African Americans; Asthma – Treatment; Discrimination in medical care; Determinant; Eco-social model; Health status disparities; Marginality; Social


Demography, Population, and Ecology | Environmental Public Health | Health Services Research | Public Health | Race and Ethnicity


Background: Asthma management disparities (AMD) between African and White Americans are significant and alarming. Various determinants have been suggested by research frameworks that affect the unfair distribution of resources for asthma management to groups who are more or less advantaged socially. Ecosocial models organize determinants into individual/family, healthcare, community, and sociocultural levels. Multilevel interventions can affect AMD through simultaneous actions on different levels and pathways between determinants.

Objective: Provide a comprehensive summary of the known determinants of AMD.

Method: Peer reviewed research frameworks of AMD from 1998-2009 were retrieved from PubMed/ Web of Science databases using (“Socioeconomic Factors”[Mesh] OR (“Healthcare Disparities”[Mesh] OR “Health Status Disparities”[Mesh])) AND “Asthma”[Mesh] AND “African Americans”[Mesh] OR “Ethnic Groups”[Mesh]). Abstracts assessed for a focus on AMD, and determinants. Articles were analyzed for ecosocial levels and determinants.

Results: 13 research frameworks described 34 determinants. Compared to other levels, Individual/family levels had the most emphasis, and frameworks using healthcare and community levels were the most narrow in focus. Stress, poverty, violence/crime, quality of care, healthcare access, and indoor air quality were well described determinants.

Conclusions: Multilevel investigations should include those well described determinants of AMD and increase knowledge of pathway interactions between healthcare and community levels.