Of the nearly 9,000 Chicago children who had an asthma-related visit to the emergency room in 2015, 63 percent were African-American, according to a new study released Tuesday – World Asthma Day.
“Asthma is considered to be a leading cause of school absenteeism due to chronic illness and it is one of the leading causes of emergency department visits among children here in Chicago,” said Joel Africk, president and CEO of the Respiratory Health Association, which conducted the study.
Chicago has been identified as an epicenter for asthma with a higher prevalence in minority communities on the city’s South and West sides. The 2016 Healthy Chicago survey estimates 216,000 adults have asthma, with the rate among African-Americans nearly 75-percent higher than whites and almost 85-percent greater than Hispanic adults.
The RHA study focused on rates of asthma-related emergency department visits by children ages 17 and younger from 2009-2015. Over that period, the number of annual visits declined by nearly 9 percent, from 9,702 in 2009 to 8,848 in 2015.
“On the surface that looked good, but on closer examination we looked at the rate of asthma-related emergency department visits per 10,000 and (found) those changed very little or even went slightly up,” said Africk. “The data also show alarming and persistent disparities among Chicago children.”
In 2009, the rate of emergency department visits among African-American children was 86 percent greater than the citywide rate, according to the study. By 2015, the rate of visits among African-American children declined by nearly 12 percent, but still remained 75 percent higher than the citywide average that year.
Dr. Ruchi Gupta, a pediatrician at Ann & Robert H. Lurie Children’s Hospital specializing in asthma, food allergies and eczema, has been studying asthma for 14 years and says the lack of progress in addressing racial disparities is frustrating.
“After 14 years of studying it, it’s difficult to hear we haven’t been able to make the dent we’ve been hoping to make,” she said. “What’s so unique about asthma is we actually have treatment. Children should be able to live completely active, normal lives with asthma but for some reason there are barriers that get in the way, especially for low-income minority children in terms of managing their asthma on a daily basis.”
Many of the children she sees end up in emergency departments aren’t taking their medications correctly, Gupta said. “It’s more complex than an oral medication,” she said. “Even if they know how to take it, are they taking it correctly so it’s getting into their lungs? ... The educational component is critical.”
Chicago Department of Public Health Commissioner Julie Morita said asthma treatment is an important component of addressing the issue, but “we have to look at children and health more holistically in terms of the environments that they live in whether it’s their communities, whether it’s their homes, etc. in addition to treatment,” she said.
Using data, such as the rate of emergency department visits, allows officials to “narrow in on the communities that are most heavily impacted by asthma,” Morita said. “Then it allows us to focus our work in improving homes and communities so we can actually prevent asthma from developing.”
Researchers estimated those visits in 2015 translated into $18.7 million in health care charges. If African-American and Latino children had the same rate of asthma-related emergency department visits as white children, health care costs could have been reduced by $6.1 million.
“Asthma should be manageable without going to the emergency room,” Africk said.
Chicago Public Schools Chief Health Officer Ken Fox said the racial disparity should not be a surprise. “Racial inequities in health care are generations in the making. They are enduring, health harming structural facts that will take time and creative collaborations to unmake,” he said.
RHA is calling for more research in asthma trends, better data tracking of asthma prevalence and demographics, broadened support for community-based asthma programming to promote asthma management, and additional collaboration between research, practice and policy partners as the first steps in closing the gap in racial disparities among children.
“If we’re really making this a health priority and this is a health disparity we want to address meaningfully, I think what we need to do is get serious about the resources we’re going to devote to our poorest citizens who are currently living with a chronic illness that’s the largest cause of school absenteeism,” Africk said. “We just have to do more.”