Stress, community violence worsened asthma severity

VANCOUVER, British Columbia — Moderate-to-severe asthma was almost twice as prevalent among children whose caregivers reported moderate-to-high exposure levels to stress and community violence, data presented at the 2010 Pediatric Academic Societies Annual Meeting indicated.

“The identification of mutable community contributors to asthma severity may alter our approach to asthma on multiple levels, including management plans, guidance to primary care physicians, education or awareness efforts and intervention strategies,” Ruchi S. Gupta, MD, MPH, of the Children’s Memorial Hospital in Chicago, said at the meeting.

Previous research has linked high-asthma rates with high incidence of violent crime in various Chicago neighborhoods. To further investigate this association, Gupta and colleagues analyzed data from an 18-month longitudinal study of children aged 8-to-14 years, conducted by the Chicago Initiative to Raise Asthma Equity during 2004 to 2005.

The researchers obtained information regarding perceived-stress and violence levels using caregiver questionnaires and data on actual violence from the Chicago Police Department.

The study population consisted of 561 caregiver and child pairs, according to Gupta, of whom 41% percent had intermittent-to-mild asthma and 59% had moderate-to-severe asthma.

Data indicated that moderate-to-severe asthma was significantly more likely among children whose caregivers reported hearing (OR=1.50; 95% CI, 1.05-2.02) or seeing violence (OR=1.84; 95% CI, 1.20-2.82) in their community, as well as among children who experienced high-stress levels (OR=2.13; 95% CI, 1.24-3.67). A similar association remained even when stress levels were moderate, Gupta noted.

High incidence of violent crime within the community also increased a child’s odds of moderate-to-severe asthma (OR=2.43; 95% CI, 1.43-4.14). Community violence remained a strong predictor of severe asthma even after adjusting for stress (OR=1.98; 95% CI, 1.11-3.54) — an interesting result because stress did not fully explain the association between violence and asthma severity, Gupta said.

After adjusting for potential confounding variables including age, gender, family history and socioeconomic status, only stress and incidence of violent crime remained asthma predictors.

“When caring for a child with asthma, physicians must consider the environment in which a child lives. As health care professionals, we have an obligation to recognize the social barriers facing our patients in managing their asthma.” – by Melissa Foster

For more information:

Springston EE. #1160.7. Presented at: 2010 Pediatric Academic Societies Annual Meeting; May 1-4, 2010; Vancouver, British Columbia.

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