Respiratory Health Equality in the United States. The American Thoracic Society Perspective

Abstract

Because the frequency of major risk factors for respiratory diseases (e.g., tobacco use) differs across demographic groups (defined by socioeconomic status, race/ethnicity, sexual orientation, health care access, occupation, or other characteristics), health disparities are commonly encountered in pediatric and adult pulmonary, critical care, and sleep medicine. As part of its policy on respiratory health disparities, the American Thoracic Society (ATS) Executive Committee created a Health Equality Subcommittee of the Health Policy Committee, with an initial mandate of defining respiratory health equality and, as a subsequent task, providing recommendations to the ATS leadership as to how our society may help attain such equality in the United States. After receiving input from the ATS assemblies and committees, the subcommittee developed this document on respiratory health equality. This document defines respiratory health disparities and respiratory health equality, and expands on a recent ATS and European Respiratory Society policy statement on disparities in respiratory health. Attainment of respiratory health equality requires the ending of respiratory health disparities, which can be achieved only through multidisciplinary efforts to eliminate detrimental environmental exposures while promoting a healthy lifestyle, implementing all components of high-quality health care (prevention, screening, diagnosis, and treatment), and conducting research that will lead to better prevention and management of respiratory diseases for everyone. The ATS recognizes that such efforts must include all stakeholders: members of society at large, governmental and nongovernmental organizations, and other professional societies. The ATS urges all of its members and those of sister societies to work to achieve this laudable goal.

Moving toward True Inclusion of Racial/Ethnic Minorities in Federally Funded Studies. A Key Step for Achieving Respiratory Health Equality in the United States

“…Genetic and environmental risk factors, as well as modifiers (e.g., healthcare access, response to and side effects from treatment) of respiratory diseases vary dramatically across racial and ethnic groups (13). Thus, underrepresentation of racial and ethnic minorities in research studies severely limits our ability to develop knowledge or awareness of racial-and ethnic-specific causes or modifiers of frequently encountered pulmonary diseases.…”

Gender-specific determinants of asthma among U.S. adults

“…Factors contributing to them include non-modifiable factors such as differences in genetic ancestry [8–10], and modifiable factors such as poor health, disease risk factors, medication non-adherence, health literacy and limited access to health care due to social, economic and environmental disadvantages [6, 11, 12]. Racial/ethnic minority groups in the U.S. disproportionately fall within low socioeconomic status categories, resulting in difficulty separating health factors that are heritable vs. socioeconomic and environmental ones [13, 14].…”

Health insurance and use of recommended routine care in adults with cystic fibrosis

“…Low SES is associated with worse respiratory disease outcomes, motivating targeted efforts to reduce this disparity. 23,24 Associations between socioeconomic disadvantage and worse clinical outcomes are well-established in CF. 3,5,25 Prior exploration of mechanisms underlying these disparities focused on children with CF, finding few differences in access to CF care according to insurance status or other aspects of SES.…”