. Association of low income with pulmonary disease progression in smokers with and without chronic obstructive pulmonary disease. ERJ Open Res 2018; 4 (04) 4
• 25 Myers JE. Differential ethnic standards for lung functions, or one standard for all?. S Afr Med J 1984; 65 (19) 768-772
• 26 Quanjer PH, Stanojevic S, Stocks J, Cole TJ. Ethnically specific norms for ventilatory function. Int J Epidemiol 2012; 41 (05) 1490 , author reply 1491–1492
• 27 Morning A. Ethnic classification in global perspective: a cross-national survey of the 2000 census round. Popul Res Policy Rev 2008; 27: 239-272
• 28 Bhakta NR, Kaminsky DA, Bime C. et al. Addressing race in pulmonary function testing by aligning intent and evidence with practice and perception. Chest 2022; 161 (01) 288-297
• 29 Campbell ME, Troyer L. The implications of racial misclassification by observers. Am Sociol Rev 2007; 72: 750-765
• 30 van Tilburg PM, Stam H, Hoogsteden HC, van Klaveren RJ. Pre-operative pulmonary evaluation of lung cancer patients: a review of the literature. Eur Respir J 2009; 33 (05) 1206-1215
• 31 Crawford SW, Fisher L. Predictive value of pulmonary function tests before marrow transplantation. Chest 1992; 101 (05) 1257-1264
• 32 Barker JN, Boughan K, Dahi PB. et al. Racial disparities in access to HLA-matched unrelated donor transplants: a prospective 1312-patient analysis. Blood Adv 2019; 3 (07) 939-944
• 33 Stein JN, Rivera MP, Weiner A. et al. Sociodemographic disparities in the management of advanced lung cancer: a narrative review. J Thorac Dis 2021; 13 (06) 3772-3800
• 34 Harrison S, Judd J, Chin S, Ragin C. Disparities in lung cancer treatment. Curr Oncol Rep 2022; 24 (02) 241-248
• 35 Smith CK. Racial Disparities in a State Based Workers' Compensation System. Portland, OR: Portland State University; 2019
• 36 Kiviranta K, Haahtela T. Caucasian race and lung function: time to revisit the racial groups used in reference values. Eur Respir J 2006; 28 (06) 1280
• 37 Elmaleh-Sachs A, Balte P, Oelsner EC. et al. Race/ethnicity, spirometry reference equations, and prediction of incident clinical events: the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study. Am J Respir Crit Care Med 2022; 205 (06) 700-710
• 38 Bailey ZD, Feldman JM, Bassett MT. How structural racism works - racist policies as a root cause of U.S. racial health inequities. N Engl J Med 2021; 384 (08) 768-773
• 39 Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet 2017; 389 (10077): 1453-1463
• 40 Bassett MT. #BlackLivesMatter–a challenge to the medical and public health communities. N Engl J Med 2015; 372 (12) 1085-1087
• 41 Gee GC, Ford CL. Structural racism and health inequities: old issues, new directions. Du Bois Rev 2011; 8 (01) 115-132
• 42 Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health 2019; 40: 105-125
• 43 Groos M, Maeve W, Hardeman R, Thella KP. Maeve; Measuring inequity: a systematic review of methods used to quantify structural racism. J Health Dispar Res Pract 2018; 11 (02) 13
• 44 Misra S, Kwon SC, Abraído-Lanza AF, Chebli P, Trinh-Shevrin C, Yi SS. Structural racism and immigrant health in the United States. Health Educ Behav 2021; 48 (03) 332-341
• 45 Joes CP. Confronting institutionalized racism. Phylon (1960-) 2002; 50 (1/2): 7-22
• 46 Eneanya ND, Boulware LE, Tsai J. et al. Health inequities and the inappropriate use of race in nephrology. Nat Rev Nephrol 2022; 18 (02) 84-94
• 47 Jackson JP, Weidman NM. The origins of scientific racism. J Blacks High Educ 2005; 2005/2006 (50) 66-79
• 48 Taylor HF. Deconstructing the bell curve: racism, classism, and intelligence in America. In: Hare BR. ed. 2001 Race Odyssey: African Americans and sociology. 2002: 60-76
• 49 Burney P, Jarvis D, Perez-Padilla R. The global burden of chronic respiratory disease in adults. Int J Tuberc Lung Dis 2015; 19 (01) 10-20
• 50 Burney PG, Hooper RL. The use of ethnically specific norms for ventilatory function in African-American and White populations. Int J Epidemiol 2012; 41 (03) 782-790
• 51 Dovidio JF, Gaertner SL. Aversive racism and selection decisions: 1989 and 1999. Psychol Sci 2000; 11 (04) 315-319
• 52 Williams DR. Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann N Y Acad Sci 1999; 896: 173-188
• 53 Wilkerson I. Caste (Oprah's Book Club): The Origins of Our Discontents. New York, NY: Random House; 2020
• 54 Willoughby CD. Running away from Drapetomania: Samuel A. Cartwright, medicine, and race in the Antebellum South. J South Hist 2018; 84: 579-614
• 55 Washington HA. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. 1st ed.. New York: Harlem Moon; 2006
• 56 Nyenhuis SM, Krishnan JA, Berry A. et al. Race is associated with differences in airway inflammation in patients with asthma. J Allergy Clin Immunol 2017; 140: 257-65.e11
• 57 Menezes AMB, Wehrmeister FC, Hartwig FP. et al. African ancestry, lung function and the effect of genetics. Eur Respir J 2015; 45 (06) 1582-1589
• 58 Bryc K, Durand EY, Macpherson JM, Reich D, Mountain JL. The genetic ancestry of African Americans, Latinos, and European Americans across the United States. Am J Hum Genet 2015; 96 (01) 37-53
• 59 Smedley BD, Stith AY, Nelson AR. eds. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington (DC): National Academies Press; 2003
• 60 2018 National Healthcare Quality and Disparities Report. Accessed August 27, 2022 at: https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-final-es.pdf
• 61 Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and Whites. Proc Natl Acad Sci U S A 2016; 113 (16) 4296-4301
• 62 Orr CJ, Ritter V, Turner L. et al. Membership trends in the academic pediatric association from 2009 to 2018. Acad Pediatr 2020; 20 (06) 816-822
• 63 Campbell KM, Corral I, Infante Linares JL, Tumin D. Projected estimates of African American medical graduates of closed historically black medical schools. JAMA Netw Open 2020; 3 (08) e2015220
• 64 Lett E, Murdock HM, Orji WU, Aysola J, Sebro R. Trends in racial/ethnic representation among US medical students. JAMA Network Open 2019; 2 (09) e1910490
• 65 Carter MC, Saini SS, Davis CM. Diversity, disparities, and the allergy immunology pipeline. J Allergy Clin Immunol Pract 2022; 10 (04) 923-928
• 66 Davis CM, Apter AJ, Casillas A. et al. Health disparities in allergic and immunologic conditions in racial and ethnic underserved populations: a work group report of the AAAAI Committee on the Underserved. J Allergy Clin Immunol 2021; 147 (05) 1579-1593
• 67 Blanchard J, Nayar S, Lurie N. Patient-provider and patient-staff racial concordance and perceptions of mistreatment in the health care setting. J Gen Intern Med 2007; 22 (08) 1184-1189
• 68 Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from Oakland. Am Econ Rev 2019; 109: 4071-4111
• 69 Bristow LR, Butler AS, Smedley BD. eds. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: National Academies Press; 2004
• 70 Santhosh L, Babik JM. Diversity in the pulmonary and critical care pipeline: trends in gender, race, and ethnicity among applicants and fellows. ATS Scholar 2020; 1 (02) 152-160
• 71 Esther Jr. CR, Oermann CM, Ross KR, Weiss P. An Assessment of Fellowship Training Issues Affecting the Pediatric Pulmonary Medicine Workforce. Wiley Online Library; 2021
• 72 Nelson BA, Boyer D, Lahiri T, Oermann CM, Rama JA. A statement on the current status and future needs of the pediatric pulmonology workforce: pipeline workgroup. Pediatr Pulmonol 2020; doi:10.1002/ppul.25139
• 73 Noah TL, Tolleson-Rinehart S, Esther CR, Peterson-Carmichael SL, Davis SD, Moore PE. The future of pediatric pulmonology: a survey of division directors, assessment of current research funding, and discussion of workforce trends. Pediatr Pulmonol 2020
• 74 Redding GJ, Cloutier MM, Dorkin HL, Brotherton SE, Mulvey HJ. Practice of pediatric pulmonology: results of the Future of Pediatric Education Project (FOPE). Pediatr Pulmonol 2000; 30 (03) 190-197
• 75 Harris C, Katkin J, Cataletto M, Dorkin H, Laskosz L, Ruch-Ross H. US pediatric pulmonology workforce. Pediatr Pulmonol 2019; 54 (04) 444-450
• 76 Collaco JM, Abman SH. Evolving challenges in pediatric pulmonary medicine. New opportunities to reinvigorate the field. Am J Respir Crit Care Med 2018; 198 (06) 724-729
• 77 Duffy TP. The Flexner Report–100 years later. Yale J Biol Med 2011; 84 (03) 269-276
• 78 Rodríguez JE, López IA, Campbell KM, Dutton M. The role of historically black college and university medical schools in academic medicine. J Health Care Poor Underserved 2017; 28 (01) 266-278
• 79 Mader EM, Rodríguez JE, Campbell KM. et al. Status of underrepresented minority and female faculty at medical schools located within historically black colleges and in Puerto Rico. Med Educ Online 2016; 21: 29535
• 80 Taffe MA, Gilpin NW. Racial inequity in grant funding from the US National Institutes of Health. eLife 2021; 10: e65697
• 81 Hoppe TA, Litovitz A, Willis KA. et al. Topic choice contributes to the lower rate of NIH awards to African-American/black scientists. Sci Adv 2019; 5 (10) eaaw7238
• 82 Ginther DK, Basner J, Jensen U, Schnell J, Kington R, Schaffer WT. Publications as predictors of racial and ethnic differences in NIH research awards. PLoS One 2018; 13 (11) e0205929
• 83 Ginther DK, Haak LL, Schaffer WT, Kington R. Are race, ethnicity, and medical school affiliation associated with NIH R01 type 1 award probability for physician investigators?. Acad Med 2012; 87 (11) 1516-1524
• 84 Ginther DK, Schaffer WT, Schnell J. et al. Race, ethnicity, and NIH research awards. Science 2011; 333 (6045): 1015-1019
• 85 Platt MO. We exist. We are your peers. Nat Rev Mater 2020; 5: 783-784
• 86 Dzirasa K. Revising the a priori hypothesis: systemic racism has penetrated scientific funding. Cell 2020; 183 (03) 576-579
• 87 Kaiser J. NIH Uncovers Racial Disparity in Grant Awards. Washington, DC: American Association for the Advancement of Science; 2011
• 88 Collins FS, Adams AB, Aklin C. et al; NIH UNITE. Affirming NIH's commitment to addressing structural racism in the biomedical research enterprise. Cell 2021; 184 (12) 3075-3079
• 89 Blau DM, Weinberg BA. Why the US science and engineering workforce is aging rapidly. Proc Natl Acad Sci U S A 2017; 114 (15) 3879-3884
• 90 Charette MF, Oh YS, Maric-Bilkan C. et al. Shifting demographics among research project grant awardees at the National Heart, Lung, and Blood Institute (NHLBI). PLoS One 2016; 11 (12) e0168511
• 91 Daniels RJ. A generation at risk: young investigators and the future of the biomedical workforce. Proc Natl Acad Sci U S A 2015; 112 (02) 313-318
• 92 Alberts B, Kirschner MW, Tilghman S, Varmus H. Rescuing US biomedical research from its systemic flaws. Proc Natl Acad Sci U S A 2014; 111 (16) 5773-5777
• 93 Lauer MS, Roychowdhury D. Inequalities in the distribution of National Institutes of Health research project grant funding. eLife 2021; 10: e71712
• 94 Katz Y, Matter U. Metrics of inequality: the concentration of resources in the US biomedical elite. Sci Cult 2020; 29: 475-502
• 95 Serchen J, Doherty R, Atiq O, Hilden D. Health and Public Policy Committee of the American College of Physicians. Racism and health in the United States: a policy statement from the American College of Physicians. Ann Intern Med 2020; 173: 556-557