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Prevalent asthma in inner city linked to demographics, not urban factors
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High asthma incidence in inner-city areas may be due to demographic factors rather than living in urban neighborhoods, according to study findings in the Journal of Allergy and Clinical Immunology.
“Despite our significant and ongoing national commitment to combating inner-city asthma, we do not actually know the prevalence of asthma in inner cities across the United States, whether it is in fact greater than that found in other areas, and, if there are differences, whether race/ethnicity, poverty, or residence in an urban area explain them,” study researcher Corinne A. Keet, MD, PhD, of Johns Hopkins University School of Medicine, and colleagues wrote.
Corinne A. Keet
Researchers analyzed data from the 2009-2011 National Health Interview Survey, the US Census and the National Center for Health Statistics for 23,065 children aged 6 to 17 years. Urban areas with at least 20% of households below the poverty line were considered inner-city areas.
Overall, 16.3% of participants reported experiencing asthma within their lifetime, 10.7% reported currently experiencing asthma, 5.9% reported an asthma episode, and 1.6% reported visiting the ED for asthma in the past year.
In inner-city areas, the overall prevalence of current asthma was 12.9% (95% CI, 11.1%-14.9%) vs. 10.6% (95% CI, 10%-11.2%) in non-inner-city areas; this difference was not significant, however, after adjusting for race/ethnicity, region, sex and age (OR=1.01; 95% CI, 0.84-1.21).
According to researchers, 8% of children with asthma live in inner-city areas, compared with 7% of children overall.
Asthma prevalence in inner-city areas ranged from 7.9% (95% CI, 5.9%-10.5%) in the West to 17.3% (95% CI, 13.2%-22.4%) in the Northeast.
Current asthma prevalence was significantly higher among blacks (17.1%) and Puerto Ricans (19.8%), compared with whites (9.6%), Hispanics (8.8%) and Asians (8.1%).
“Black race and Puerto Rican ethnicity remained strong independent predictors of current asthma, even when neighborhood-level poverty, urban/rural status, region, sex, age and birth in the United States were included in the model,” Keet and colleagues wrote.
Birth outside of the US was a significant protective factor against asthma.
Race and ethnicity, particularly Hispanic ethnicity, influenced the relationship between living in a neighborhood below the poverty line and asthma (P=.004).
Adjusted analyses indicated living in a neighborhood with households below the poverty line was a significant risk factor for asthma among non-Hispanics and Puerto Ricans, but had a protective affect among Hispanics.
Similarly, household poverty increased risk for asthma among non-Hispanics and Puerto Ricans (P<.001), but not Hispanics. Further, Hispanic ethnicity significantly influenced the relationship between household poverty and asthma (P=.002).
“Residence in urban areas, a potential risk factor for asthma hypothesized to be mediated by exposure to indoor and outdoor pollution, pest allergens, and violence and other stressful life events, was not found to be a significant risk factor for prevalent asthma,” Keet and colleagues wrote. “The lack of relationship between urban residence and asthma prevalence, even in crude analyses, might reflect shifting demographics since the inner-city asthma epidemic was first described.”
Disclosure: The researchers received research support from the NIH and the National Cancer Institute. One researcher received royalties from UpToDate.
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