The NHLBI initiative addresses a critical need for identifying the factors that contribute to substantially higher rates of emergency room visits, hospital admissions, and deaths due to asthma among certain populations. African Americans, for example, have a slightly higher asthma prevalence rate than Caucasians (8.5 percent versus 7.1 percent), yet they are three times more likely to be hospitalized or to die from asthma complications, according to the Centers for Disease Control and Prevention. Hispanics and families with low income are also at increased risk.
"This new initiative generates important research that will lead to better ways to reduce the burden of asthma among the groups that are most strongly affected," said NHLBI Director Dr. Claude Lenfant. "We expect this program to have a far-reaching impact by creating a legacy of research programs for improving asthma care and by ultimately serving as a model for studying ways to reduce disparities in other chronic diseases."
Scientists at the five new Centers will examine a range of research topics focusing on the differences in asthma prevalence, emergency department use, hospitalizations, and deaths between the ethnic and racial groups, and between low-income populations and their more affluent counterparts. Research projects will evaluate the role of psychosocial factors in disparities in asthma care over time, differences in symptom perception among racial and ethnic groups and how these differences affect patients' patterns for seeking care, and ways to improve communications between patients and their doctors about asthma treatment. Other studies will focus on the biological and genetic mechanisms involved in asthma disparities, such as ethnic variations in sensitivity to environmental allergens and the interrelationship between genetic susceptibility and stress, smoking, and exposure to diesel exhaust in provoking asthma symptoms.
The Centers will also collaborate on training activities -- a critical feature of the program. "This initiative does not just support individual projects," emphasized Dr. Lenfant. "The partnering institutions in each Center will teach each other and build opportunities in this scientific area of reducing health disparities. We envision the research intensive institutions becoming more adept in applying resources to culturally responsive research and the minority-serving institutions gaining organizational infrastructure and experience for future research." Career development and mentorship opportunities for minority clinical researchers are related components of the initiative.
NHLBI has awarded a total of $5.9 million to the following centers for the first year of funding, which began September 30, 2002, and which will continue for five years:
- Baltimore-Washington (Johns Hopkins University and Howard University)
- Boston (Brigham and Women's Hospital and Center for Community Health Education)
- Chicago (Northwestern University and Cook County Hospital)
- Nashville (Vanderbilt University and Meharry Medical College)
- Providence and San Juan (Rhode Island Hospital and University of Puerto Rico).
More than 14 million Americans reported having asthma in 2000, according to the National Center for Health Statistics (NCHS). Asthma is a leading contributor of limited activity and absences from work and school; it also causes 5,000 deaths each year in the U.S. NHLBI estimates that the annual direct and indirect costs of asthma were $12.7 billion in 2000.
The NHLBI Centers for Reducing Disparities in Asthma initiative directly addresses one of the top four priorities of the U.S. Department of Health in Human Services' (HHS) "Action Against Asthma." Released in May 2000, this strategic plan was developed to help achieve the national Healthy People 2010 goals for asthma. NHLBI is a component of the National Institutes of Health, an HHS agency.
NHLBI supports other educational programs to encourage early diagnosis and effective treatment of asthma and to decrease asthma disparities. Through the National Asthma Education and Prevention Program (NAEPP), the Institute funds several coalitions serving communities with exceptionally high rates of asthma-related illnesses and deaths, and it provides a vital communications network for more than 40 local asthma coalitions nationwide.
Information on asthma, the NAEPP, and other NHLBI-supported research and educational programs is available online at www.nhlbi.nih.gov. Related resources are listed below:
- National Asthma Education and Prevention Program, www.nhlbi.nih.gov/about/naepp/index.htm
- Asthma Management Model System (Web Site), www.nhlbisupport.com/asthma/index.html
- NAEPP Coalition Contract Awardees, http://hin.nhlbi.nih.gov/ast_maps/awardee.html
- Action Against Asthma: A Strategic Plan for the Department of Health and Human Services, http://aspe.hhs.gov/sp/asthma/