Asthma and the social determinants of health

Objective: To synthesize the growing body of literature on the role of social determinants of health (SDoH) in asthma and asthma disparities. Data Sources: A pubmed.gov search was performed to identify published literature on SDoH, asthma, asthma dispar-ities, and race and ethnicity. Current asthma statistics of the Centers for Disease Control and Prevention were reviewed. Study Selections: Relevant articles on SDoH, asthma, asthma disparities, and race and ethnicity were reviewed in detail. Results: Black and Latinx Americans have a higher asthma prevalence and greater asthma morbidity than White Americans and also bear a disproportionate burden of SDoH. Inequities in SDoH are rooted in structural racism and population-level injustices that affect the socioeconomic status, physical environment, and health care access/qual-ity of Black and Latinx Americans. There is evidence that racial/ethnic inequities in SDoH, such as socioeconomic sta-tus, neighborhood environment, housing, environmental exposures, and health care access/quality, contribute to excess burden of asthma prevalence/incidence, morbidity, exacerbations, and abnormal lung function among cer-tain racial/ethnic populations. In addition, Black and Latinx communities experience high levels of long-term stress, which may increase asthma risk through direct effects on the immune system and hypothalamic-pituitary-adreno-cortical activation. Long-term stress may also mediate the effects of SDoH on asthma. Conclusion: Although there is clear evidence linking SDoH to excess asthma risk and implicating SDoH in asthma disparities, the extent to which asthma disparities are explained by inequities in SDoH and the relative contribu-tions of each of these SDoH to asthma disparities remain unclear. This knowledge is needed to effectively develop and test systems-level interventions targeting SDoH, with the ultimate goal of meaningfully reducing racial/eth-nic asthma disparities. (c) 2021 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Automated summary

Black and Latinx Americans have higher rates of asthma prevalence and morbidity compared to White Americans, and bear a disproportionate burden of social determinants of health. Inequities in social determinants of health are rooted in structural racism and impact the socioeconomic status, physical environment, and healthcare access/quality of Black and Latinx Americans.