Health Disparities: Interventions for Pulmonary Disease - a narrative review.

TOPIC IMPORTANCE

There is an expansive literature documenting the presence of health disparities, but disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the United States healthcare system to support future initiatives to reduce disparity.

REVIEW FINDINGS

We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or gender. We grouped the studies into four categories: Biologic, Educational, Behavioral, and Structural. We identified five main themes: There were few interventional trials compared to the breadth of studies describing health disparities. Trials involving patients with asthma who were Black, low income, and living in an urban setting were over represented. Race or socioeconomic status were not effective markers of individual pharmacologic treatment response. Telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities. Future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone. Individual interventions will only be maximally effective when specifically tailored to local needs.

SUMMARY

Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.