Innovative Study Design, Funding, and Community Engagement Needed to Address Systemic Racism in Childhood Asthma

An American Thoracic Society report published in Annals of the American Thoracic Society demonstrates a framework that can help initiate research that is necessary to make progress in the treatment of asthma in Black and Latino children. These patient subgroups, according to the authors, are more likely to report to the emergency room for asthma exacerbations compared with White patients.¹

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The authors noted that many might cite patient-level socioeconomic status and access to health care as a primary driver of disparities; however, systemic racism is an emerging focus as the root cause of these disparities. Additionally, current conceptual models of asthma disparities show that both historical and current effects of systemic racism as the foundation for unequal exposures to social determinants of health (SDOH), environmental exposures, epigenetic factors, as well as differential health care access and quality, which can then lead to changes that result in asthma morbidity and mortality.²

For this study, a panel of experts was established to identify gaps and opportunities to address systemic racism in childhood asthma research. According to the panelists, to properly examine and address impacts of systemic racism on pediatric patients with asthma, both researchers and medical systems that support biomedical research had to do the following: address current gaps and understand how to conceptualize and characterize the influences of systemic racism on pediatric health; design research studies that leverage diverse disciplines and engage the communities affected by systemic racism in identifying and designing studies to evaluate interventions that address the racialized system that contributes to disparities within asthma health outcomes; and address funding mechanisms and institutional research practices that are necessary to better promote anti-racist practices in research and its distribution.²

“Although many studies show that exposure to SDOH as housing, neighborhood violence, limited access to care and poor air quality largely explain these disparities, few studies have evaluated the impact of racism and the resulting creation of racialized structures and systems as the root cause of the different level of exposure to these factors,” said Monica Federico, MD, a co-chair of the committee that authored the report, in a news release. “We wanted to support this work with guidelines for that research from national and international experts in research and in addressing racism in health.”¹

The results of this literature review demonstrated that innovative study design, new identification tools to detect impacts of systemic racism, community engagement, improved infrastructure, and funding are all necessary to better support research that properly addresses impacts of systemic racism on childhood asthma outcomes. Additionally, the study found that few childhood asthma studies identify systemic racism as a root cause of disparities present in childhood asthma.²

Further, community engagement and participation in research studies is necessary to properly design intervention methods that will address the racialized system patients and families live in. Additionally, dissemination and implementation studies that have an equity lens will provide the multilevel evaluations that are required to understand the impacts of interventions to address system racism and the downstream impacts. Increased training for researchers and teams are needed to properly address these impacts, funding is needed for studies, for diverse and multidisciplinary research teams—including community members—as well as institutional and financial support for advocating for policy changes that can be developed based on study findings.²

“This current report supports that goal by highlighting research priority areas for addressing health equity in childhood asthma,” said Stephanie Lovinsky-Desir, MD, pediatric pulmonologist, Department of Pediatrics, Columbia University, in the news release. “The report also provides several practical and useful frameworks that our ATS members can apply to research in this field.”¹

REFERENCES

1. American Thoracic Society. Addressing health equity in childhood asthma requires engaging affected communities. News release. October 1, 2024. Accessed October 11, 2024. https://www.eurekalert.org/news-releases/1059794

2. Lovinsky-Desir S, Riley IL, Bryant-Stephens T, et al. Research Priorities in Pediatric Asthma Morbidity: Addressing the Impacts of Systemic Racism on Children with Asthma in the United States. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2024;21(10):1349-1364. doi:10.1513/AnnalsATS.202407-767ST