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

被引:0
作者
Lovinsky-Desir, Stephanie [1 ]
Riley, Isaretta L. [2 ]
Bryant-Stephens, Tyra [13 ]
De Keyser, Heather [6 ,7 ]
Forno, Erick [14 ]
Kozik, Ariangela J. [18 ,19 ]
Louisias, Margee [5 ]
Matsui, Elizabeth C. [20 ]
Sheares, Beverley J. [21 ]
Thakur, Neeta [27 ,28 ]
Apter, Andrea J. [8 ]
Beck, Andrew F. [9 ]
Bentley-Edwards, Keisha L. [3 ]
Berkowitz, Carol [10 ]
Braxton, Charmane [12 ]
Dean, Jasmine [12 ]
Jones, Camara Phyllis [15 ]
Koinis-Mitchell, Daphne [16 ,17 ]
Okelo, Sande O. [11 ]
Taylor-Cousar, Jennifer L. [22 ,23 ,24 ,25 ]
Teach, Stephen J. [26 ]
Wechsler, Michael E. [22 ,23 ]
Gaffin, Jonathan M. [4 ]
Federico, Monica J. [6 ,7 ]
机构
[1] Columbia Univ, Vagelos Coll Phys & Surg, Div Pediat Pulmonol, New York, NY USA
[2] Duke Univ, Sch Med, Div Pulm Allergy & Crit Care, Durham, NC USA
[3] Duke Univ, Dept Med, Div Gen Internal Med, Sch Med, Durham, NC USA
[4] Harvard Med Sch, Boston Childrens Hosp, Dept Pediat, Div Pulm Med, Boston, MA USA
[5] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Div Allergy & Clin Immunol, Boston, MA USA
[6] Univ Colorado, Sch Med, Breathing Inst, 13123 East 16th Ave, Aurora, CO 80045 USA
[7] Childrens Hosp Colorado, 13123 East 16th Ave, Aurora, CO 80045 USA
[8] Univ Penn, Pulm Allergy Crit Care Div, Philadelphia, PA USA
[9] Univ Cincinnati, Coll Med, Dept Pediat, Coll Med, Cincinnati, OH USA
[10] Univ Calif Los Angeles, DEPT PEDIAT, LOS ANGELES, CA USA
[11] Univ Calif Los Angeles, David Geffen Sch Med, Div Pediat Pulmonol & Sleep Med, Los Angeles, CA USA
[12] Childrens Hosp Philadelphia, Community Asthma Prevent Program, Philadelphia, PA USA
[13] Childrens Hosp Philadelphia, Dept Pediat, Gen Pediat, Philadelphia, PA USA
[14] Indiana Univ Sch Med, Dept Pediat, Pulmonol Allergy Immunol & Sleep Med, Indianapolis, IN USA
[15] Georgetown Univ, Law Ctr, ONeill Inst Natl & Global Hlth Law, Washington, DC USA
[16] Rhode Isl Hosp, Dept Pediat, Dept Child Psychiat, Providence, RI USA
[17] Brown Univ, Alpert Med Sch, Providence, RI USA
[18] Univ Michigan, Dept Internal Med, Div Pulm & Crit Care Med, Ann Arbor, MI USA
[19] Univ Michigan, Dept Mol Cellular & Dev Biol, Ann Arbor, MI USA
[20] Univ Texas Austin, Dell Med Sch, Dept Pediat, Austin, TX USA
[21] Yale Sch Med, Sect Pulm Allergy Immunol & Sleep Med, Sect Pediat Pulm Allergy Immunol & Sleep Med, New Haven, CT USA
[22] Natl Jewish Hlth, Div Pulm Crit Care & Sleep Med, Denver, CO USA
[23] Natl Jewish Hlth, Div Pediat Pulm Med, Denver, CO USA
[24] Univ Colorado, Div Pulm Sci & Crit Care Med, Anschutz Med Campus, Aurora, CO USA
[25] Univ Colorado, Div Pediat Pulmonol, Anschutz Med Campus, Aurora, CO USA
[26] Childrens Natl Hosp, Washington, DC USA
[27] Zuckerberg San Francisco Gen Hosp, Div Pulm & Crit Care Med, San Francisco, CA USA
[28] Univ Calif San Francisco, Dept Med, San Francisco, CA USA
关键词
asthma; racism; health disparities; minority and disadvantaged populations; social determinants of health; HEALTH DISPARITIES; STRUCTURAL RACISM; PUBLIC-HEALTH; PARTICIPATORY RESEARCH; HOME VISITS; RACE; EQUITY; ANTIRACISM; FRAMEWORK; DISCRIMINATION;
D O I
10.1513/AnnalsATS.202407-767ST
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background: In the United States, Black and Latino children with asthma are more likely than White children with asthma to require emergency department visits or hospitalizations because of an asthma exacerbation. Although many cite patient-level socioeconomic status and access to health care as primary drivers of disparities, there is an emerging focus on a major root cause of disparities-systemic - systemic racism. Current conceptual models of asthma disparities depict the historical and current effects of systemic racism as the foundation for unequal exposures to social determinants of health, environmental exposures, epigenetic factors, and differential healthcare access and quality. These ultimately lead to biologic changes over the life course resulting in asthma morbidity and mortality. Methods: At the 2022 American Thoracic Society International Conference, a diverse panel of experts was assembled to identify gaps and opportunities to address systemic racism in childhood asthma research. Panelists found that to examine and address the impacts of systemic racism on children with asthma, researchers and medical systems that support biomedical research will need to 1 ) address the current gaps in our understanding of how to conceptualize and characterize the impacts of systemic racism on child health, 2 ) 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 in asthma health outcomes, and 3 ) address funding mechanisms and institutional research practices that will be needed to promote antiracism practices in research and its dissemination. Results: A thorough literature review and expert opinion discussion demonstrated that there are few studies in childhood asthma that identify systemic racism as a root cause of many of the disparities seen in children with asthma. Community engagement and participation in research studies is essential to design interventions to address the racialized system in which patients and families live. Dissemination and implementation studies with an equity lens will provide the multilevel evaluations required to understand the impacts of interventions to address systemic racism and the downstream impacts. To address the impacts of systemic racism and childhood asthma, there needs to be increased training for research teams, funding for studies addressing research that evaluates the impacts of racism, funding for diverse and multidisciplinary research teams including community members, and institutional and financial support of advocating for policy changes based on study findings. Conclusions: Innovative study design, new tools to identify the impacts of systemic racism, community engagement, and improved infrastructure and funding are all needed to support research that will address impacts of systemic racism on childhood asthma outcomes.
引用
收藏
页码:1349 / 1364
页数:16
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