Socioeconomic deprivation impacts asthma, allergic rhinitis in children with food allergy
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Key takeaways:
- Mean area deprivation index (ADI) was 43.3 for children with asthma and 31.8 for those without asthma.
- Mean ADI was 39.1 for children with allergic rhinitis and 33.4 for those without allergic rhinitis.
Neighborhood-level socioeconomic deprivation may play a role in the prevalence of asthma and allergic rhinitis among children with food allergy, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
Also, Black children with food allergy were at higher risk for asthma and allergic rhinitis independent of socioeconomic factors, Anandu Dileep, DO, an internist in the division of allergy/immunology at Rush University Medical Center, and colleagues wrote.
The researchers examined data from 700 children (62% boys) aged 4 to 12 years in the Food Allergy Outcomes Related to White and African American Racial Differences prospective cohort study.
Participants were recruited from four allergy clinics including two diverse facilities in Chicago (56%), one in the Washington, D.C., area (21%) and one in the Cincinnati region (22%). Also, 51% were non-Hispanic white, 37% were non-Hispanic Black and 12% were Hispanic/“Latinx.”
Annual household incomes were approximately evenly distributed into groups classified as less than $50,000, between $50,000 and $150,000, and more than $150,000.
The area deprivation index (ADI), which combines 17 census-derived indicator variables related to income, education, employment and housing quality, served as a proxy for local socioeconomic conditions. Scores range from 1 to 100 for those who are least to most socioeconomically disadvantaged.
Overall, the mean ADI was 37.7 (95% CI, 35.6-39.7), with means of 51.5 for Black children, 41 for Hispanic/“Latinx” children and 24.2 for white children (P < .0001 for both).
Mean ADIs based on region included 45.2 for the Rush University Medical Center in Chicago, 33.4 for Lurie Children’s Hospital in Chicago, 17.4 for Washington, D.C., and 55.2 for Cincinnati (P < .0001).
There was an inverse association between household income and ADI, with a mean of 53.9 among those with less than $50,000, 40.5 for those between $50,000 and $150,000 and 17.7 for those above $150,000 (P < .0001).
Similarly, higher education levels were associated with lower mean ADI, including 49.2 for those with less than a bachelor’s degree, 41.4 for those with a bachelor’s degree and 25.6 for those with education beyond a bachelor’s degree (P < .0001).
The 229 patients with asthma had a mean ADI of 43.3, whereas the patients who did not have asthma had a mean of 31.8 (P < .001). The 293 patients with allergic rhinitis had a mean ADI of 39.1, whereas those who did not have allergic rhinitis had a mean of 33.4 (P = .008).
There was no significant difference between patients who did or did not also have eczema, the researchers said, but the association between higher ADI and asthma and allergic rhinitis persisted after adjusting for race, ethnicity and recruitment site.
Children with no atopic comorbidities had a mean ADI of 30.4. Those with one comorbidity had a mean of 33.7. Mean ADIs also included 33.8 for those with two comorbidities and 44.7 for those with three (P = .0001).
Children who lived in a household with a smoker had a mean ADI of 48.1, whereas those who did not had a mean ADI of 32.5 (P < .0001). Also, 21.8% of Black participants, 9.8% of Hispanic/“Latinx” participants and 3.2% of white participants lived in households with a smoker (P < .001).
By income, 20.2% of children from households with less than $50,000, 7.8% of those from households with between $50,000 and $150,000 and 4.4% of those from households greater than $150,000 had a smoker in the household as well (P < .001).
Smokers in the household also were reported by 26.5% of those children from families with less than a bachelor’s degree, 13% of those with a bachelor’s degree and 3.7% of those above a bachelor’s degree (P < .001).
After adjusting for ADI and recruitment site, Black children were significantly more likely to have asthma than white children (adjusted OR = 2.76; 95% CI, 1.77-4.29). However, Hispanic/“Latinx” children did not have significantly higher asthma than white children after the same adjustments (aOR = 1.23; 95% CI, 0.69-2.22).
Black children also were more likely to have allergic rhinitis than white children (aOR = 2.5; 95% CI, 1.63-3.85) but not Hispanic/“Latino” children (aOR = 1.45; 95% CI, 0.83-2.52) in the adjusted model.
The researchers said there was no statistical evidence suggesting that ADI moderates the link between race and prevalence of asthma, with a null association evident for Black and Hispanic/Latino children compared with white children.
But the researchers did indicate that there was evidence for the moderation of ADI on the link between race and allergic rhinitis in Hispanic/“Latinx” children compared with white children (OR = 0.969; 95% CI, 0.945-0.995). Across the full range of observed ADIs, the researchers continued, Black children had the highest rates of allergic rhinitis.
Based on these findings, the researchers called upon providers to screen for asthma and allergic rhinitis more diligently among Black patients with food allergy. Also, the researchers encouraged providers to engage their patients’ caregivers to understand the socioeconomic obstacles that they may be facing.