URBAN CHILDREN AND ASTHMA

Two studies suggest that the three components of ethnicity, poverty, and residence cannot be dissected easily, and should be viewed together when trying to understand risk factors for asthma.

Abstract

Within the United States, asthma morbidity and mortality has increased disproportionately among poor, minority children living in the inner city. 9,15,19,47 Poverty, ethnicity, and residence in the inner city are closely related in the United States, and considerable effort has been directed at dissecting these factors. There seems to be definite racial differences in prevalence that cannot be accounted for by socioeconomic status. From National Health and Nutrition Examination Survey (NHANES) II data 39 the rate of asthma among children aged 6 months to 11 years was 3.0% in whites and 7.2% in African–Americans. Although the rate of asthma was related to age, gender, and residence in the inner city, even when adjusted for these factors, the ethnic differences were significant. Similarly, in the Six Cities Study 21 the unadjusted prevalence in whites 7 to 14 years was 4.8% and in blacks was 6.7%, and the differences were statistically significant after adjustment for confounding variables. Hispanic children also have a higher prevalence of asthma. 19 Morbidity from asthma is also higher in minorities, 19 but poverty seems to largely explain these differences. 49 Mortality from asthma is as much as three times higher in minorities, 19 and the relation of mortality to black and Hispanic ethnicity has been found by some 47 but not all 28 investigators to be explained by poverty. Taken together, these studies suggest that the three components of ethnicity, poverty, and residence cannot be dissected easily, and should be viewed together when trying to understand risk factors for asthma. A number of factors have been proposed as responsible for the increased prevalence and severity of asthma among inner city children. These include large categories: access to medical care, patterns of medical care, psychosocial stress, and environmental exposures.