Asthma is one of the most common chronic illnesses in the United States, affecting six million children under the age of 18, about 8% of this population. As with other chronic disease, it is a burden distributed unevenly, falling disproportionately on poor children and children of color.
For example, kids in low-income families suffer asthma rates almost 1.5 times greater than the national rate. Black and Native American children also experience asthma at well above national percentages. And, among Hispanics, Puerto Ricans are most likely to have asthma, at almost twice the national rate.
Children with asthma who are poor (40.8%) or near poor (35.7%) were more likely than children without asthma who are poor (29.5%) and near poor (24.5%) to have visited a health care provider three or more times.
Asthma is influenced by both genetic and environmental factors. Environmental triggers include indoor allergens, dampness and mold, inadequate ventilation, lead, asbestos, tobacco smoke and rodents and other pests in rooms, doorways and corridors. These irritants are often found in older, poorly maintained or high-density housing.
Renters, especially those receiving housing assistance, suffer asthma at higher rates than owners and make more frequent visits to the hospital as a result. Children who live in urban areas also have higher rates of asthma prevalence, morbidity and mortality.
Asthma can create staggering costs for low-income families. While the average yearly cost is $3,266 per person, individuals below the poverty line pay $3,581, almost 10% more each year, for asthma-related hospitalizations, office visits and medication. When asthma is not well-controlled, the financial and health outcomes may be even more extreme. Over 6% of children with asthma live in families that cannot not afford prescription medicine. When these drugs are not affordable, other less costly but far more dangerous options may be the only way to treat symptoms.
This puts kids at much higher risk for severe asthma attacks, increasing emergency room visits and triggering another round of cascading costs. For the 40% of Americans who lack even $400 for emergency expenses, one major medical episode may be devastating.
Other demands, such as traveling to and from office visits and waiting for appointments, are similarly cumbersome. Taking a sick child to the doctor may cost a parent a half a day or more of work, resulting in lost earnings that are crucial to paying household expenses. Kids with asthma are also deprived of valuable time in the classroom.
Each year, children and adolescents lose more than 5 million school days due to asthma, resulting in incalculable effects on their educational development. What’s more, these costs are not spread equally among groups. For example, among children with asthma, 52.7% of African American kids and 56.5% of Hispanic kids miss school each year, compared to 43.8% of white kids.
Ultimately, asthma disparities, like all health disparities, hurt those immediately affected by illness, but they also harm the social and economic well-being of the wider society. The inability to counteract health disparities leads to long-term direct and indirect costs, preventing financial layouts in other areas that could improve quality of life.
Most recent estimates suggest that asthma costs the U.S. $81.9 billion annually in medical expenses, days missed from work and school, and deaths. This sum does not include the impact of lost productivity and education on individuals, families and their communities. Best estimates suggest that medical and absenteeism costs of asthma will rise in the near future.
To bring down costs, there is an urgent need for strategies to build and strengthen local, state and national efforts to prevent and control asthma.