Asthma morbidity and mortality rates are rising at an alarming rate among minority populations in the United States, and are strikingly high in inner City Communities. Excess rates of morbidity carry with them substantial human, social and economic costs; 30% of the economic burden of asthma in the U.S. is associated with emergency room use and hospitalization. It is crucial to understand the causes of excess asthma morbidity among minorities and to identify factors that can serve as the basis for interventions. The investigative team for the proposed research has a unique opportunity to use national data (NHANES III, HHANES) and specifically linked population-based and hospital-based data on men, women and children from two inner city communities, one largely African-American (Harlem) and one largely Hispanic (Washington Heights), to address the following objectives: l) to distinguish the independent effects on asthma morbidity of race from those of socioeconomic status and community disadvantage, over and above known risk factors such as age, gender, and smoking; and 2) to identify social, behavioral and health service factors in disadvantaged minority communities that can be targeted as effective points of health education and primary care intervention. Such factors include access to and utilization of primary care, health promotion behaviors, social support, and strategies to cope with asthma. No previous research has systematically addressed these risk factors in defined minority populations with measures comparable to those used in the HANES. Theoretically guided, multivariate, multi-level analyses will a) provide current national estimates of asthma morbidity for the African-American and Hispanic populations by poverty status, b) determine whether the higher risk among African-American and Hispanic populations is due to race, to particular socioeconomic, social, behavioral, or co-morbid conditions, to lack of access to primary care, or to interactions of these factors with age and gender, c) test the generalizability of national patterns to those in two inner city minority communities, and d) identify community-specific factors that are barriers to the successful management of asthma. The fundamental goal of this research is to identify barriers to care and other risk factors that are potentially amenable to intervention.
