Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct a comprehensive literature review. The results were compiled into a meta-analysis (U.S. National Library of Medicine, 2023). Because every analysis was based on previously published articles, neither consent nor ethical approval was required for the research. The protocol for this study needed to be registered appropriately.
Search strategy
I searched through the online resources provided by WHO, the National Library of Medicine, reputable websites, and a large number of peer-reviewed journals, as well as dissertations and research papers obtained from Google Scholar, amongst many other sources, looking for English-language content. The creation dates of these resources ranged from 2013 to 2023. Throughout my search, I zeroed in on four major categories of possible research designs: “Asthma is more common in low-income groups,” “Asthma prevalence and Patient disparities,” and “Asthma prevalence and risk factors.” Both the Boolean “OR” and “AND” operators were utilized in order to combine search keywords within each category; however, only the “OR” operator was utilized in order to incorporate search phrases across categories. I did cross-referencing by looking up the references in each article so that this procedure would go more smoothly. Following the retrieval of the results of the search, the titles and abstracts of the results were examined to determine whether or not they were relevant. The full texts of all the articles that had abstracts that could be considered appropriate were read and analyzed.
For studies to be eligible for consideration in the review, they were required to fulfill the following criteria: In quantitative empirical research conducted in English, there is a prospective or longitudinal relationship on whether “Asthma is more prevalent in low-income communities” or “Asthma prevalence and Patient disparities” throughout follow-up. This connection can be either prospective or longitudinal. The following factors were not taken into account: (1) an investigation based on experiments; (2) a review of the relevant prior literature; and (3) an abstract that has been presented elsewhere. In this synthesis, the impacts that did not consider the results’ levels at the baseline were referred to as “possible designs.” Examples of how the “process of integrating” handled the normality of the data of the outcome include accounting for baseline levels of the result in the analytic models, coding any outcome measure to represent only new occurrences, and excluding individuals who encountered the end at baseline. All of these are examples of how the normality of the data was handled.
Expected findings
Some significant findings concerning asthma prevalence and patient disparities were discovered by reviewing the literature. Asthma is more common in low-income areas, which is not surprising given the prevalence of environmental and social variables in the development and worsening of asthma in these areas. World Health Organization. (2023) reported that children in poverty had a higher prevalence of asthma (13.8%) than children in wealthier households. In contrast, the percentage was just 7.1% among kids whose families had incomes over the poverty line. In addition, the inequalities in access to excellent healthcare and treatment options that are more common in low-income neighborhoods can exacerbate asthma symptoms and worsen outcomes (Gong et al. n.d)
The literature study also emphasized racial and ethnic differences in asthma prevalence and outcomes. In particular, patients from racial and ethnic minorities are more likely to suffer from asthma and have poorer results than non-Hispanic white patients (Thakur et al.,2013). For instance, compared to non-Hispanic whites, people of color are more likely to attend an emergency room or be hospitalized due to asthma (Thakur et al.,2013). Housing circumstances, air pollution exposure, and access to healthcare services are among the essential determinants identified in the literature as having a substantial effect on asthma outcomes (Ogbogu et al.,2021). Asthma care and control ultimately rely on patient education and self-management, as patients who are knowledgeable about their condition and have the tools to manage their symptoms have better health outcomes (Grant et al.,2021)
The literature review also uncovered several gaps and restrictions in the previously conducted studies on asthma and health disparities. For instance, most research overlooked considering the larger social and environmental contexts influencing asthma outcomes in favor of individual-level factors like genetics and personal habits (Ogbogu et al.,2021). Further study is required to determine how socioeconomic determinants of health, such as housing rules, urban planning, and environmental restrictions, contribute to or lessen asthma inequities. Furthermore, there is insufficient research on how well policies and interventions reduce asthma disparities, especially in low-income and minority neighborhoods (Bryant-Stephens et al.,2022).
Discussion
The higher frequency of asthma in regions with lower incomes can be ascribed to various social factors that play a role in determining health (Stern et al.,2020). Asthma attacks can be sparked and worsened by living in substandard housing and being subjected to pollution in the surrounding environment (Bryant-Stephens et al.,2022). Because low-income neighborhoods are more likely to be close to industrial zones or highways, their overall exposure to air pollution is likely to be more significant. (Stern et al.,2020) In addition, residents of these places have limited access to high-quality medical care, which results in longer wait times between diagnosis and treatment (Pate et al.,2021). People hailing from these areas frequently lack health insurance and have restricted access to modes of transportation that can take them to medical facilities (Grant et al.,2021). These discrepancies in access to healthcare can result in inadequate management of asthma, which can lead to an increased risk of problems associated with asthma
In addition, the increased prevalence of asthma in racial and ethnic minority groups can be traced back to hereditary and environmental variables. For instance, research has found that African Americans had a higher prevalence of a genetic variant that is connected with asthma compared to other ethnic groups’ rates of having the variant (Pate et al.,2021). On the other hand, environmental variables such as exposure to air pollution, housing conditions, and access to healthcare also have a role in the increased prevalence of asthma in minority communities.
The findings generally point to the necessity of tackling social determinants of health and health disparities in asthma care. It is possible to lessen the burden of asthma in low-income and minority populations by implementing interventions such as improving living conditions, reducing exposure to environmental contaminants, and increasing access to excellent healthcare (Gong et al.,2022). In addition, patient education and programs that encourage self-management can enhance asthma control and overall health outcomes.
Conclusion
In conclusion, asthma is a complicated disorder affecting millions of people worldwide, with a higher prevalence among low-income communities and minority racial and ethnic groups. The previously published research has shed light on the different social determinants of health influencing asthma outcomes. These social determinants of health include housing conditions, exposure to air pollution, and access to healthcare facilities. In addition, patients from these communities frequently experience inequities in terms of their access to high-quality medical care and the range of treatment options available to them. There have been a number of studies done on asthma; however, the existing literature still has a number of holes and limitations, highlighting the need for additional research to better understand the underlying mechanisms of asthma and the factors contributing to disparities in the outcomes of asthma. In order to develop more effective interventions and treatment options for people who live with asthma, it is necessary to address the gaps and limitations that currently exist in research. This will ultimately lead to an improvement in the overall quality of life for asthma sufferers.
References
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Bryant-Stephens, T. C., Strane, D., Robinson, E. K., Bhambhani, S., & Kenyon, C. C. (2021). Housing and asthma disparities. Journal of Allergy and Clinical Immunology, 148(5), 1121-1129. https://doi.org/10.1016/j.jaci.2021.09.023
Gong, T., Lundholm, C., Rejnö, G., Mood, C., Långström, N., & Almqvist, C. (n.d.). Parental socioeconomic status, childhood asthma and medication use – a population-based study. PLOS ONE. Retrieved February 26, 2023, from https://journals.plos.org/plosone/article? id=10.1371%2Fjournal.pone.0106579
Grant, T., Croce, E., & Matsui, E. C. (2022). Asthma and the social determinants of health. Annals of Allergy, Asthma & Immunology, 128(1), 5-11. https://doi.org/10.1016/j.anai.2021.10.002
Ogbogu, P. U., Capers IV, Q., & Apter, A. J. (2021). Disparities in asthma and allergy care: what can we do?. The Journal of Allergy and Clinical Immunology: In Practice, 9(2), 663-669. https://doi.org/10.1016/j.jaip.2020.10.030
Pate, C. A., Zahran, H. S., Qin, X., Johnson, C., Hummelman, E., & Malilay, J. (2021). Asthma surveillance—United States, 2006–2018. MMWR Surveillance Summaries, 70(5), 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8480992/
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