[Congressional Record (Bound Edition), Volume 157 (2011), Part 3]
[Senate]
[Pages 3695-3697]
[From the U.S. Government Publishing Office, www.gpo.gov]




              ASTHMA AND THE IMPACT OF HEALTH DISPARITIES

  Mr. CARDIN. Mr. President, I rise to speak about asthma and the 
impact of health disparities. I have pointed out on the floor before 
that race and ethnic health disparities exist in America. I have talked 
on the floor before about sickle cell disease. Well, the same thing is 
true with the chronic inflammatory diseases of the body's airways that 
impede breathing, such as asthma.
  As I pointed out before, the Affordable Care Act includes a provision 
I helped write that establishes the Institute for Minority Health and 
Health Disparities at NIH. The purpose for including this information 
about asthma in the Record is to point out that we still have 
challenges that need to be met. I look forward to working with my 
colleagues on that issue.
  Asthma is a chronic inflammatory disease of the body's airways that 
impairs breathing and affects more than 20 million Americans. People 
with this condition have overly reactive airways that constrict in 
response to allergens, temperature changes, physical exercise, and 
stress. During asthma attacks, the airways spasm and prevent oxygen 
from getting to the lungs. This leads to chest tightness, shortage of 
breath, wheezing and mucus production. Severe attacks can require 
intubation and even result in death. Of the 20 million Americans 
affected by asthma, about 7 million are children. In fact, about 10 
percent of all American children have asthma.
  Genetics play a significant role in the development of asthma in 
children and adults, but asthma is also influenced by environmental 
factors and racial, ethnic, and socioeconomic factors. Asthma is 
consistently found to be more prevalent among certain minority groups, 
particularly among Blacks, Native Americans, and Puerto Ricans. To be 
more precise, research indicates that asthma is 30 percent more 
prevalent in Blacks than in Whites; American Indians and Alaska Natives 
are 20 percent more likely to have asthma than Whites; Asian/Pacific 
Islander children are three times more likely to have asthma than White 
children; and Puerto Rican Americans have twice the asthma rate as the 
Latino American population overall.
  In addition to occurring more often, asthma is also more severe in 
minority populations, and this leads to higher mortality rates for 
Black Americans. Asthma accounts for more than 4,000 deaths in the 
United States each year. Blacks are 2.5 times more likely to die from 
asthma-related causes than Whites. Among children, this ratio is even 
more staggering--Black children are 7 times more likely to die from

[[Page 3696]]

asthma-related causes than White children. Interestingly, although 
Latino Americans and American Indian/Alaskan Natives are more likely 
than Whites to have asthma, they have a 50 percent lower mortality 
rate.
  As I noted earlier, the gap in asthma outcomes is also influenced by 
several socioeconomic factors. Health disparities can be attributed to 
differences in education level, independent of race or ethnicity. 
Research shows that children whose mothers have not completed high 
school are twice as likely to develop asthma as children whose mothers 
have a high school diploma, and this difference remains significant 
even when controlling for race and ethnicity.
  Economic status also influences the incidence of asthma. Studies have 
shown that unemployment is correlated with increased incidence, and 
that people with incomes below the Federal poverty level are 30 percent 
more likely to develop asthma as those who are above the Federal 
poverty level.
  One reason is that income level is correlated with quality of 
housing, and substandard housing is strongly associated with poor 
asthma outcomes. Substandard housing exposes residents to environmental 
triggers for asthma such as dust mites, roaches, mold, and rodents.
  A study in the journal Pediatrics showed that eliminating these 
indoor pollutants could prevent 39 percent of asthma cases in children. 
Other studies have shown that substandard housing accounts for up to a 
50-percent increase in asthma cases.
  In addition to indoor triggers, outdoor pollutants are also 
contributing factors. Researchers have shown that among people living 
within 50 yards of major car traffic, people living near a road 
traveled by 30,000 vehicles per day are three times more likely to 
develop asthma that those who live near a road traveled by 10,000 
vehicles per day. To put these figures into perspective, the average 
segment of I-495, our Capital Beltway, carries about 200,000 cars per 
day.
  The built environment comprising roads, factories, and other human-
made surroundings is a substantial risk factor for asthma. Many people 
are stuck in unhealthy living conditions because they can't afford to 
move elsewhere, particularly in the case of public housing projects, 
which are often situated in the most polluted locations. Initiatives 
such as the Healthy Homes Program run by the U.S. Department of Housing 
and Urban Development are encouraging, but greater effort must be 
devoted to raising the quality of the home environment for people 
living in poverty.
  Whether due to one or more of these factors, the impact of 
disparities in asthma is profound because asthma is such a crippling 
condition. Untreated or inappropriately treated, asthma makes it 
difficult to concentrate at school and work, limits physical activity, 
and often results in absenteeism. It also reaches beyond the patient to 
family members, as parents are often required to miss work to care for 
sick children. The Nation's 20 million asthma patients account for more 
than 100 million days each year in lost productivity due to absence 
from school and work, according to the American Academy of Allergy, 
Asthma, and Immunology. Yearly, asthma patients account for more than 
11 million office visits and 500,000 hospitalizations. That is an 
annual cost of more than $6 billion in direct and indirect medical 
expenditures. Much of this expense could be avoided with proper asthma 
management.
  Patients who are diagnosed at an early age and whose conditions are 
well managed by a primary care physician and an asthma specialist can 
avoid many of the complications associated with the condition. The 
ability to secure medications, such as an albuterol inhaler to 
alleviate attacks and steroids to suppress inflammation, can allow 
patients to play sports and live normal lives.
  But patients who lack access to specialists or can't afford needed 
medicines will frequently miss school, must forgo physical activity, 
and are often hospitalized. So the effect of access to affordable, 
comprehensive care is apparent.
  Even so, coverage is not enough. Asthma disparities have multiple 
interrelated causes, as I have outlined. We often view health 
disparities through the narrow lenses of genetic differences and 
differences in medical care. But upstream determinants such as social 
inequalities and neighborhood conditions can have a significant impact 
on health outcomes as well.
  Even though we know this, national policies have not effectively 
addressed the problem of health disparities pertaining to asthma. 
National asthma guidelines that are supported by the National 
Institutes of Health recommend preventive services and asthma care by a 
specialist. These guidelines have been found to save money and improve 
quality of life. But data still show that patients covered by Medicaid 
are offered less preventive care and fewer referrals to asthma 
specialists compared to patients in the private insurance market. This 
matters when it comes to outcomes because specialists are more likely 
to prescribe controller medications than primary care providers, 
regardless of the patient's racial or ethnic background. Decreased 
access to specialists has been associated with higher rates of 
hospitalization, emergency room use, and mortality. The bottom line is 
that Medicaid patients have been receiving lower quality treatment for 
asthma, despite the guidelines put forth by NIH and the American 
College of Allergy, Asthma, and Immunology.
  I am encouraged that there are significant efforts taking place to 
close the gaps at the local level. In Maryland, the University of 
Maryland Medical Center has developed an innovative approach to 
bringing specialized care to children who otherwise would not have 
access to it. Their BreathMobile program, led by Dr. Mary Beth 
Bollinger, is an asthma clinic on wheels. It is staffed by a pediatric 
allergist, a pediatric nurse practitioner, a registered nurse, and a 
driver who regularly travels to over two dozen schools in Baltimore 
City. The BreathMobile has provided ongoing care to more than 800 
students.
  At Johns Hopkins University, the Harriet Lane Clinic provides a 
comprehensive medical home for asthma patients. Over 90 percent of 
Harriet Lane's caseload are Medicaid patients, and they are provided 
with pulmonary specialists, social workers, and case managers who help 
them secure healthy housing, and seek help from other programs for 
which they may be eligible.
  With the passage of the Affordable Care Act, we have additional tools 
to address the problem of health disparities at a national level. I 
helped write into that law the new Institute for Minority Health and 
Health Disparities at NIH as well as the Offices of Minority Health at 
CMS and the Agency for Healthcare Research and Quality.
  These offices are charged with evaluating, coordinating, and 
advocating for efforts to eliminate disparities, and they can do much 
to close the gaps with respect to asthma.
  The new Institute will be instrumental in overseeing the coordination 
of asthma research at the National Heart, Lung, and Blood Institute and 
ensuring that the focus of biomedical research sufficiently addresses 
health disparities. We must encourage participation in clinical trials, 
particularly for underrepresented populations, so that we can speed the 
discovery of the most effective treatments. Provisions to encourage 
physicians to practice in underserved areas can improve access to care. 
The Office at AHRQ can help translate these findings into practice, and 
the Office at CMS can be instrumental in ensuring that eligible CHIP 
and Medicaid beneficiaries are enrolled in these programs and that they 
can receive the best possible care. With the Affordable Care Act, we 
have the momentum and the tools needed to make a difference in asthma 
health disparities.
  I look forward to returning to the floor soon to explore the issue of 
health disparities further by focusing on another condition that 
disproportionately affects minorities.

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  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. LAUTENBERG. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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