Asthma Prevalence, Severity, and Nonfatal Burden by Race/Ethnicity in the United States: A Bayesian Meta-regression Analysis

Abstract

Context: Asthma is the most common chronic respiratory disease and is characterized by inflammation of the airways in response to stimuli. Evidence additionally suggests that asthma is more prevalent and more severe in Black American and Hispanic populations, influenced by factors such as chronic stress, access to healthcare, and medical racism. We aimed to quantify the prevalence, severity, and nonfatal burden of asthma by race/ethnicity, utilizing a Bayesian meta-regression analytical method. Methods: We ran models of asthma prevalence by race/ethnicity, year, sex, and age, utilizing data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS). We separately quantified the severity of asthma using NHANES data on functional health loss due to wheeze, mapping this information to health states and disability weights sourced from the Global Burden of Disease study. This information was used to calculate Years Lived With Disability, a metric of nonfatal disease burden. We conducted a Das Gupta decomposition analysis to assess whether differences in nonfatal burden between different race/ethnicity groups were driven by prevalence or severity. Results: Non-Hispanic Black women had the highest age-standardized asthma prevalence rates (6.1%, 95% Uncertainty Interval [UI] 5.7 to 6.3). Black women also had the highest age-standardized mean disability weight of all race/ethnicity and sex combinations (0.049, 95% UI 0.040 to 0.060), while Non-Hispanic White men have the least severe asthma on average. An estimated 66% (37.2 to 80.8) of the difference in age-standardized YLDs between Black and White women was attributable to severity. Conclusion: This study indicates large racial disparities in the nonfatal burden of asthma in the United States, with the largest burden in Non-Hispanic Black women. Concerted policy action should be taken to increase access to high-quality healthcare in this group to reduce observed disparities.