Asthma morbidity measures across Black ethnic subgroups

Abstract

Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences. We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups. Adults with moderate-severe asthma were recruited across the continental United States and Puerto Rico for the PREPARE (PeRson EmPowered Asthma RElief) trial. Using self-identifications, we categorized multiethnic Black (ME/B) participants (n= 226) as Black Latinx participants (n= 146) or Caribbean, continental African, or other Black participants (n= 80). African American (AA/B) participants (n= 518) were categorized as Black participants who identified their ethnicity as being American. Baseline characteristics and retrospective asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids [SCs], emergency department/urgent care [ED/UC] visits, hospitalizations) were compared across subgroups using multivariable regression. Compared with AA/B participants, ME/B participants were more likely to be younger, residing in the US Northeast, and Spanish speaking and to have lower body mass index, health literacy, and <1 comorbidity, but higher blood eosinophil counts. In a multivariable analysis, ME/B participants were significantly more likely to have ED/UC visits (incidence rate ratio [IRR]= 1.34, 95% CI= 1.04-1.72) and SC use (IRR= 1.27, 95% CI= 1.00-1.62) for asthma than AA/B participants. Of the ME/B subgroups, Puerto Rican Black Latinx participants (n= 120) were significantly more likely to have ED/UC visits (IRR= 1.64, 95% CI= 1.22-2.21) and SC use for asthma (IRR= 1.43, 95% CI= 1.06-1.92) than AA/B participants. There were no significant differences in hospitalizations for asthma among subgroups. ME/B adults, specifically Puerto Rican Black Latinx adults, have higher risk of ED/UC visits and SC use for asthma than other Black subgroups.