Ann Am Thorac Soc. 2024 Oct;21(10):1349-1364. doi: 10.1513/AnnalsATS.202407-767ST.
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 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. 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 ) address the current gaps in our understanding of how to conceptualize and characterize the impacts of systemic racism on child health, ) 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 ) address funding mechanisms and institutional research practices that will be needed to promote antiracism practices in research and its dissemination. 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. 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.
在美国，患有哮喘的黑人和拉丁裔儿童因哮喘恶化而需要急诊就诊或住院治疗的可能性高于患有哮喘的白人儿童。尽管许多人将患者的社会经济地位和获得医疗保健的机会作为差异的主要驱动因素，但人们越来越关注造成差异的一个主要根源——系统性种族主义。当前哮喘差异的概念模型将系统性种族主义的历史和当前影响描绘为不平等暴露于健康的社会决定因素、环境暴露、表观遗传因素以及差异的医疗保健获取和质量的基础。这些最终导致一生中的生物学变化，导致哮喘发病率和死亡率。在 2022 年美国胸科学会国际会议上，一个多元化的专家小组聚集在一起，确定了在儿童哮喘研究中解决系统性种族主义的差距和机会。小组成员发现，要研究和解决系统性种族主义对哮喘儿童的影响，支持生物医学研究的研究人员和医疗系统需要）解决我们对如何概念化和描述系统性种族主义对儿童健康影响的理解中的当前差距，）设计利用多种学科并让受系统性种族主义影响的社区参与确定和设计研究的研究，以评估解决导致哮喘健康结果差异的种族化系统的干预措施，以及）解决促进研究中的反种族主义实践及其传播所需的资金机制和机构研究实践。彻底的文献回顾和专家意见讨论表明，在儿童哮喘中，很少有研究将系统性种族主义确定为哮喘儿童中许多差异的根源。社区参与和参与研究对于设计干预措施以解决患者和家庭所处的种族化系统至关重要。具有公平视角的传播和实施研究将提供了解解决系统性种族主义和下游影响的干预措施的影响所需的多层次评估。为了解决系统性种族主义和儿童哮喘的影响，需要为研究团队提供更多培训，为解决评估种族主义影响的研究提供资金，为包括社区成员在内的多元化和多学科研究团队提供资金，并为根据研究结果倡导政策变革提供机构和财务支持。创新的研究设计、新的工具来识别系统性种族主义的影响、社区参与以及改善的基础设施和资金都是支持研究的必要条件，这些研究将解决系统性种族主义对儿童哮喘结果的影响。
