Gaps Found in Lung Care

An exhaustive report released today by the American Lung Association finds that minorities have a disproportionately wide range of respiratory ailments, from childhood infections to occupational lung disease, asthma and cancer. The report cites a long list of racial disparities:

* Blacks are three times more likely to die from asthma than whites. Black children also are three times as likely as other children to develop sleep apnea. Blacks have one of the highest rates in the world of sarcoidosis, a dangerous lung inflammation that contributed to the death in December of former NFL star Reggie White at age 43.

* Hispanics are more than twice as likely as blacks or whites to live in areas with high particulate matter, which increases the risk of early death. They also are twice as likely to work in high-risk industries.

* Native Americans die of sudden infant death syndrome, which could be linked to smoking during pregnancy, at rates twice as high as the rest of the country.

Although many reports have shown that minorities have greater health problems than whites, experts say it’s difficult to pin down the causes of such disparities. Some studies point to racial bias. In 2002, the Institute of Medicine, which advises Congress, found racial gaps even among patients of comparable insurance, income and age. Today’s report notes that black children covered by Medicaid had worse asthma and used less preventive medicine than other Medicaid patients.

Poverty probably plays a role, too, says James Donohue, chief of pulmonary medicine at the University of North Carolina-Chapel Hill. He notes that minorities are more likely to live in the inner city, where substandard housing and crowding contribute to lung disease. Minorities and immigrants, who are more likely to be poor, more often take jobs that expose them to hazardous chemicals.

Poor people frequently have trouble controlling chronic diseases, Donohue says. Asthmatics, for example, usually must take daily medications to prevent attacks. But low-income patients might miss medical appointments — and fail to receive prescriptions — because they don’t have a car and are unable to take time off from work. The poor also might lack insurance or a regular family doctor. Donohue says that may explain why, according to the report, blacks with asthma are five times more likely to seek care in the emergency room.

Donohue says it would help to have more clinics with night and weekend hours in minority neighborhoods and greater follow-up by emergency rooms. ”They may get excellent care in the ER,” Donohue says. ”But they don’t get follow-up because they don’t have a relationship with a doctor.”

LeRoy Graham, a lung specialist in Atlanta, says many patients are not aware of the best ways to manage chronic disease. He heads a group, Not One More Life, that provides free exams and asthma education in black churches.

Some experts say cultural differences might keep doctors from delivering the best care to minority patients. On Monday, the American Medical Association, the National Hispanic Medical Association and the National Medical Association announced the creation of the Commission to End Health Care Disparities to address questions of culture and access to care.