Research Addressing the Impact of Systemic Racism on Childhood Asthma Outcomes

Research study background

A diverse group of pediatric asthma experts convened by the American Thoracic Society (ATS) recently released a comprehensive report examining how systemic racism impacts asthma outcomes in children from marginalized groups. Among children in the United States with asthma, Black and Latino children are more likely to go to the emergency department or hospital compared to those who are white. Systemic racism leads to unequal access to social resources, harmful environmental conditions and differences in healthcare quality. These factors, over time, lead to biological changes that increase asthma severity and related health risks.

Co-authored by Monica Federico, MD, pediatric pulmonologist and Medical Director of the Asthma Program at Children’s Hospital Colorado with additional contributions from Heather De Keyser, MD, the report identifies key research priorities and suggests a framework for research to help bring about meaningful change. Many studies have focused on racial disparities in the treatment of asthma. Here, the authors reviewed existing conceptual models of how racism affects health and proposed revisions based on their findings. The result was a proposed model that links the historical process of racialization, driven by colonization, to modern systemic racism and highlights how past policies such as redlining can impact current asthma outcomes.

The report also identified several important ethical considerations for researching systemic racism and pediatric asthma, including engaging affected communities, building diverse teams, ensuring fair participation and carefully managing data and recruitment. One key consideration is evaluating how reference communities are selected for research. White participants have historically been the de facto reference group to compare other racial or ethnic groups, which can negatively impact healthcare inequities.

The report suggested that in order to decenter whiteness, comparators like whole population, multiple groups, or nondominant racial groups, depending on the outcome, should be used instead (when applicable). In addition, to identify metrics of success and solutions, this research should engage the community by considering the lived experiences of families and children with asthma.

The group recommended dissemination and implementation science — the study of real-world application of evidence-based practices and policies — as the ideal research model for understanding the impacts of interventions addressing systemic racism. Authors of the report call for more research training, funding for diverse research teams that include and engage affected community members, as well as stronger institutional and financial support to advocate for policy changes informed by research. To build on current recommended topics for responsible research, the authors suggest adding modules that cover the effects of systemic racism on health disparities and inequities and that incorporate antiracism methodologies into research on human participants.

Relevance to future research

Future research efforts should focus on dismantling the inequitable policies perpetuating these disparities. While challenges remain, the report offers a practical framework for designing innovative studies that identify systemic racism’s impact on childhood asthma, leverage community engagement and improve infrastructure.

1. Dr. Federico Contributes to Improving Asthma Guidelines to Change Outcomes
2. Best in Pediatrics for Asthma Care
3. Transforming Community Health
4. Diversity, Health Equity and Inclusion (DHE&I) at the Breathing Institute
5. Health Equity in Primary Care