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Ethnicity, Culture Play Role in Lung Health

Posted on: Sunday, 6 February 2005, 12:00 CST

When it comes to lung health, ethnic and culturally diverse communities face significant disparities, according to a report released this past week by the American Lung Association.

"Knowledge is power," said Dr. LeRoy M. Graham, pediatric lung specialist at Morehouse School of Medicine in Atlanta, representing the association in discussing the report. "We are finding, as in many chronic diseases, huge health disparities in several aspects of lung disease."

There may be several reasons for the disparities, he said, including socioeconomic status and cultural issues in how health care is accessed.

"A lot of people in lower socioeconomic statuses are in the business of surviving and putting food on the table and not as into health maintenance. Another factor may be racism or other factors; it's known that African Americans are less likely to be referred to specialists than Caucasians. It may be the squeaky wheel gets oil.

"But physicians have to realize these populations are often diagnosed later and at a more advanced stage" of lung disease, Graham said. "The medical community has to be aware and focus more on education. We all have to look at causes."

While delayed diagnosis may be responsible for some of the trends, it could also be that genetics creates more severe disease in some ethnic populations, he said.

It is well known that there are genetic differences in diseases and that many therapies are more effective in one ethnic group than in another. For instance, high blood pressure is treated "fundamentally different" in African Americans than in other populations.

The report, "Lung Disease Data in Culturally Diverse Communities 2005" looked at health data nationwide from the year 2002. Among its findings:

The asthma rate is highest among African Americans.

Smoking is most common with American Indians, Chinese Americans and lesbian, gay, bisexual and transgender communities. But African Americans "are more likely to develop and die from lung cancer, although they have lower overall exposure to tobacco smoke."

Lung cancer kills more African Americans, American Indians and Alaskan natives than any other cancer and is one of the most common types of cancer in Hispanic men and women.

African American children are three times as likely to develop sleep-disordered breathing or sleep apnea than their young peers.

Hispanics are more apt to work in high-risk occupations than any other race or ethnic group and are more likely to suffer exposure to occupational respiratory hazards. Nearly 15 percent of asthma cases in America are related to occupational exposure.

Culturally diverse communities account for 61 percent of HIV/ AIDS cases. And Hispanics with HIV were more likely than whites and African Americans to have their condition turn into AIDS within a year of diagnosis. The lung is the "major target of infection" for HIV/AIDS patients.

American Indians and Alaskan natives have sudden infant death rates twice that of the rest of the population, while the rate for African Americans is 2.5 times higher than the rate for whites. Maternal smoking during pregnancy is thought to double the risk for an infant.

Only Zuni Indians have a higher rate of cystic fibrosis than whites, the one area of lung health where whites fare worse than others. The disease is the No. 1 genetic killer in the United States.

Flu/pneumonia is the fourth leading cause of death among elderly Asian/Pacific Islanders.

Tuberculosis rates are much higher for Asians/Pacific Islanders.

Respiratory syncytial virus occurs at especially high rates among American Indians and Alaskan natives.

The incidence of sarcoidosis, the lung disease thought responsible for the fatal cardiac rhythm that recently claimed former NFL player Reggie White at age 43, is eight times higher for African Americans than for whites.

How different ethnic groups access care also plays a role, Graham said. "One of the ideals of care is that everyone should have a primary care physician. Many people who are poor or minorities rely on emergency rooms for access to care. That's not the way to accurately and adequately address lung disease."

E-mail: lois@desnews.com

Source: Deseret News (Salt Lake City)

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