Disparities in Lung Disease: Ethnic & Racial Clues

Understanding the story of disparities in lung disease is like trying to complete a two-sided jigsaw puzzle—rich in dimension, intricate and frustrating, but ultimately ripe for solutions that can one day interlock many seemingly disparate pieces.

At one time, the most obvious cause for lung disease disparities was that minority populations were disproportionately affected by occupational lung diseases because they were more likely to work in jobs that present an increased risk for lung disease. They include construction and industry workers exposed to asbestos, farmers exposed to a variety of dust and mineral particles and miners exposed to coal and minerals while on the job. Workers in those jobs are at an increased risk for diseases such as mesothelioma, occupational asthma, lung cancer, silicosis, asbestosis, pneumoconiosis, byssinosis (brown lung), and others. 

And unfortunately, that holds true today, but research has moved us forward to understanding elements of lung disease among diverse communities that require attention through investigations into genetics and physiology, environmental exposure and educational approaches. Perhaps most dramatic are the confluence of research findings related to lung disease and exposure to indoor and outdoor air pollution as well as violence, and access to health care and health insurance. Socioeconomic differences among racial and ethnic groups influence patterns of disease, disability and healthcare. Fifty-eight percent of the 39.8 million Americans living in poverty are racial and ethnic minorities, and communities of color make up 54 percent of uninsured Americans. They are less likely to have a regular health care provider, one of the reasons people living in poverty suffer from poor health. Many studies have consistently associated greater harm from air pollution with low socioeconomic level and living closer to major sources of pollution such as highways and industrialized areas. The largest study of particle pollution mortality nationwide found that low socioeconomic status consistently increased the risk of premature death from fine particle pollution among 13.2 million Medicare recipients. The level of stress among communities also may contribute to the higher prevalence of asthma for children living in those areas. Research has identified a relationship between high crime and neighborhood violence and asthma.

In the area of basic research, scientists are working to isolate genetic influences on asthma development. Results indicate that there are different types of asthma that vary according to ancestry, among many groups, including Caucasians. Some asthma variations include allergic sensitization, IgE levels and bronchial hyper-responsiveness. These all present in a unique manner for each racial and ethnic group.  The amount of research being conducted into asthma has grown, but its complexity continues to challenge investigators. Specific research barriers, however, are the lack of sufficiently large studies of minority populations, the large number of asthma-related environmental factors and varied possible levels of exposure, and the many interactions between these factors and genetic influences.

Lung cancer presents glaring disparities, particularly related to African Americans, who have higher lung cancer incidence rates than any other ethnic or racial group and are more likely to die of lung cancer, despite lower smoking rates. Researchers are working to understand reasons for the dramatic discrepancy, including issues surrounding genetics, health care quality and delayed diagnoses. Access to quality healthcare has become integral for patients in their fight against lung cancer. One study found disparities in the quality of care received by African-American and Caucasian lung cancer patients, including data that African Americans are less likely to undergo staging, receive surgery once staged, or receive a recommendation for surgery even when there were no clear indications against it.

Genetics research, however, holds the promise to benefit all racial and ethnic groups. Investigators continue to work toward "personalized medicine" tailored to identify which specific medications will be effective with an individual’s DNA. Preventing lung disease disparities, however, will continue to be a focus of the American Lung Association and a cadre of researchers nationwide.