RESUMO
BACKGROUND: Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences. OBJECTIVE: We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Assuntos
Asma , População Negra , Adulto , Humanos , Asma/complicações , Asma/epidemiologia , Asma/etnologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Hispânico ou Latino/etnologia , Hispânico ou Latino/estatística & dados numéricos , Morbidade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Porto Rico/etnologia , Negro ou Afro-Americano/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , População do Caribe/estatística & dados numéricos , África/etnologia , População Negra/etnologia , População Negra/estatística & dados numéricosRESUMO
Although all ethnic/racial groups underutilize mental health services, only about one-third of African Americans and Caribbean Blacks in need utilize mental health services. An extensive literature review led us to examine if an association between perceived discrimination and mental health utilization exists. The National Survey of American Life 2001-2003 nationally representative dataset was analyzed. Variables including utilization of mental health services, perceived discrimination, and socio-demographic variables were assessed for their relationships. The study found that each of the following predictors statistically significant: being male, being employed, having household income higher than 100,000, perceiving no discrimination, being African American, or being Caribbean Black are less likely to utilize mental health services than their counterparts. This study contributes to the emerging body of evidence demonstrating that perceived discrimination has a strong connection with the utilization of mental health services.