Health-Related Disparities in Pediatric Asthma: Morbidity, Attitudes Toward Illness, and Symptom Perception
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Abstract
Asthma disproportionately affects racial/ethnic minorities and children from low socioeconomic backgrounds; however, an explanation for these disparities is unclear. Furthermore, little is known about psychological outcomes that might vary by race/ethnicity and socioeconomic status (SES) in parallel with differences in physical health outcomes. Symptom perception accuracy--in this case, the degree of correspondence between estimated and actual peak flow--is one promising area of research that has only recently been applied to pediatric asthma in an attempt to explain disparities in asthma outcomes. Adding to the relevance of mental health outcomes in pediatric asthma, research suggests that certain psychological variables have a significant influence on symptom perception accuracy. Therefore, the current study sought to explore possible racial and socioeconomic differences in psychological outcomes, examine the role of symptom perception accuracy in pediatric asthma disparities, and investigate the impact of attitudes toward asthma on symptom perception accuracy. As part of participation in a large-scale pediatric asthma education program (Project On TRAC: Taking Responsibility for Asthma Control), 158 non-Hispanic Black (NHB) and White (NHW) children with persistent asthma between the ages of 8 and 15 years and their caregivers reported on demographic characteristics, signs and symptoms of asthma, asthma morbidity, health-related quality of life (HRQL), and attitudes toward asthma. These children also completed assessments of symptom perception accuracy by making daily estimates of peak flow, which were then compared to actual peak flow measured by hand-held electronic spirometers at home. Results indicated that race influences symptom perception independent of SES. NHW youths were more accurate in estimating peak flow than NHB youths but the types of errors made (i.e., overestimating or underestimating peak flow) were generally similar between races. More accurate estimates of peak flow predicted higher HRQL. Attitudes toward asthma varied by SES but not by race, with higher SES predicting more positive attitudes. However, only a non-significant trend was identified for more favorable attitudes to predict more accurate peak flow estimates. As findings suggest that NHB youths are less likely to make accurate estimates of peak flow and symptom perception is associated with HRQL, researchers and clinicians should consider interventions to improve symptom perception as one strategy for reducing the disproportionate burden of asthma morbidity on NHB youths. Findings of the present investigation also highlight the importance of assessing psychological responses to pediatric asthma and providing treatment when indicated, particularly among children from low socioeconomic backgrounds. Additional research is needed to identify variables that mediate the relationship between symptom perception accuracy and asthma outcomes, develop interventions to improve symptom perception accuracy, and further explore the role of psychological variables in pediatric asthma self-management.