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A new analysis of hospital visits indicates that Black children enrolled in Medicaid are less likely to get asthma medication than white children also enrolled in the program. The Black children are also more likely to be hospitalized, according to Urban Institute analysis. 

It is not new that Black American children are more likely to develop asthma than other races and ethnicities. According to Centers for Disease Control and Prevention data, nationwide approximately 4.5 million children have the condition, defined as a tightening or blocking of the airways, and 12 percent of them are Black compared to 5.5 percent white children.

And about half of U.S. children with asthma are covered by Medicaid or Children’s Health Insurance Program, according to the Asthma and Allergy Foundation of America. 

The Urban Institute analysis found racial disparities in asthma-related emergency room visits and hospitalizations among Black and white Medicaid-enrolled children. The disparities are possibly due to Black children receiving prescription asthma medication less often, according to the brief, “Black-White Racial Differences in Asthma Medication Receipt among Medicaid-Enrolled Children.”

While the institute’s findings could suggest that healthcare coverage does not equal care, lead report author Laura Barrie Smith said, “racial disparities in childhood asthma outcomes are evidence of larger systemic conditions, beyond medication.”

And others, such as Dr. Tyree M.S. Winters, president of the American College of Osteopathic Pediatricians, agree.

“The data supports that there is a higher prevalence of asthma in children of African descent. However, there is a perspective that global ecology medicine has a role and that we live in places where environments have an impact on our health. And I am not only referring to urban centers, but to rural places, too. Where do we put manufacturing facilities, or in what areas are pesticides used, for example?” Winters said.

According to the Child Opportunity Index, about 4 in 10 Black children reside in neighborhoods with poor environmental conditions compared to 1 in 10 white children. And the Environmental Protection Agency (EPA) says Black children, and children from other marginalized groups, may be exposed to more pollution than others, which puts them at greater risk for environmental health conditions such as asthma.

And more broadly, a 2019 study found that Black Americans carry a heavy pollution burden — they experience 56 percent more pollution than they cause. Non-Hispanic white Americans cause more pollution than other groups, but have a pollution advantage because they are exposed to about 17 percent less pollution than they generate, per the same study.

To curb pollution inequity and adverse asthma outcomes, interventions such as the CDC’s National Asthma Control Program EXHALE strategies incorporate social drivers of health to address environmental conditions, housing quality, and individual-level factors. 

Dr. Tyra Bryant-Stephens of Children’s Hospital of Pennsylvania, founded the Community Asthma Prevention Program to “improve the health and well-being of children with asthma” in Philadelphia. The CAPP team provides free home visits and supplies to help reduce asthma triggers such as pest residue, mold, and dust. The Pennsylvania Department of Health in 2025 found that 1 in eight Black children in the state have current asthma.

Winters said parents and providers have a role in improving asthma outcomes among Black children.

“We need to make sure we are educating our communities about childhood asthma  — what it is, triggers, and the medication types, and how to recognize an emergency, and when to follow up when necessary,” he said. “I do not believe any provider is a willing agent. But we have an opportunity to collaborate to fix it as healthcare providers. It is within your wheelhouse and sphere to make a change,” Winters said.

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